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Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV
Shia T Kent1, Greer A Burkholder2, Gabriel S Tajeu3
1Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd RPBH 220, Birmingham, AL, 35294, USA. shia@uab.edu.
Insights
Ambulatory blood pressure monitoring (ABPM) can reveal hypertension patterns in HIV+ individuals, offering insights into their elevated cardiovascular disease (CVD) risk. Identifying these patterns may explain why HIV+ persons face higher CVD rates.
Area of Science:
- Cardiology
- Infectious Diseases
- Hypertension Research
Background:
- Individuals with HIV (HIV+) have a higher risk of cardiovascular disease (CVD).
- Standard clinic blood pressure (BP) measurements miss crucial BP patterns like masked hypertension and nighttime hypertension.
- Ambulatory blood pressure monitoring (ABPM) over 24 hours can identify these critical BP patterns.
Purpose of the Study:
- To review the significance of ABPM in assessing cardiovascular risk in HIV+ individuals.
- To explore how specific ABPM phenotypes relate to increased CVD risk in the context of HIV.
- To discuss the potential impact of HIV infection and antiretroviral therapy (ART) on ABPM findings.
Main Methods:
- Review of existing literature on ABPM and its application in HIV+ populations.
- Analysis of ABPM phenotypes associated with increased CVD risk.
- Consideration of factors in HIV+ individuals (inflammation, psychosocial burden, sleep disturbance, autonomic dysfunction) and ART side effects (mitochondrial toxicity, oxidative stress) influencing BP patterns.
Main Results:
- Adverse ABPM phenotypes linked to higher CVD risk include masked hypertension, nighttime hypertension, and non-dipping BP patterns.
- These patterns may be more prevalent in HIV+ individuals due to disease and treatment-related factors.
- Limited data suggests a higher prevalence of non-dipping BP patterns in HIV+ persons.
Conclusions:
- ABPM can identify specific hypertension phenotypes in HIV+ individuals that are associated with increased cardiovascular risk.
- These findings may elucidate the mechanisms behind the heightened CVD risk observed in this population.
- ABPM offers valuable diagnostic information for managing CVD risk in HIV+ patients.
Abstract:
HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % 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+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.
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