NDT Advance Access originally published online on July 6, 2004
Nephrology Dialysis Transplantation 2004 19(9):2250-2258; doi:10.1093/ndt/gfh393
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved
Original Article
Hypertension in HIV-1-infected patients and its impact on renal and cardiovascular integrity
1 Medical Clinic IV Department of Nephrology and 2 Medical Clinic III Department of Infectious Disease, J.W. Goethe University, Frankfurt/Main, Germany
Correspondence and offprint requests to: Dr Oliver Jung, Klinikum der Johann Wolfgang Goethe-Universität, Medizinische Klinik IV, Funktionsbereich Nephrologie, D-60590 Frankfurt/Main, Germany. Email: jung{at}zphys1.uni-frankfurt.de The authors wish it to be known that, in their opinion, the first two authors contributed equally to this work.
Background. With increasing life spans of HIV-infected individuals under highly active antiretroviral therapy, long-term consequences of the chronic infection and antiretroviral treatment are becoming more prevalent. Data on prevalence and consequences of hypertension are limited, but recent studies suggest that HIV-infected individuals are at a higher risk of developing hypertension.
Methods. In this prospective study, HIV-1-infected patients from the Frankfurt AIDS Cohort Study (FACS) were followed for 1 year to determine the frequency of systemic hypertension and to assess the associated clinical and demographic factors.
Results. A total 214 HIV-1-infected patients, predominantly Caucasian males, participated in the study. Prevalence of systemic hypertension was 29%. The groups of hypertensive and normotensive individuals were comparable in terms of ethnic background and duration of infection. As in the general population, hypertensive subjects were older (49.1±11.1 vs 39.0±8.1 years; P<0.0001) and waist-to-hip ratio was higher than in normotensive individuals (0.99±0.07 vs 0.93±0.08; P<0.0001). Hypertension was associated with a much higher frequency of persistent proteinuria (41.1% vs 2.8%; P<0.001), coronary heart disease (16.1% vs 1.3%; P<0.0001) and myocardial infarction (8.1% vs 0.7%; P<0.005), whereas most cardiovascular risk factors were similar in both groups.
Conclusions. Our data do not demonstrate any association between the presence of hypertension and antiretroviral therapy or immune status. However, hypertension seems to have a high impact on the existing risk for premature cardiovascular disease. Furthermore, overt proteinuria is frequent in HIV-1 infection with hypertension and might be due to hypertensive nephrosclerosis as well as yet undefined renal disease in these patients.
Keywords: cardiovascular disease; HIV; hypertension; proteinuria
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