The relationship between HIV infection and high blood pressure (hypertension) is complex. People living with HIV (PLWH) have an increased likelihood of developing hypertension compared to those without the virus. This elevated risk stems from various factors, including the virus’s direct effects, antiretroviral therapies (ART), and co-occurring health conditions and lifestyle elements. Understanding these connections aids in managing the health of individuals with HIV.
How HIV Affects Blood Pressure
HIV can contribute to elevated blood pressure through several biological mechanisms, even independent of medication. The virus causes chronic inflammation and immune activation. This continuous immune response can lead to changes in blood vessels, such as endothelial dysfunction, impairing their ability to relax and widen.
Ongoing inflammation in people with HIV can stiffen and enlarge arteries, directly impacting blood flow and pressure. Inflammation markers, like interleukin (IL)-6 and soluble CD14 (sCD14), have been associated with hypertension in individuals with HIV. Additionally, HIV can disrupt the gut’s natural mucosal defenses, leading to microbial translocation, where bacterial products enter the bloodstream and further aggravate inflammation, potentially contributing to hypertension.
Impact of HIV Treatment on Blood Pressure
Antiretroviral therapy (ART) has improved the lifespan of people with HIV, but these medications can also influence blood pressure. Certain ART classes, such as older protease inhibitors (PIs) like lopinavir/ritonavir, have been linked to an increased risk of elevated blood pressure. This association might be partly mediated by changes in body mass index or metabolic alterations.
Newer integrase strand transfer inhibitors (INSTIs), including dolutegravir, have been associated with weight gain, contributing to higher blood pressure. While some studies show no difference in hypertension rates with dolutegravir compared to other regimens, others indicate a potential increase in hypertension risk. The exact mechanisms by which INSTIs affect blood pressure are still being investigated, but metabolic disturbances like insulin resistance and oxidative stress are being considered.
Other Factors Influencing Blood Pressure in People with HIV
Beyond the virus and its treatments, several other factors can influence blood pressure in individuals with HIV. Traditional hypertension risk factors, such as increasing age, male gender, and a higher body mass index (BMI), play a role. Lifestyle choices, including diet, physical activity, and smoking, also contribute to blood pressure regulation.
Co-existing health conditions are relevant in the HIV-positive population. Kidney disease, more prevalent in people with HIV, can significantly impact blood pressure. Other conditions like diabetes, dyslipidemia, and obesity can further increase hypertension risk. Long-term survival with HIV, due to effective ART, means individuals are living longer and are more susceptible to age-related health issues, including hypertension.
Managing Blood Pressure with HIV
Regular blood pressure monitoring is important for individuals with HIV to detect and manage hypertension early. General strategies for managing high blood pressure apply to people with HIV, with considerations for their HIV status and ART regimen. Lifestyle modifications form a foundational approach to blood pressure management.
These modifications include adopting a balanced diet, such as the Dietary Approaches to Stop Hypertension (DASH) plan, emphasizing fruits, vegetables, and whole grains while limiting saturated fats and sodium. Engaging in regular physical activity, managing body weight, and avoiding smoking are also beneficial. When lifestyle changes are insufficient, pharmacological interventions are necessary. Healthcare providers consider potential drug interactions between antihypertensive medications and ART regimens, often preferring ACE inhibitors, ARBs, or thiazide-type diuretics as initial therapies.