“HIV positive individuals have an increased risk for cardiovascular disease, but the mechanisms behind this association are poorly understood. While hypertension is a well-established cardiovascular disease risk factor, clinic-based blood pressure assessment by itself cannot identify several important blood pressure patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime blood pressure dipping. These blood pressure patterns can be identified over a 24-hour period by ambulatory blood pressure monitoring (ABPM),” writes Dr. Shia T. Kent, postdoctoral fellow in the department of epidemiology at the University of Alabama at Birmingham School of Public Health, in “Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV,” published in November in Current Hypertension Reports. Co-investigators are post-doctoral fellow Dr. Gabriel S. Tajeu, and professor and vice chair Dr. Paul Muntner, in the department of epidemiology; as well as assistant professor Dr. Greer A. Burkholder, and associate professor Dr. E. Turner Overton, in the division of infectious diseases.
[Photo: Dr. Shia T. Kent]
The researchers present a summary of the possible benefits of performing ABPM in individuals who are HIV positive. Dr. Kent notes, “ABPM phenotypes associated with increased cardiovascular disease risk include masked hypertension (i.e., elevated out-of-clinic blood pressure despite non-elevated clinic blood pressure), nighttime hypertension, and a non-dipping blood pressure pattern (i.e., a drop in blood pressure of below 10 percent from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV positive persons.”
Moreover, although antiretroviral therapy is linked to lower incidences of AIDS-related illness and risk of cardiovascular disease, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance related to long-term use of antiretroviral therapy possibly produce adverse ABPM phenotypes. Data on ABPM phenotypes in the setting of HIV are not prevalent, but what exist indicate enhanced incidence of a non-dipping blood pressure pattern.
“In conclusion,” says Dr. Kent, “identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess cardiovascular disease risk in HIV positive individuals.”
Journal article: http://link.springer.com/article/10.1007%2Fs11906-015-0598-1