Incidence of hypertension and factors associated with blood pressure control among older adults living with HIV in Western Kenya: a retrospective cohort study

Abstract

Background People living with HIV are living longer due to expanded access to antiretroviral treatment (ART). As they age, their risk of hypertension is greater due to HIV-immune activation and long-term use of some antiretrovirals. Screening and treatment of hypertension and monitoring hypertension control are key strategies for averting morbidity and mortality from cardiovascular disease and improving the health outcomes of older adults living with HIV (OALWH). We sought to estimate the incidence of hypertension and determine the proportion of blood pressure control among OALWH in western Kenya. Methods We analyzed deidentified clinical data for OALWH (≥ 50 years) attending a large HIV care and treatment program in western Kenya, between January 1, 2016, and August 24, 2021. Hypertension was defined by two consecutive blood pressure (BP) readings with systolic BP (SBP) ≥ 140 and diastolic BP (DBP) ≥ 90, a clinical diagnosis of hypertension, or the use of hypertension medication. Screening and monitoring were defined as having BP measurements in individuals without or with hypertension, respectively. Descriptive statistics and logistic regression assessed baseline characteristics and factors associated with hypertension. Linear mixed models estimated the rates of screening, monitoring, BP control, and sex differences. Results Of 6216 eligible OALWH, 52.5% were female and 23.0% were hypertensive at baseline. Baseline factors associated with hypertension included, age, body mass index, sex, prior ART exposure and having health insurance. On follow up, 91.1% (95% CI, 90.8%-91.4%) of non-hypertensive individuals were screened. The incidence of hypertension was 84 cases per 1000-person years. Of individuals with hypertension, 91.2% (95% CI, 90.9%-91.5%) were monitored and 47.9% (95% CI, 46.6%, 49.1%) achieved BP control. No gender differences were identified in BP screening, monitoring, or control rates. Conclusion The high incidence of hypertension with less than half of those with hypertension achieving controlled BP, reveals a significant gap between detection and effective management. This highlights the needs not only in the continuity of hypertension screening but also the need for strengthened hypertension management within HIV programs.