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Hypertension prevalence and Framingham risk score stratification in a large HIV-positive cohort in Uganda

Mateen, Farrah J.a; Kanters, Steveb,c; Kalyesubula, Robertd; Mukasa, Barbarae; Kawuma, Esthere; Kengne, Andre P.f; Mills, Edward J.b

doi: 10.1097/HJH.0b013e328360de1c

Background: To report the prevalence of hypertension and projected 10-year absolute risk of acute cardiovascular disease in a large prospectively followed cohort of HIV-positive youth and adults beginning antiretroviral therapy in sub-Saharan Africa.

Methods: HIV-positive individuals seeking HIV treatment, ages 13 years and older, were assessed for repeated blood pressure measurements over the first year following initiation of antiretroviral therapy, including serum total cholesterol, high-density lipoprotein, CD4 cell count and related clinical and laboratory measurements. Outcomes include hypertension, defined according to the 7th Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories, and Framingham Risk Score based 10-year cardiovascular disease risk estimates.

Results: Five thousand, five hundred and sixty-three patients had at least two blood pressure measurements on at least two separate occasions during the first year of antiretroviral therapy [median age of therapy initiation 34, first and third quartile (Q1–Q3) 28–40 years, 1841 (33.1%) men, baseline CD4 cell count 161 cells/μl (Q1–Q3 72–231 cells/μl]. Hypertension was diagnosed in 1551 patients [27.9%, 95% confidence interval (CI) 26.7– 29.1] including 786 (14.1%, 95% CI 13.2–15.1) who met criteria for stage 2 hypertension. The age-standardized prevalence for Ugandans aged 13 or more was 24.8% (95% CI 23.8–26.1). Among those with complete laboratory studies (n = 1102), nearly all women were in the 10% or less 10-year Framingham Risk Score category, but 20% of men were at at least 10% or more long-term risk of acute cardiovascular disease.

Conclusion: : Efforts to combine HIV treatment with vascular disease risk factor prevention and management are urgently needed to address noncommunicable disease multimorbidity in HIV-positive persons in sub-Saharan Africa, particularly in men.

aDepartment of International Health, the Bloomberg School of Public Health, the Johns Hopkins University, Baltimore, Maryland, USA

bFaculty of Health Sciences, University of Ottawa, Ottawa, Ontario

cSchool of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada

dDivision of Nephrology, Department of Medicine, Makerere University

eMildmay Uganda, Kampala, Uganda

fNational Collaborative Research Programme for Cardiovascular and Metabolic Diseases, South African Medical Research Council, Cape Town, South Africa

Correspondence to Farrah J. Mateen, MD, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E8527, Baltimore, MD 21205, USA. Tel: +1 410 935 5181; e-mail:

Abbreviations: ART, antiretroviral therapy; CVD, cardiovascular disease; FRS, Framingham Risk Score; HDL, high-density lipoprotein; SSA, sub-Saharan Africa

Received 29 November, 2012

Revised 21 December, 2012

Accepted 4 March, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins