HIV and Hypertension

Hypertension, or high blood pressure, can lead to a number of health problems including cardiac failure, ischaemic heart disease and renal failure. There are two types of blood pressure: systolic blood pressure, which is displayed as the “top number” in assessment tools, refers to the amount of pressure in the arteries when the heart contracts; diastolic blood pressure, which is displayed as the “bottom number,” refers to the amount of pressure in the arteries when the heart is resting between beats. Normal blood pressure is defined as less than 120 mm Hg systolic and less than 80 mm Hg diastolic. The pre-hypertension range is between 120 and 139 mm Hg systolic or between 80 and 89 mm Hg diastolic. Blood pressure readings above these numbers indicate hypertension and may necessitate both lifestyle changes and treatment with medication.

Prevalence of high blood pressure in people living with HIV

Hypertension is more common in HIV patients than in non-infected individuals. One study suggests that 21 percent of the HIV positive population has high blood pressure compared to only about 16 percent of the general population. Research on elderly HIV patients indicates that this disparity seems to increase with age. Researchers are unsure if higher rates of hypertension in HIV patients are due to the virus itself, the antiretroviral drugs used to treat HIV or other factors. Another study comparing HIV patients with and without hypertension found that those with high blood pressure were more likely to experience health problems such as persistent proteinuria, coronary heart disease and myocardial infarction.

Assessment for hypertension in people living with HIV

Assessment for hypertension should be a routine part of annual check-ups for all HIV patients even if they are not currently taking antiretrovirals.

Risk Reduction and Management of Hypertension in People Living With HIV

Patients in the pre-hypertension stage may be able to significantly lower their blood pressure by making some lifestyle adjustments such as:

• Reducing salt intake
• Exercising regularly several times a week
• Maintaining a healthy weight
• Avoiding tobacco use
• Limiting alcohol consumption
• Healthily managing stress
• Avoiding prolonged hot tub sessions

People with normal blood pressure are also encouraged to practice these healthy habits to prevent hypertension.

Drug treatment for hypertension in people living with HIV

Patients with blood pressure above 140/90 may require medication in addition to lifestyle changes. Many drug interactions have been documented between anti-hypertensives and antiretrovirals used to treat HIV, so doctors should consult an up-to-date list of antiretroviral drug interactions before prescribing a new medication. Patients should also be carefully monitored for adverse effects.