Elevated blood pressure in HIV-infected individuals receiving highly active antiretroviral therapy

Objective: We examined the effects of antiretroviral regimens on blood pressure (BP). Method: This retrospective study examined systolic and diastolic BP (SBP and DBP) measurements among participants of a State of Hawaii Department of Health program from January 1995 to July 2001. The change in BP during four consecutive 6-month visits was estimated using linear regression and was interpreted as the change in BP per year. BP changes among the antiretroviral treatment groups were compared to untreated controls. Results: Of 1,601 patients identified, 286 met the criteria for inclusion. After adjustment for baseline age, BP, and CD4+ count, there was an increase in SBP by 4.71 mmHg/year (p = .005) and DBP by 2.26 mmHg/year (p = .076) among patients initiating HAART. Among these patients, an increase of 4.75 mmHg/year in SBP (p = .002) and 1.96 mmHg/year in DBP (p = .042) was seen with HAART regimens containing a protease inhibitor (PI) but no nonnucleoside reverse transcriptase inhibitor (NNRTI). In NNRTI-containing HAART regimens without Pis, an increase of 3.21 mmHg/year in SBP (p = .011) and 2.62 mmHg/year in DBP (p = .050) was observed. No significant BP changes were noted with patients on regimens containing only nucleoside reverse transcriptase inhibitors (NRTIs). Conclusion: The use of NNRTI- or PI-containing HAART is associated with elevation of both SBP and DBP in HIV-infected individuals.