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Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
BP control in HIV positive patients
Blood Pressure Targets IN HIV+ patients
Again another very interesting session from a GP perspective.
Dr Shanti Narayanasamy discussed the challenge of meeting BP targets in HIV positive outpatients.
The background to the problem is concerning; high BP accounts for 45% of heart disease mortality and 51% of stroke deaths. Rates of hypertension in people living with HIV in Australia is approximately 20-25% and those affected have higher rates of myocardial infarction than the general population.
This cross sectional, retrospective study examined whether HIV positive patients attending an outpatient clinic who were diagnosed and treated for hypertension were meeting blood pressure targets as per the Heart Foundation guidelines. Please see below:
People with proteinuria >1 g/day (with or without diabetes) < 125/75
People with associated condition/s or end-organ damage:* • Coronary heart disease • Diabetes • Chronic kidney disease • Proteinuria (> 300 mg/day) • Stroke/TIA < 130/80
People with none of the following: • Coronary heart disease • Diabetes • Chronic kidney disease • Proteinuria (> 300 mg/day) • Stroke/TIA < 140/90 or lower if tolerated
Of the 69 patients studied, 97% studied were male. Of these 48% met the target BP and 59% had end organ disease from hypertension. Most of these patients were treated with ACE-i medications (no: 39). Most patients were treated with monotherapy (70%) and 30% were taking more than 1 anti-hypertensive. Of the patients that had end organ disease only 68% had seen either a cardiac or renal specialist as per the guidelines. Of those that had seen a specialist; this was correlated with better BP control.
Those patients that were virologically suppressed had better BP control. This could be attributed to overall better medication compliance. Older patients also had better BP control.
This raised the question of whether there was some reluctance/inexperience of the ID physicians or general practitioners involved in these patients care to up-titrate hypertensive management when necessary.
Certainly this appears to be an issue that is likely faced in a number of different settings and was a great way to raise the awareness of meeting BP targets and involving specialist opinion when required.