The human immunodeficiency virus (HIV) targets the immune system. While it can lead to acquired immunodeficiency syndrome (AIDS), modern antiretroviral therapy (ART) has transformed HIV into a manageable chronic condition, allowing people to live longer, healthier lives. Blood pressure, or hypertension, refers to the force of blood against artery walls as the heart pumps. Understanding the relationship between HIV and blood pressure is increasingly relevant for long-term health management.
Understanding the Connection
Hypertension is a common co-occurring condition among people living with HIV (PLHIV), with a notable link to the virus. Studies indicate a higher prevalence and earlier onset of hypertension in this population compared to the general population. For instance, a meta-analysis showed that 35% of HIV-infected adults on ART have hypertension, a rate higher than the estimated 30% in HIV-uninfected adults.
This increased risk is a growing concern as effective ART has extended the lifespan of PLHIV. As people with HIV live into older age, they face a higher burden of age-related conditions, including cardiovascular diseases. Hypertension is a risk factor for serious cardiovascular events such as heart attack, stroke, and heart failure, making its management a central aspect of comprehensive HIV care.
Causes of Elevated Blood Pressure
Several factors contribute to elevated blood pressure in people living with HIV, stemming from the virus, its treatment, and lifestyle influences. Chronic inflammation and immune activation, consequences of HIV infection, play a role even when the virus is suppressed by ART. This persistent activation can stiffen and inflame blood vessels, directly contributing to hypertension. Elevated levels of inflammatory markers like interleukin-6 (IL-6) have been linked to hypertension in PLHIV.
Antiretroviral therapy (ART), while life-saving, can also influence blood pressure. Some ART medications may contribute to increased blood pressure, either directly or through metabolic changes. For example, some older anti-HIV medications were associated with lipodystrophy, a change in body fat storage, which has been linked to high blood pressure. Newer integrase inhibitors, such as dolutegravir, have been associated with weight gain, which can in turn increase blood pressure.
Traditional cardiovascular risk factors also contribute to hypertension in PLHIV. These include aging, obesity, unhealthy dietary habits, insufficient physical activity, and smoking. These factors are often prevalent in the HIV-positive population and can be exacerbated by HIV itself or by ART, further increasing the risk of high blood pressure. Kidney impairment, which can be more common in PLHIV, also affects blood pressure regulation. HIV can directly harm kidney filters, and some ART medications can also impact kidney function, leading to issues that can raise blood pressure.
Strategies for Management
Managing elevated blood pressure in people with HIV involves a multi-faceted approach, starting with regular monitoring. Frequent blood pressure checks are a part of routine HIV care, allowing for early detection and intervention. This proactive monitoring helps identify hypertension before it leads to more serious complications.
Lifestyle modifications form the foundation of blood pressure management. Adopting a heart-healthy diet, such as one low in sodium and rich in fruits and vegetables, can lower blood pressure. Regular physical activity, maintaining a healthy weight, limiting alcohol consumption, and quitting smoking are also recommended to reduce cardiovascular risk. These changes can be impactful, potentially reducing the need for medication or supplementing its effects.
When lifestyle changes are not enough, pharmacological treatment with antihypertensive medications may be necessary. Healthcare providers carefully consider potential interactions between these medications and ART to ensure both conditions are managed effectively. For example, some calcium channel blockers and beta-blockers can interact with certain antiretroviral drugs, necessitating careful selection and dosing.
Consistent adherence to ART is also important for overall health in PLHIV, which indirectly aids in managing co-occurring conditions like hypertension. Effective viral suppression through ART can reduce chronic inflammation, a factor contributing to high blood pressure. Finally, close collaboration between the patient, their HIV specialist, and other healthcare providers ensures integrated and comprehensive care. This collaborative approach helps address the complex interplay of HIV and cardiovascular health.