Department of International Health, the Bloomberg School of Public Health, the Johns Hopkins University, Baltimore, Maryland 21205, USA.
J Hypertens. 2013 Jul;31(7):1372-8; discussion 1378. doi: 10.1097/HJH.0b013e328360de1c.
To report the prevalence of hypertension and projected 10-year absolute risk of acute cardiovascular disease in a large prospectively followed cohort of HIV-positive youth and adults beginning antiretroviral therapy in sub-Saharan Africa.
HIV-positive individuals seeking HIV treatment, ages 13 years and older, were assessed for repeated blood pressure measurements over the first year following initiation of antiretroviral therapy, including serum total cholesterol, high-density lipoprotein, CD4 cell count and related clinical and laboratory measurements. Outcomes include hypertension, defined according to the 7th Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories, and Framingham Risk Score based 10-year cardiovascular disease risk estimates.
Five thousand, five hundred and sixty-three patients had at least two blood pressure measurements on at least two separate occasions during the first year of antiretroviral therapy [median age of therapy initiation 34, first and third quartile (Q1-Q3) 28-40 years, 1841 (33.1%) men, baseline CD4 cell count 161 cells/μl (Q1-Q3 72-231 cells/μl]. Hypertension was diagnosed in 1551 patients [27.9%, 95% confidence interval (CI) 26.7- 29.1] including 786 (14.1%, 95% CI 13.2-15.1) who met criteria for stage 2 hypertension. The age-standardized prevalence for Ugandans aged 13 or more was 24.8% (95% CI 23.8-26.1). Among those with complete laboratory studies (n=1102), nearly all women were in the 10% or less 10-year Framingham Risk Score category, but 20% of men were at at least 10% or more long-term risk of acute cardiovascular disease.
Efforts to combine HIV treatment with vascular disease risk factor prevention and management are urgently needed to address noncommunicable disease multimorbidity in HIV-positive persons in sub-Saharan Africa, particularly in men.
报告在撒哈拉以南非洲接受抗逆转录病毒治疗的大量艾滋病毒阳性青年和成年人队列中，高血压的患病率和 10 年内急性心血管疾病的绝对风险预测。
对 13 岁及以上接受艾滋病毒治疗的艾滋病毒感染者进行评估，在开始抗逆转录病毒治疗后的第一年中重复测量血压，包括血清总胆固醇、高密度脂蛋白、CD4 细胞计数以及相关的临床和实验室测量。结果包括根据第七次联合国家预防、检测、评估和治疗高血压委员会分类定义的高血压，以及基于Framingham 风险评分的 10 年内心血管疾病风险估计值。
5563 名患者在开始抗逆转录病毒治疗的第一年中至少有两次血压测量值，且至少有两次在不同时间进行[治疗开始时的中位年龄为 34 岁，第一和第三四分位数（Q1-Q3）为 28-40 岁，1841 名（33.1%）男性，基线 CD4 细胞计数为 161 个/μl（Q1-Q3 为 72-231 个/μl）]。1551 名患者被诊断为高血压（27.9%，95%置信区间[CI]为 26.7-29.1），其中 786 名（14.1%，95%CI 为 13.2-15.1）符合 2 期高血压标准。年龄标准化后，乌干达人的患病率为 24.8%（95%CI 为 23.8-26.1）。在完成完整实验室研究的患者中（n=1102），几乎所有女性的Framingham 风险评分都在 10%或更低的 10 年心血管疾病风险类别中，但 20%的男性存在至少 10%或更高的长期急性心血管疾病风险。
迫切需要努力将艾滋病毒治疗与血管疾病风险因素预防和管理相结合，以解决撒哈拉以南非洲艾滋病毒感染者的非传染性疾病多重疾病问题，尤其是男性。
