Assessing Risk Factors for Hypertension in Young Adults With Perinatally Acquired HIV Infection

A Case-Control Study

Patrick J. O'Neil; Kristen A. Stafford; Patrick A. Ryscavage

Disclosures

HIV Medicine. 2022;23(5):457-464. 

In This Article

Methods

We conducted a case–control study among a population of adults with PHIV aged 18–35 years. Subjects were identified as patients of at least one of four adult HIV clinics and/or one paediatric/adolescent HIV clinic at University of Maryland School of Medicine. Patients' HIV status was confirmed by positive HIV-1 virology testing on two separate occasions in infancy, or by the presence of anti-HIV-1 antibodies persisting beyond 18 months of age; their mothers had a documented HIV-positive status as well. Exclusion criteria included those aged < 18 years on 31 December 2017 and/or those with documented or suspected non-perinatally acquired HIV infection. Cases were defined as follows:

  1. Patients receiving antihypertensive medication (at the most recent time period of data abstraction) for a provider diagnosis of systemic hypertension; and/or

  2. Patients with two or more blood pressure readings of systolic blood pressure (SBP) > 140 mmHg or diastolic blood pressure (DBP) > 90 mmHg, separated in time by at least 3 months, including one or more hypertensive reading within the previous 2 years.

Controls were defined as those subjects who did not meet the aforementioned criteria for hypertension. To minimize the potential of spurious diagnosis of hypertension, blood pressure readings obtained during emergency department visits were omitted from the study, as such readings might occur in the setting of trauma, high stress and/or other conditions which could acutely and transiently raise blood pressure.

Data were abstracted from charts (in both electronic and paper format) at each participating clinical site. The period of study for an individual subject was defined as the entirety of time spent in clinical care up to 1 January 2018. Blood pressures were collected almost exclusively from 2013 to 2017, reflecting the availability of these data in the University of Maryland Medical System electronic medical record. All subjects were assigned a study number under which data were collected using a standardized data collection form. All data were abstracted into an electronic database using a chart abstraction coding sheet. The study was approved by the institutional review board of the University of Maryland, Baltimore.

Covariates assessed included age, family history of hypertension, smoking, alcohol use, drug use, specific ART exposure and diagnosis of chronic kidney disease (CKD). Antiretroviral monotherapy was defined as treatment with a single antiretroviral (ARV) agent for any period of time and treatment interruption was defined as any prolonged period (> 3 months) off ART. For the purposes of family history of hypertension, first-degree family was defined as a subject's birth mother, birth father or a full- or half-sibling. Comorbidities were limited to those with a biologically plausible association with the development of hypertension.

Descriptive statistics, including mean, median, standard deviation and interquartile ranges for continuous measures, were used to characterize the study population. In comparing events/proportions with those without hypertension, χ 2 test were used to compare categorical variables. Where the expected cell size was less than five, Fisher's exact test was used. The Wilcoxon rank-sum test was used to compare medians for continuous variables, where applicable. Unadjusted odds of being a case versus a control were estimated using simple logistic regression. Covariates for potential inclusion in adjusted models were chosen a priori based on the medical literature. Multivariable logistic regression was used to estimate the odds of being a case compared with a control. The final multivariable model was built by including all covariates that had a bivariate association with the odds of being a case with a p-value ≤ 0.3. Variables with p > 0.1 after adjustment were removed from the model.

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