Comparing blood pressure control between HIV positive and HIV negative hypertensive patients attending Webuye County Hospital, Kenya

Abstract

Background: The prevalence of hypertension in Sub Saharan Africa has risen dramatically over the years. The burden is also rising among the HIV positive clients. Globally, hypertension control remains sub-optimal due to complex factors affecting blood pressure control and adherence to care. The multi-morbidity nature of HIV, including the pill burden may negatively affect adherence to antihypertensives. Conversely, intense adherence interventions targeting ARVs may positively influence hypertension medication adherence and control in hypertensive patients living with HIV. Objective: To assess blood pressure control among HIV positive and HIV negative hypertensive patients on follow up at the medical outpatient clinic in Webuye County Hospital. Methods: This was a cross sectional study. The study population comprised of hypertensive patients attending the medical outpatient clinic at Webuye County Hospital. Systematic random sampling was used to recruit 73 HIV positive hypertensive participants who were then matched 1:2 for age and gender with the HIV negative participants (146 participants). A structured interviewer guided questionnaire was administered to obtain demographic and socio-economic characteristics while the clinical information was obtained from the patient files. Questionnaires were checked for errors and completeness before entry of data into access database. Blood pressure was considered controlled if the average of two previous and enrollment Bp reading was less than 140/90 mm Hg, while adherence to medication was assessed using adherence questionnaire in the patient encounter form. Descriptive data were presented as means and standard deviation (SD), median with inter quartile range (IQR), or number with percentage as appropriate. Chi-squared test and Fisher’s exact test were used to check for association between the categorical variables. The results were presented in form of tables. A p-value of <0.05 was considered statistically significant. Results: A total of 219 participants were included in the analysis (73 HIV positive and 146 HIV negative). The mean age was 55 years, while 54.8% were females. Majority (78.1%) of the participants were married. More than half (53%) had a family history of hypertension, 36% had history of alcohol intake, and only 10% had history of cigarette smoking. 40% had a BMI above the recommended levels and 43% lived a sedentary lifestyle. 20% of HIV negative and 23% of HIV positive participants had controlled BP with a p value of 0.592 (95% CI: -8.5, 14.9). Adherence to hypertensive medication was 68.95% and 69.4% among the HIV negative and HIV positive participants respectively p value = 0.887 (95% CI: -12.4, 13.9). Conclusion: There was no difference in adherence to hypertensive medication among the HIV positive and the HIV negative participants. The HIV positive participants had better Bp control, though not statistically significant. Recommendation: Further study on determinants and optimization of blood pressure control should be conducted