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Home >> Publications >> D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda.

Publication

Author(s):

Okello S, Asiimwe SB, Kanyesigye M, Muyindike WR, Boum Y, Mwebesa BB, Haberer JE, Huang Y, Williams K, Burdo TH, Tracy RP, Bangsberg DR, Mocello AR, Martin JN, Hunt PW, Siedner MJ.

Pub Title:

D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda.

Pub Date:

Dec 1 2016

Pub Region(s):

West Africa

Journal:

Title: 
JAIDS Journal of Acquired Immune Deficiency Syndromes

PubMed: 27171743
Pub PDF:

OBJECTIVES: We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda.

METHODS: We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension.

RESULTS: In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count <100 cells (AOR 3.08, 95% CI: 1.07 to 8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio.

CONCLUSION: BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population.

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Citation:

J Acquir Immune Defic Syndr. 2016 Dec 1;73(4):396-402. D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda. Okello S1, Asiimwe SB, Kanyesigye M, Muyindike WR, Boum Y 2nd, Mwebesa BB, Haberer JE, Huang Y, Williams K, Burdo TH, Tracy RP, Bangsberg DR, Mocello AR, Martin JN, Hunt PW, Siedner MJ.