Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York City, New York.
The Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
J Clin Hypertens (Greenwich). 2018 Oct;20(10):1485-1492. doi: 10.1111/jch.13392. Epub 2018 Sep 26.
HIV-positive adults with hypertension have increased risk of mortality but HIV clinics often do not provide hypertension care. The authors integrated hypertension management into existing HIV services at a large clinic in Haiti. Of 1729 documented HIV-positive adults presenting for care at the GHESKIO HIV clinic between March and July 2016, 551 screened positive for hypertension, with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg. A convenience sample of 100 patients from this group received integrated hypertension and HIV care for 6 months. At time of identification, patients were screened for proteinuria and initiated on antihypertensive medication. Hypertension and HIV visits coincided; medications were free. Outcomes were retention in care and change in blood pressure over 6 months. Average blood pressure over 6 months was described using linear mixed-effects model. Of 100 HIV-positive adults with hypertension referred for integrated care, three were ineligible due to comorbidities. Among 97 participants, 82% (N = 80) remained in care at 6 months from time of positive hypertension identification. 96% (N = 93) were on antiretroviral therapy with median CD4+ count of 442 cells/µL (IQR 257-640). Estimated average blood pressure over 6 months decreased from systolic 160 mmHg (CI 156, 165) to 146 mmHg (CI 141, 150), P-value <0.0001, and diastolic 105 mmHg (CI 102, 108) to 93 mmHg (CI 89, 96), P-value <0.0001. HIV and hypertension management were successfully integrated at a HIV clinic in Haiti. Integrated management is essential to combat the growing burden of cardiovascular disease among HIV-positive adults.
HIV 阳性合并高血压的成年人死亡率增加，但 HIV 诊所通常不提供高血压护理。作者在海地的一家大型诊所将高血压管理整合到现有的 HIV 服务中。在 2016 年 3 月至 7 月期间，1729 名有记录的 HIV 阳性成年人在 GHESKIO HIV 诊所就诊，其中 551 名筛查出高血压，收缩压≥140mmHg 和/或舒张压≥90mmHg。从该组中随机抽取 100 名患者接受 6 个月的综合高血压和 HIV 护理。在识别时，对患者进行蛋白尿筛查并开始使用降压药物。高血压和 HIV 就诊同时进行，药物免费。结果是 6 个月时的护理保留率和血压变化。使用线性混合效应模型描述 6 个月的平均血压。在被转诊接受综合护理的 100 名 HIV 阳性合并高血压患者中，有 3 名因合并症而不合格。在 97 名参与者中，有 82%（N=80）在从高血压阳性识别开始的 6 个月时保持护理。96%（N=93）正在接受抗逆转录病毒治疗，中位数 CD4+计数为 442 个/µL（IQR 257-640）。估计的平均血压在 6 个月内从收缩压 160mmHg（CI 156，165）下降到 146mmHg（CI 141，150），P 值<0.0001，舒张压从 105mmHg（CI 102，108）下降到 93mmHg（CI 89，96），P 值<0.0001。在海地的一家 HIV 诊所成功地整合了 HIV 和高血压管理。综合管理对于应对 HIV 阳性成年人中日益增加的心血管疾病负担至关重要。
