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Symmetric ambulatory arterial stiffness index and 24-h pulse pressure in HIV infection: results of a nationwide cross-sectional study

Schillaci, Giuseppea; Maggi, Paolob; Madeddu, Giordanoc; Pucci, Giacomoa; Mazzotta, Elenad; Penco, Giovannie; Orofino, Giancarlof; Menzaghi, Barbarag; Rusconi, Stefanoh; Carenzi, Laurai; Celesia, Benedetto M.j; Martinelli, Caniok; Bonfanti, Paolol; De Socio, Giuseppe Vittoriomfor the CISAI Study Group

doi: 10.1097/HJH.0b013e32835ca949
ORIGINAL PAPERS: Blood vessels

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:

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

© 2013 Lippincott Williams & Wilkins, Inc.