Population-Based Assessment of Hypertension Epidemiology and Risk Factors among HIV-Positive and General Populations in Rural Uganda

Dalsone Kwarisiima, Laura Balzer, David Heller, Prashant Kotwani, Gabriel Chamie, Tamara Clark, James Ayieko, Florence Mwangwa, Vivek Jain, Dathan Byonanebye, Maya Petersen, Diane Havlir, Moses R Kamya, Dalsone Kwarisiima, Laura Balzer, David Heller, Prashant Kotwani, Gabriel Chamie, Tamara Clark, James Ayieko, Florence Mwangwa, Vivek Jain, Dathan Byonanebye, Maya Petersen, Diane Havlir, Moses R Kamya

Abstract

Background: Antiretroviral therapy scale-up in Sub-Saharan Africa has created a growing, aging HIV-positive population at risk for non-communicable diseases such as hypertension. However, the prevalence and risk factors for hypertension in this population remain incompletely understood.

Methods: We measured blood pressure and collected demographic data on over 65,000 adults attending multi-disease community health campaigns in 20 rural Ugandan communities (SEARCH Study: NCT01864603). Our objectives were to determine (i) whether HIV is an independent risk factor for hypertension, and (ii) awareness and control of hypertension in HIV-positive adults and the overall population.

Results: Hypertension prevalence was 14% overall, and 11% among HIV-positive individuals. 79% of patients were previously undiagnosed, 85% were not taking medication, and 50% of patients on medication had uncontrolled blood pressure. Multivariate predictors of hypertension included older age, male gender, higher BMI, lack of education, alcohol use, and residence in Eastern Uganda. HIV-negative status was independently associated with higher odds of hypertension (OR 1.2, 95% CI: 1.1-1.4). Viral suppression of HIV did not significantly predict hypertension among HIV-positives.

Significance: The burden of hypertension is substantial and inadequately controlled, both in HIV-positive persons and overall. Universal HIV screening programs could provide counseling, testing, and treatment for hypertension in Sub-Saharan Africa.

Conflict of interest statement

Competing Interests: The authors hereby acknowledge as a Competing Interests Statement that Gilead Sciences, a commercial funder, has provided financial support to this study, but had no role in study design, data collection and analysis. Although Gilead Sciences reserves the right to review SEARCH manuscripts prior to submission to remove any confidential information, Gilead Sciences did not request any revisions or redactions to this manuscript on review, nor was Gilead Sciences involved in the decision to publish, or the preparation of the manuscript, in any other way. This acknowledgement does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

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