Correlates of hypertension among persons living with HIV at Livingstone Central Hospital: A cross sectional study

Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria. Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables. Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%.Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertension in PLWH were increasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment of hypertension among PLWH.

Valores de pressão arterial para o diagnóstico e metas: análise crítica das diretrizes mais recentes / The value of arterial pressure for diagnosis and targets: critical analysis of the most recent guidelines

O diagnóstico da Hipertensão Arterial Sistêmica (HAS) sofreu mudanças com o advento das medidas de Pressão Arterial (PA) fora do consultório, quer por meio da Monitorização Ambulatorial da Pressão Arterial de 24 horas – MAPA, quer pela Monitorização Residencial da Pressão Arterial – MRPA. Mais recentemente, dois novos tipos de comportamento foram individualizados e representados por: hipertensão do avental branco, quando os valores de PA são sistematicamente elevados nas medidas casuais e normais pela MAPA ou MRPA e normotensão do avental branco ou hipertensão mascarada quando o inverso ocorre qual seja, pressões arteriais sistematicamente normais no consultório com valores indubitavelmente anormais pelos métodos de medidas fora dele (MAPA ou MRPA). Este artigo discute as principais diretrizes de Hipertensão arterial publicadas pelas Sociedades Brasileiras de Cardiologia, Nefrologia e de Hipertensão – DBH VI, Sociedades Europeias de Cardiologia e Hipertensão, 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Eighth Joint National Committee (JNC 8), Sociedades Americana e Internacional de Hipertensão e CHEP – Canadian Hypertension Education Program Recomendations, pela suas relevâncias ao estabelecimento correto do diagnóstico e também para que se objetive o melhor nível de controle da pressão arterial com a finalidade de oferecer maiores benefícios aos pacientes sob tratamento.).

The diagnosis of arterial hypertension has undergone changes, with the advent of blood pressure measurements outside the doctor’s clinic, whether through 24-hour Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM).More recently, two types of behavior have been individualized and represented by: White coat Hypertension, where the AP values are systematically elevated in the causal andnormal measurements for MAPA or MRPA, and White coat normotension, or masked ypertension, where the inverse occurs, i.e. systematically normal arterial pressures are recorded in the clinic, with undoubtedly abnormal values by the measurement methods utside the clinic (MAPA or MRPA). This article discusses the main guidelines on arterial Hypertension published by the Brazilian Societies of Cardiology, Nephrology and Hypertension – DBH VI, the European Societies of Cardiology and Hypertension, 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Eighth Joint National Committee (JNC 8), American and International Societies of Hypertension, and the CHEP – Canadian Hypertension Education Program Recommendations, due to their importance for the correct establishment of the diagnosis, and also seeking to obtain the best level of blood pressure control, in order to offer greater benefits for patients undergoing treatment.