D-dimer levels and traditional risk factors are associated with incident hypertension among HIV-infected individuals initiating antiretroviral therapy in Uganda

Abstract

Objectives-We sought to describe blood pressure changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-individuals in Uganda. Methods -We used mixed effects linear regression to model changes in systolic blood pressure (BP) over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with pre-existing hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Prior to ART initiation, participants had testing for lnterleukin-6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at six months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension. Results- In the entire cohort, systolic BP increased by 9.6 mmHg/year (95% CI 7.3 - 11.8) in the first six months of ART, then plateaued. Traditional factors: male gender (AOR 2.76, 95% CI 1.34-5.68), age (AOR 1.09, 95% CI 1.04-1.13), overweight (AOR 4.48, 95%CI 1.83-10.97), and a CD4 count < 100 cells (AOR 3.08, 95% CI 1.07-8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI 0.37-0.99). Although not significant, similar associations were seen with sCD14 and Kynurenine/Tryptophan (K/T) ratio. Conclusion-Blood pressure increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation were associated with incident hypertension in this population.