Unit of Infectious Diseases, Perugia University Hospital, Perugia, Italy.
Am J Hypertens. 2014 Feb;27(2):222-8. doi: 10.1093/ajh/hpt182. Epub 2013 Sep 27.
We aimed to assess the prevalence of hypertension in an unselected human immunodeficiency virus (HIV)-infected population and to identify factors associated with hypertension prevalence, treatment, and control.
We used a multicenter, cross-sectional, nationwide study that sampled 1,182 unselected, consecutive, HIV-infected patients. Office blood pressure was accurately measured with standard procedures.
Patients were 71% men and 92% white, with a median age of 47 years (range = 18-78); 6% were antiretroviral treatment naive. The overall prevalence of hypertension was 29.3%; high-normal pressure accounted for an additional 12.3%. Among hypertensive subjects, 64.9% were aware of their hypertensive condition, 52.9% were treated, and 33.0% were controlled (blood pressure < 140/90 mm Hg). Blood pressure-lowering medications were used in monotherapy in 54.3% of the subjects. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers were the most frequently used drugs (76.1%: monotherapy = 39.1%, combination treatment = 37.0%). In multivariable regression models, hypertension was independently predicted by traditional risk factors, including age ≥50 years, male sex, family history of cardiovascular disease, body mass index ≥25 kg/m2, previous cardiovascular events, diabetes, central obesity, and metabolic syndrome, as well as by duration of HIV infection, duration of antiretroviral therapy, and nadir CD4+ T-cell count <200/μl. The choice of protease inhibitors vs. nonnucleoside reverse transcriptase inhibitors as a third antiretroviral drug was irrelevant.
Hypertension affects nearly 30% of HIV adult outpatients in Italy. More than one-third of the hypertensive subjects are unaware of their condition, and more than two-thirds are uncontrolled. A higher level of attention to the diagnosis and treatment of hypertension is mandatory in this setting.
本研究旨在评估未选择的人类免疫缺陷病毒（HIV）感染人群中高血压的患病率，并确定与高血压患病率、治疗和控制相关的因素。
我们采用多中心、横断面、全国性研究，对 1182 例未选择的连续 HIV 感染患者进行抽样。使用标准程序准确测量诊室血压。
患者中 71%为男性，92%为白人，中位年龄为 47 岁（范围 18-78 岁）；6%为初治患者。高血压总患病率为 29.3%；高正常血压占 12.3%。在高血压患者中，64.9%知晓自身高血压状况，52.9%接受治疗，33.0%血压得到控制（血压＜140/90mmHg）。54.3%的患者接受单药降压治疗。血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂是最常用的药物（76.1%：单药治疗 39.1%，联合治疗 37.0%）。多变量回归模型显示，高血压与传统危险因素独立相关，包括年龄≥50 岁、男性、心血管疾病家族史、体质指数≥25kg/m2、既往心血管事件、糖尿病、中心性肥胖和代谢综合征，以及 HIV 感染持续时间、抗逆转录病毒治疗持续时间和 CD4+T 细胞计数＜200/μl 的最低值。选择蛋白酶抑制剂而非非核苷类逆转录酶抑制剂作为第三种抗逆转录病毒药物与高血压无关。
在意大利，近 30%的成年 HIV 门诊患者患有高血压。超过三分之一的高血压患者不知道自己的病情，超过三分之二的患者血压未得到控制。在这种情况下，需要更加关注高血压的诊断和治疗。
