Hypertension and Associated Factors in Patients Attending HIV Clinic at the Korle-Bu Teaching Hospital in Accra

Abstract

Two decades into the highly active antiretroviral therapy (ART) era, there has been a lot of improvement in the management of HIV/AIDS. Persons Living with HIV (PLHIV) now have life expectancy near that of the general population. However, with increasing years of survival, patients will transit into age groups with greater prevalence of cardiovascular events including hypertension. PLHIV in sub-Saharan Africa are in addition faced with an epidemiological transition of an increasing burden of noncommunicable diseases. With the debate still ongoing, on whether ART is associated with hypertension, this thesis aimed to determine the prevalence of hypertension and associated factors among patients attending the HIV clinic at the Korle-Bu Teaching Hospital (KBTH) and also estimates the average treatment effect on the treated (ATT) of ART on hypertension and blood pressure values. The study design was cross sectional and 311 PLHIV were randomly selected into the study. The WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance instrument was modified and used to collect data on socio-demographic, life-style factors, anthropometric, biochemical and HIV/ART-related parameters from study participants' clinical folders. The prevalence of hypertension was 36.7% (95% CI, 31.3- 42.3). Study participants on ART had a significantly higher prevalence of hypertension (41.3% [95% CI, 35.2-47.3]) compared with their ART-naive counterparts (16.9%, [95% CI, 7.4-26.5]). Regression modelling indicated the factors associated with hypertension were, increasing age, positive family history of cardiovascular disease/hypertension, inadequate exercising, a BMI ::::25.0kg/rn", abdominal obesity, hypercholesterolemia and exposure to ART. Propensity score-matching analysis estimated an ATT of ART on systolic and diastolic blood pressure values of 12.0 mmHg (95% CI, 5.7-18.3) and 6.1mmHg (95% CI, 1.3-10.8) respectively and on hypertension of26.2 % (95% CI, 13.3-39.1). Estimated risk of cardiovascular disease using the Data Collection on Adverse Events of anti-Hl V Drugs (D:A:D) risk score indicated 52.4% of the study participants were of moderate to high risk of cardiovascular event. This study showed that hypertension, as a cardiovascular risk factor is prevalent among patients on ART attending HIV clinic at the KBTH. It also established a plausible causal relation between ART and hypertension/blood pressure levels and estimated that most patients were of moderate to high risk of cardiovascular event.