Raised blood pressure more common in lipodystrophy

Raised blood pressure is more common in HIV-positive people with lipodystrophy than either the general population or people with HIV without lipodystrophy, and tended to be associated with elevated triglyceride levels, not central fat accumulation, say researchers from the University of California.

Reporting in the October edition of AIDS, the researchers describe an analysis of blood pressure measurements in 42 consecutive patients attending the Rand-Schrader HIV clinic at the University of Southern California, Los Angeles, in comparison with 42 age and sex-matched HIV-positive patients at the same clinic, and 13 randomly selected HIV-negative clinic staff.

Seventy-eight per cent of the lipodystrophy patients had three or more elevated blood pressure readings, and 38% of all blood pressure measurements were elevated during the two year period under review, compared with 22% of age matched HIV-positive controls. The factor most strongly associated with raised blood pressure was an increased waist-hip ratio (a sign of central fat accumulation) in both men and women.

Family history of hypertension was not a significant factor contributing to raised blood pressure in this group of patients; when the statistical analysis was adjusted for a family history of raised blood pressure, the difference between the lipodystrophy group and the HIV control group was reduced, despite the fact that patients in the lipodystrophy group were more likely to have a family history of hypertension.

The study also found that HIV-positive patients without lipodystrophy had raised blood pressure, which tended to be associated with the same factors as in the lipodystrophy group. These patients were already receiving HIV treatment, but had not developed body fat changes or lipid elevations sufficient to warrant a description of lipodystrophy.

The average blood pressure elevation for lipodystrophy was in the category called Stage 1 hypertension, which means that interventions to lower salt and alcohol intake, to reduce weight and increase exercise will be recommended before any anti-hypertensive medication is prescribed in the United States.