Objective: HIV infection has been associated with increased cardiovascular risk. Twenty-four-hour ambulatory blood pressure (BP) is a more accurate and prognostically relevant measure of an individual's BP load than office BP, and the ambulatory BP-derived ambulatory arterial stiffness index (AASI) and symmetric AASI (s-AASI) are established cardiovascular risk factors.
Methods: In the setting of the HIV and HYpertension (HIV-HY) study, an Italian nationwide survey on high BP in HIV infection, 100 HIV-infected patients with high-normal BP or untreated hypertension (72% men, age 48 ± 10 years, BP 142/91 ± 12/7 mmHg) and 325 HIV-negative individuals with comparable age, sex distribution, and office BP (68% men, age 48 ± 10 years, BP 141/90 ± 11/8 mmHg) underwent 24-h ambulatory BP monitoring.
Results: Despite having similar office BP, HIV-infected individuals had higher 24-h SBP (130.6 ± 14 vs. 126.4 ± 10 mmHg) and pulse pressure (49.1 ± 9 vs. 45.9 ± 7 mmHg, both P < 0.001), and a lower day-night reduction of mean arterial pressure (14.3 ± 9 vs. 16.3 ± 7%, P = 0.025). Both s-AASI and AASI were significantly higher in HIV patients (s-AASI, 0.22 ± 0.18 vs. 0.11 ± 0.15; AASI, 0.46 ± 0.22 vs. 0.29 ± 0.17; both P <0.001). In a multivariate regression, s-AASI was independently predicted by HIV infection (β = 0.252, P <0.001), age, female sex, and 24-h SBP. In HIV patients, s-AASI had an inverse relation with CD4+ cell count (Spearman's ρ −0.24, P = 0.027).
Conclusion: Individuals with HIV infection and borderline or definite hypertension have higher symmetric AASI and 24-h systolic and pulse pressures than HIV-uninfected controls matched by office BP. High ambulatory BP may play a role in the HIV-related increase in cardiovascular risk.
aThe Università di Perugia and Struttura Complessa di Medicina Interna, Ospedale ‘S. Maria’, Terni
bUnit of Infectious Diseases, University of Bari, Bari
cDepartment of Clinical and Experimental Medicine, University of Sassari, Sassari
dDepartment of Infectious Diseases, Pescara Hospital, Pescara
eDepartment of Infectious Diseases, Galliera Hospital, Genova
fDepartment of Infectious Diseases, Amedeo di Savoia Hospital, Turin
gUnit of Infectious Diseases, Busto Arsizio Hospital, Busto Arsizio
hUnit of Infectious Diseases, University of Milan
iDepartment of Infectious Diseases, Luigi Sacco Hospital, Milan
jUnit of Infectious Diseases, Garibaldi Hospital, University of Catania, Catania
kDepartment of Infectious Diseases, Careggi Hospital, Florence
lUnit of Infectious Diseases, Manzoni Hospital, Lecco
mUnit of Infectious Diseases, Santa Maria Hospital, Perugia, Italy
Correspondence to Professor Giuseppe Schillaci, Università di Perugia, Struttura Complessa di Medicina Interna, Ospedale ‘S. Maria’, viale Tristano di Joannuccio, 1, IT-05100 Terni, Italy. Tel: +39 0744 205201; e-mail: firstname.lastname@example.org
Abbreviations: AASI, ambulatory arterial stiffness index; ABPM, ambulatory BP monitoring; BP, blood pressure, MAP; mean arterial pressure
Received 7 August, 2012
Revised 31 October, 2012
Accepted 15 November, 2012