Crane Heidi M, Van Rompaey Stephen E, Kitahata Mari M
Department of Medicine, Center for AIDS and STD Research, University of Washington, Harborview Medical Center, 325 9th Avenue, Seattle, WA 98104, USA.
AIDS. 2006 Apr 24;20(7):1019-26. doi: 10.1097/01.aids.0000222074.45372.00.
To examine the effect of antiretroviral agents and clinical factors on the development of elevated blood pressure (BP).
Observational cohort study of patients initiating their first HAART regimen. We evaluated mean BP prior to HAART and while receiving HAART in relation to antiretroviral classes and individual agents, and demographic and clinical characteristics including change in body mass index (BMI) while on HAART. We used logistic regression analysis to examine factors associated with elevated BP [> or = 10 mmHg increase in systolic BP (SBP), diastolic BP (DBP) or new diagnosis of hypertension].
Among 444 patients who had 4592 BP readings, 95 patients developed elevated SBP (n = 83), elevated DBP (n = 33), or a new diagnosis of hypertension (n = 11) after initiating HAART. In multivariate analysis, patients on lopinavir/ritonavir had the highest risk of developing elevated BP [odds ratio (OR), 2.5; P = 0.03] compared with efavirenz-based regimens. When change in BMI was added to the model, increased BMI was significantly associated with elevated BP (OR, 1.3; P = 0.02), and the association between lopinavir/ritonavir and elevated BP was no longer present. Compared with lopinavir/ritonavir-based regimens, patients receiving atazanavir (OR, 0.2; P = 0.03), efavirenz (OR, 0.4; P = 0.02), nelfinavir (OR, 0.3; P = 0.02), or indinavir (OR, 0.3; P = 0.01) had significantly lower odds of developing elevated BP.
Treatment with lopinavir/ritonavir is significantly associated with elevated BP, an effect that appears to be mediated through an increase in BMI. Patients receiving atazanavir were least likely to develop elevated BP. The impact of antiretroviral medications on cardiovascular disease risk factors will increasingly influence treatment decisions.
研究抗逆转录病毒药物及临床因素对血压升高的影响。
对开始首次高效抗逆转录病毒治疗（HAART）方案的患者进行观察性队列研究。我们评估了患者在接受HAART治疗前及治疗期间的平均血压，分析其与抗逆转录病毒药物类别及具体药物的关系，以及人口统计学和临床特征，包括接受HAART治疗期间体重指数（BMI）的变化。我们采用逻辑回归分析来研究与血压升高相关的因素[收缩压（SBP）升高≥10 mmHg、舒张压（DBP）升高或新诊断为高血压]。
在444例患者中，共进行了4592次血压测量，95例患者在开始HAART治疗后出现收缩压升高（n = 83）、舒张压升高（n = 33）或新诊断为高血压（n = 11）。在多变量分析中，与基于依非韦伦的治疗方案相比，接受洛匹那韦/利托那韦治疗的患者血压升高风险最高[比值比（OR）为2.5；P = 0.03]。当将BMI变化纳入模型时，BMI升高与血压升高显著相关（OR为1.3；P = 0.02），此时洛匹那韦/利托那韦与血压升高之间的关联不再存在。与基于洛匹那韦/利托那韦的治疗方案相比，接受阿扎那韦（OR为0.2；P = 0.03）、依非韦伦（OR为0.4；P = 0.02）、奈非那韦（OR为0.3；P = 0.02）或茚地那韦（OR为0.3；P = 0.01）治疗的患者血压升高的几率显著降低。
洛匹那韦/利托那韦治疗与血压升高显著相关，这种影响似乎是通过BMI升高介导的。接受阿扎那韦治疗的患者血压升高的可能性最小。抗逆转录病毒药物对心血管疾病危险因素的影响将越来越多地影响治疗决策。
