High blood pressure and HIV

Blood pressure is the name given to the force that your beating heart causes in your arteries, veins, and blood vessels which carry blood around the body.

When your blood pressure is measured, the result is given as two numbers. One number is higher than the other, for example, 120/80 (120 over 80). The higher number is called systolic blood pressure. This is the amount of pressure when your heart contracts (squeezes) and forces blood through your arteries and other blood vessels. The lower number is called diastolic blood pressure. This is the amount of pressure when your heart relaxes. The numbers are followed by the letters mmHG, which stands for millimetres of mercury.

Healthy blood pressure is considered to be between 90/60 mmHg and 120/80 mmHg. If you have high blood pressure, one or both of the numbers will be higher than the healthy range. High blood pressure is also known as hypertension.

Hypertension can cause a strain on your blood vessels and your heart. This can increase your risk of conditions such as kidney disease, heart disease, vascular dementia, erectile dysfunction, and stroke.

Your lifestyle and high blood pressure

You can reduce your risk of developing high blood pressure (hypertension) by making changes to your lifestyle. These changes will generally improve your heart health and can help reduce the chance of you developing heart disease. 

• Eat a healthy, balanced diet that contains plenty of fruits, vegetables and whole grains such as brown rice.
• Eat fewer foods that contain saturated fats, such as butter, cheese, and coconut oil. Instead, replace them with foods that contain unsaturated fats, such as vegetable oils and nuts.  
• Avoid highly processed foods wherever possible as these tend to contain large amounts of salt, sugar, and trans fats.
• Eat less than 6g of salt a day (about 1 teaspoon). Try to cut down or remove salt when you’re cooking from scratch and check the labels of the foods you’re buying.
• Get regular exercise. Try to aim for 150 minutes of moderate-intensity exercise, such as cycling or brisk walking, each week. If you have very high blood pressure you should speak to a doctor about what type of exercise is safe for you.
• Don’t smoke. If you are a smoker, you can get support to stop smoking from your doctor.
• Limit your intake of alcohol. In the UK, the recommended limit is no more than 14 units a week. You should also try and avoid drinking too much coffee or other drinks and foods that contain a lot of caffeine.
• Limit your use of recreational drugs. Taking cocaine, MDMA (ecstasy) and amphetamines (such as crystal meth) can all quickly increase your blood pressure. Taking drugs can also raise your blood pressure over time. If you’re concerned about your drug use, speak to your doctor.
• Manage your weight. If you're overweight try to lose weight in a safe and healthy way by eating a healthy balanced diet and getting enough exercise.
• Find ways to manage or cope with stress. This might involve exercise, mindfulness, or making time to do the things you enjoy.

Some medications such as the combined contraceptive pill, ibuprofen, steroids, and some anti-depressants can increase your blood pressure. It can also be increased by some herbal remedies. This means that if you have high blood pressure it's important to tell your doctor or pharmacist about all the medicines you are taking, including products you buy over the counter, herbal or traditional medicines, and recreational drugs.

Who’s at risk?

There are also some things which increase your risk of high blood pressure which you can’t change, including:

• having a close family member who has high blood pressure
• having a health condition such as diabetes or kidney disease
• being over 65
• being from a Black or South Asian background.

High blood pressure in people living with HIV

There is evidence that some people living with HIV are more likely to develop high blood pressure than people without HIV. However, the risk only seems to be higher if you live in a high-income country such as those in western Europe and north America. This might be due to people with HIV in high-income countries having longer life expectancies, as your risk of high blood pressure increases as you get older.

It’s not known for sure why this increase in risk exists. It’s thought it might be because of the effects HIV has on your body such as:

• chronic inflammation (when your immune system has an unhelpful reaction to the virus) – this has been linked to hardening of the arteries and kidney problems
• changes in the way the body processes fat
• changes in some brain chemicals such as noradrenaline. 

It could also be because of the effects of some anti-HIV medications.

One study has found that people taking integrase inhibitors are more likely to develop high blood pressure than people taking NNRTIs. It’s not known for sure why this is, but it could be related to weight gain. Integrase inhibitors include:

• dolutegravir (Tivicay, also in Triumeq, Juluca and Dovato)
• bictegravir (in Biktarvy)
• raltegravir (Isentress)
• elvitegravir (in Stribild and Genvoya).

Several studies have found that protease inhibitors are also linked to high blood pressure. Protease inhibitors include:

• atazanavir (Reyataz, also in Evotaz)
• darunavir (Prezista, also in Rezolsta and Symtuza)
• lopinavir (in Kaletra)
• ritonavir (Norvir, also in Kaletra).

This could be because protease inhibitors can increase your blood fats (lipids). Having increased amounts of fat in your blood is linked to an increased risk of high blood pressure.

Some people experience an increase in blood pressure once they start anti-HIV treatment. This could be a side effect of the immune system recovering.

A side effect of some older anti-HIV medications was lipodystrophy, which is a change in the way your body stores fat. Lipodystrophy has also been linked to high blood pressure.

Newer anti-HIV treatments cause fewer problems than older medications. It’s also important to know that the benefits of HIV medication far outweigh the risks. If you’re worried about the way your medication might affect your heart, speak to your doctor.

Symptoms

High blood pressure doesn’t usually cause any symptoms, so having it measured regularly is important.

Diagnosis and monitoring

Your HIV clinic should monitor your blood pressure at least once a year as part of your routine check-ups. Your GP may also sometimes measure your blood pressure. If you’re pregnant you will have your blood pressure measured as part of your antenatal care.

Your blood pressure is measured using a cuff which is placed around your upper arm and filled with air until it’s tight. The air is then let out of the cuff slowly and a blood pressure reading is taken.

• Ideal blood pressure is between 90/60mmHg and 120/80mmHg.
• High blood pressure (hypertension) is 140/90mmHg or higher.
• Low blood pressure is below 90/60mmHg.

If your blood pressure is between 120/80mmHg and 140/90mmHg you’re at a higher risk of developing high blood pressure. Your doctor might suggest you make some lifestyle changes to try and reduce this risk, especially if you have other risk factors such as kidney disease.

If you have high blood pressure you might be given medication to bring it down, as well as being advised to make some lifestyle changes. There is more information on treatment options below.

Treatment and management of high blood pressure

There are some things that you can do to help your blood pressure. Your doctor might recommend you make some changes to your lifestyle – see the section ‘Your lifestyle and high blood pressure’ at the top of the page.

You might also be prescribed medication to bring your blood pressure down. Blood pressure medications include:

• angiotensin-converting enzyme (ACE) inhibitors, which stop your body from making a chemical that tightens your blood vessels (angiotensin)
• angiotensin II receptor blockers (ARBs), which stop angiotensin from working
• diuretics (sometimes called water tablets), which flush out excess fluid from your body
• beta-blockers, which slow your heartbeat and make your heart beat less forcefully.

There is more information on the NICE website.

Although beta-blockers are no longer the first choice for treating high blood pressure, some doctors might still prescribe them. However, it’s important to know that beta-blockers are linked to poorer outcomes in people living with HIV, so ACE inhibitors and ARBs are usually a better choice.

You might also be prescribed a calcium-channel blocker (CCB). Some anti-HIV medications can interact with CCBs so it’s important to make sure your doctor knows you are taking anti-HIV treatment.

The CCB lercanidipine should not be prescribed to you if you are taking a protease inhibitor.

You might be prescribed a different dose of a CCB and be monitored more closely if your anti-HIV treatment includes:

• a protease inhibitor such as atazanavir, darunavir or lopinavir
• efavirenz, nevirapine or etravirine.
• Stribild or Genvoya.

The CCB verapamil can also interact with tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF).

Other sources of information

You may find the organisations listed below have further helpful information:

• Blood Pressure UK. Visit their website www.bloodpressureuk.org or call their helpline on 020 7882 6218.
• The British Heart Foundation. Visit their website www.bhf.org or call their helpline on 0300 330 3311.