撒哈拉以南非洲地区的 24 小时动态血压监测：抗逆转录病毒治疗的马拉维 HIV+患者中的高血压表型和血压下降模式。

24-h-Ambulatory Blood Pressure Monitoring in Sub-Saharan Africa: Hypertension Phenotypes and Dipping Patterns in Malawian HIV+ Patients on Antiretroviral Therapy.

机构信息

Clinic for Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, DE.

Lighthouse Clinic, Lilongwe, MW.

出版信息

Glob Heart. 2021 Oct 13;16(1):67. doi: 10.5334/gh.945. eCollection 2021.

DOI:10.5334/gh.945

PMID:34692392

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8516010/

Abstract

BACKGROUND

Cardiovascular disease and especially hypertension are a growing problem among people living with HIV (PLHIV) on antiretroviral therapy (ART) in sub-Saharan Africa.

OBJECTIVES

As robust data on hypertension phenotypes associated with distinct cardiovascular risks among PLHIV are limited, we aimed to assess the frequency of white-coat (WCH), masked (MH) hypertension, and blood pressure dipping-patterns in a group of Malawian PLHIV.

METHODS

As part of the prospective Lighthouse-Tenofovir-Cohort-Study, we analyzed clinical, laboratory and 24-h-ambulatory blood pressure monitoring (ABPM) data of PLHIV from urban Lilongwe with treated or untreated hypertension or raised office blood pressure (OBP) during routine study-visits.

RESULTS

118 PLHIV were included and data of 117 participants could be analyzed. Twenty-four-hour ABPM normotension was found in a total of 73 PLHIV including 14/37 on antihypertensive treatment (37.8%). Using strict definitions, i.e. normal OBP plus normal mean BP for all periods of ABPM, controlled hypertension was found in only 4/37 (10.8%) PLHIV on antihypertensive treatment while true normotension was observed in 10/24 untreated patients (41.7%) with previously diagnosed hypertension and 22/56 patients (39.3%) without a medical history of hypertension. WCH with normal BP during all periods of 24-h-ABPM was identified in 12/64 OBP-hypertensive PLHIV (18.8%), primarily in patients with grade 1 hypertension (11/41 patients; 26.8%). MH was found in 17/53 PLHIV with OBP-normotension (32.1%), predominantly in patients with high normal BP (11/20 patients; 55%). The estimated glomerular filtration rate tended to be lower in MH compared to strictly defined normotensive PLHIV (92.0±20.4 vs. 104.8±15.7 ml/min/m²). 64.1 percent of PLHIV (59.5% with 24-h hypertension and 66.7% with 24-h normotension) had abnormal systolic dipping.

CONCLUSION

The high prevalence of WCH and MH with signs of early renal end-organ damage and an abnormal dipping in approximately 2/3 of PLHIV warrants further investigation as these factors may contribute to the increased cardiovascular risk in PLHIV in resource-limited settings like Malawi.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov (NCT02381275), registered March 6th, 2015.

摘要

背景

在撒哈拉以南非洲接受抗逆转录病毒疗法（ART）的艾滋病毒感染者（PLHIV）中，心血管疾病尤其是高血压是一个日益严重的问题。

目的

由于与 PLHIV 不同心血管风险相关的高血压表型缺乏强有力的数据，我们旨在评估马拉维一组 PLHIV 中白大衣（WCH）、隐匿性（MH）高血压和血压下降模式的频率。

方法

作为前瞻性灯塔-替诺福韦队列研究的一部分，我们分析了来自城市利隆圭的接受治疗或未接受治疗的高血压或在常规研究就诊期间办公室血压升高（OBP）的 PLHIV 的临床、实验室和 24 小时动态血压监测（ABPM）数据。

结果

共纳入 118 名 PLHIV，其中 117 名参与者的数据可进行分析。共有 73 名 PLHIV 出现 24 小时 ABPM 正常血压，其中包括 14/37 名接受抗高血压治疗的患者（37.8%）。使用严格的定义，即正常 OBP 加上 ABPM 所有时期的正常平均 BP，仅在接受抗高血压治疗的 37 名 PLHIV 中的 4/37 名（10.8%）患者中发现控制良好的高血压，而在未接受治疗的 24 名患者中（41.7%），10/24 名患有先前诊断的高血压的患者和 56 名无高血压病史的患者（39.3%）观察到真正的正常血压。在 64 名 OBP 高血压的 PLHIV 中（18.8%）发现了 12/64 名 OBP 高血压患者（18.8%）的 WCH，其中主要是 1 级高血压患者（41 名患者中的 11 名；26.8%）。在 53 名 OBP 正常血压的 PLHIV 中发现了 17 名 MH（32.1%），主要是高正常血压患者（20 名患者中的 11 名；55%）。与严格定义的正常血压 PLHIV 相比，MH 患者的估计肾小球滤过率趋于降低（92.0±20.4 与 104.8±15.7 ml/min/m²）。64.1%的 PLHIV（24 小时高血压患者为 59.5%，24 小时正常血压患者为 66.7%）存在异常收缩压下降。