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Open Access 06-07-2023 | Human Immunodeficiency Virus | Original Paper

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

Authors: Hans-Michael Steffen, Melani Ratih Mahanani, Florian Neuhann, Angelina Nhlema, Philipp Kasper, Andrew de Forest, Thom Chaweza, Hannock Tweya, Tom Heller, Jane Chiwoko, Volker Winkler, Sam Phiri

Published in: Clinical Research in Cardiology | Issue 11/2023

Abstract

Background

Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial.

Methods

Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression.

Results

1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%).

Conclusion

Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved.

Trial registration

NCT02381275.

Graphical abstract

Available only for authorised users

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Title: Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study
Authors: Hans-Michael Steffen
Melani Ratih Mahanani
Florian Neuhann
Angelina Nhlema
Philipp Kasper
Andrew de Forest
Thom Chaweza
Hannock Tweya
Tom Heller
Jane Chiwoko
Volker Winkler
Sam Phiri
Publication date: 06-07-2023
Publisher: Springer Berlin Heidelberg
Keywords: Human Immunodeficiency Virus
Hypertension
Tenofovir
Hypertension
Published in: Clinical Research in Cardiology / Issue 11/2023
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-023-02253-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study

Abstract

Background

Methods

Results

Conclusion

Trial registration

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Graphical abstract

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