Objective: An attenuation of the physiological day-night blood pressure (BP) reduction is an important predictor of cardiovascular (CV) events and death. We compared circadian BP profile in treatment-naive HIV-infected patients and in healthy control subjects. Methods: Fifty-two antiretroviral therapy-naive HIV-infected patients (85% men, age 39 +/- 11 years, BP 125/78 +/- 11/9 mm Hg) and 156 age- and BP-matched HIV-negative controls (85% men, age 39 +/- 10 years, BP 125/78 +/- 9/7 mm Hg) underwent 24-hour BP monitoring. Subjects with a nocturnal reduction of systolic BP <10% were defined as "nondippers." Results: Nighttime BP was higher in HIV-infected subjects (113/69 +/- 11/9 vs 109/67 +/- 8/6 mm Hg, P = 0.008/0.005). Nocturnal systolic/diastolic BP reduction was 8.8/13.2% in HIV-positive patients and 11.7/17.2% in HIV negative (P = 0.002/0.001). The prevalence of "nondippers" was 35% and 15%, respectively (P = 0.003). In multivariate analysis, nocturnal systolic BP fall was negatively associated to HIV infection (beta = -0.22, P = 0.001). HIV viral load, low CD4(+) cell count, and AIDS progression risk were all related with a flattened day-night BP profile (P < 0.01). Conclusions: HIV infection per se negatively affects circadian BP rhythm. These findings, obtained in subjects without major CV risk factors and antiretroviral naive, suggest that day-night BP changes may play a role in the HIV-related increase in CV risk.
Negative influence of HIV infection on day-night blood pressure variability.
PUCCI, GIACOMO;SCHILLACI, Giuseppe
2010
Abstract
Objective: An attenuation of the physiological day-night blood pressure (BP) reduction is an important predictor of cardiovascular (CV) events and death. We compared circadian BP profile in treatment-naive HIV-infected patients and in healthy control subjects. Methods: Fifty-two antiretroviral therapy-naive HIV-infected patients (85% men, age 39 +/- 11 years, BP 125/78 +/- 11/9 mm Hg) and 156 age- and BP-matched HIV-negative controls (85% men, age 39 +/- 10 years, BP 125/78 +/- 9/7 mm Hg) underwent 24-hour BP monitoring. Subjects with a nocturnal reduction of systolic BP <10% were defined as "nondippers." Results: Nighttime BP was higher in HIV-infected subjects (113/69 +/- 11/9 vs 109/67 +/- 8/6 mm Hg, P = 0.008/0.005). Nocturnal systolic/diastolic BP reduction was 8.8/13.2% in HIV-positive patients and 11.7/17.2% in HIV negative (P = 0.002/0.001). The prevalence of "nondippers" was 35% and 15%, respectively (P = 0.003). In multivariate analysis, nocturnal systolic BP fall was negatively associated to HIV infection (beta = -0.22, P = 0.001). HIV viral load, low CD4(+) cell count, and AIDS progression risk were all related with a flattened day-night BP profile (P < 0.01). Conclusions: HIV infection per se negatively affects circadian BP rhythm. These findings, obtained in subjects without major CV risk factors and antiretroviral naive, suggest that day-night BP changes may play a role in the HIV-related increase in CV risk.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
