High prevalence of hypertension among HIV-positive people in the US with 'missed opportunities' for its diagnosis and control

There is a high prevalence of hypertension among HIV-positive people in the United States and many of these individuals are not receiving hypertensive therapy, investigators report in Open Forum Infectious Diseases. Overall, 42% of people were classified as hypertensive and 13% of these people were undiagnosed with a further 26% with uncontrolled high blood pressure despite therapy.

“We found that about 1 in 8 patients has undiagnosed and untreated hypertension,” write the researchers. “Since PLWH [people living with HIV] may be at increased risk for hypertension and its complications, including CVD [cardiovascular disease], the importance of hypertension screening by providers, with the intent to effectively treat, cannot be over-emphasized.”

Risk factors for untreated hypertension included younger age, male sex, being uninsured and recent imprisonment.

Cardiovascular disease is now a leading cause of serious illness and death in people with HIV, and hypertension is a recognised – and potentially modifiable – risk factor for cardiovascular disease. Several studies have shown an increased prevalence of hypertension among HIV-positive people.

Correctly diagnosing and treating hypertension is an important part of CVD risk reduction in HIV-positive people. Investigators therefore estimated the prevalence of hypertension, as well as its diagnosis, treatment and control in a nationally representative sample of adult patients who received HIV care in the United States in 2013 and 2014.

The patients were enrolled in the Medical Monitoring Project. Data were collected via interviews or from medical records.

Hypertension was defined according to three criteria: diagnosis (documented diagnosis of hypertension), treatment (prescription of antihypertensive medication) and high blood pressure readings (last two readings at or above 140/90 mm/Hg).

People with hypertension were classified as undiagnosed and untreated; treated and controlled hypertension; treated and uncontrolled hypertension; unclassified (missing data, or meeting treatment and high blood pressure criteria but without a diagnosis).

A total of 8631 people were included in the analysis. Overall, 42% of individuals were hypertensive. Of these 13% were undiagnosed and untreated, 49% were treated and controlled, 26% were treated and uncontrolled and 12% were unclassified.

The overall prevalence of hypertension was much higher than the 29% observed in the general United States population.

Hypertension was associated with older age (p < 0.001), male sex (p < 0.001), non-white race/ethnicity (p < 0.001), recent homelessness (p = 0.027), poverty (p = 0.01), lower levels of education (p < 0.001), recent incarceration (p = 0.024), lack of health insurance (p < 0.001), high BMI (p < 0.001), low recent CD4 cell count (p = 0.03), a detectable viral load (p = 0.026).

Factors associated with undiagnosed and untreated hypertension included younger age (p < 0.001), male sex (p = 0.006), poverty (p = 0.018), lower levels of education (p = 0.045), recent imprisonment (p = 0.01), no health insurance (p = 0.003), smoking (p = 0.042), and current viraemia (p = 0.04).

“PLWH who received medical care in the United States had a high prevalence of hypertension,” conclude the authors. “Providers may be missing opportunities to diagnose and treat hypertension among their HIV patients, especially those who are younger and have less access to care. It is important to improve hypertension screening and management to prevent CVD outcomes for which PLWH have high risk.”