Association between HIV infection and hypertension: a global systematic review and meta-analysis of cross-sectional studies

Davis, Katherine; Perez-Guzman, Pablo; Hoyer, Annika; Brinks, Ralph; Gregg, Edward; Althoff, Keri N.; Justice, Amy C.; Reiss, Peter; Gregson, Simon; Smit, Mikaela

doi:10.1186/s12916-021-01978-7

Table 1 Observational studies of hypertension in people living with HIV and HIV-negative individuals that met the inclusion criteria

From: Association between HIV infection and hypertension: a global systematic review and meta-analysis of cross-sectional studies

Authors,year	Continent	Country	Study period	Hypertensiondefinition	Age included(years)	Number ofparticipants	Mean age(years)^a	Proportionfemale (%)	Proportion of people livingwith HIV who were exposedto antiretroviral therapy (%)	Risk ratio forhypertension^b (95%confidence interval)
Ake et al., 2018 [32]	Africa	Kenya, Uganda, Tanzania and Nigeria	2013–2016	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	2538	38.5^a	59	66	0.67 (0.53–0.85)
Akl et al., 2016 [33]	South American	Brazil	Not specified	SBP ≥ 130 mmHg or DBP ≥ 85 mmHg	40–60	388	48.7	100	91	1.03 (0.85–1.26)
Benzekri et al., 2018 [34]	Africa	Senegal	1994–2015	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 18	2120	37.2	66.9	14.1	0.61 (0.50–0.75)
Bergersen et al., 2003 [35]	Europe	Norway	2000–2001	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	Adults^c	657	43.2	81	100	0.88 (0.65–1.19)
Bonfanti et al., 2007 [36]	Europe	Italy	1995–2005	Use of antihypertensives	≥ 18	3135	47.8	41.3	85.0	0.53 (0.43–0.65)
Burkhalter et al., 2014 [37]	North America	Haiti	2013	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	608	54.2^a	64.5	Not specified	1.03 (0.51–2.07)
Chhabra et al., 2018 [38]	Europe	UK	2013–2016	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 50	88	Living with HIV 58^a HIV-negative 60^a	17.1	100	1.34 (0.79–2.27)
Chow et al., 2012 [39]	North America	USA	2005–2007	Electronic health records	≥ 18	36,731	40.9	34.2	49	1.19 (1.14–1.24)
Clark et al., 2015 [40]	Africa	South Africa	2014–2015	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 15	4350	Not specified	59.4	Not specified	0.92 (0.85–1.00)
Cortes et al., 2017 [41]	North America	USA	2002–2014	Use of antihypertensives	≥ 40	152	57.3	100	78.9	0.86 (0.66–1.11)
Crystal et al., 2011 [42]	North America	USA	2005–2008	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	Adults^c	1325	Not specified	100	Not specified	1.13 (1.04–1.22)
Ding et al., 2017 [43]	Asia	China	2014–2015	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 40	690	52.8	33.3	87	0.75 (0.58–0.95)
Drain et al., 2019 [23]	Africa	South Africa	2013–2017	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 18	5428	31	49.4	0	0.89 (0.75–1.05)
Durand et al., 2011 [44]	North America	Canada	1985–2007	Electronic health records	≥ 20	34,734	39.7	22	76.2	1.44 (1.38–1.52)
Echeverria et al., 2014 [45]	Europe	Spain	2010–2011	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	254	46.5 ^a	28.6	94.4	1.03 (0.55–1.94)
Gallant et al., 2017 [46]	North America	USA	2003–2013	Electronic health records	≥ 18	121,738	45.8	29	100	1.06 (1.04–1.08)
Gelpi et al., 2018 [47]	Europe	Denmark	2015–2016	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	13,260	Living with HIV 50.1^a HIV-negative 52.2^a	18.3	98.4	0.72 (0.67–0.77)
Godijk et al., 2020 [48]	Africa	South Africa	2014–2017	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 18	318	41.9	47.3	100	0.93 (0.81–1.08)
Guaraldi et al., 2011 [49]	Europe	Italy	2002–2019	Electronic health records	≥ 18	11,416	46	37	100	1.13 (1.04–1.22)
Guaraldi et al., 2018 [50]	Europe	Italy	2015–2016	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 65	1183	71.6	17.2	100	0.95 (0.87–1.04)
Hasse et al., 2015 [51]	Europe	Switzerland	2009–2011	SBP ≥ 160 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 40	7799	Living with HIV 50^a HIV-negative 57^a	39.2	Not specified	0.96 (0.92–1.01)
Hendriks et al. 2012 [52]	Africa	Kenya, Namibia, Tanzania and Nigeria	2009–2011	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 15	1848	41.0	56.6	Not specified	1.06 (0.65–1.71)
Hopkins et al., 2019 [53]	Africa	South Africa	2018	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 18	136	Not specified	51.1	Not specified	0.67 (0.37–1.20)
Jerico et al., 2005 [54]	Europe	Spain	2003	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 20	1512	42.3	29.6	88	0.97 (0.75–1.26)
Kavishe et al., 2015 [55]	Africa	Tanzania and Uganda	2012–2013	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	1928	Not specified	56	Not specified	2.00 (1.51–2.66)
Kelly et al., 2008 [56]	Africa	Zambia	2003	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 18	312	34.2	67	0	0.40 (0.22–0.72)
Kingery et al., 2016 [57]	Africa	Tanzania	2012–2013	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 18	454	40.5	65.6	49.8	1.04 (0.67–1.61)
Klein et al., 2015 [58]	North America	USA	1996–2011	Electronic health records	≥ 18	282,368	50	9	90	0.89 (0.85–0.93)
Kunisaki et al., 2015 [59]	North America	USA	2002–2010	Electronic health records	≥ 18	7324	49.9	4.9	72.7	0.55 (0.52–0.59)
Kwarisiima et al., 2016 [60]	Africa	Uganda	Not specified	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	59,631	34^a	59	Not specified	0.79 (0.71–0.86)
Maciel et al., 2018 [61]	South America	Brazil	2016	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 50	416	57^a	44.2	98.1	0.89 (0.77–1.02)
Malaza et al., 2012 [24]	Africa	South Africa	2010	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 15	10,429	Not specified	Not specified	Not specified	0.70 (0.64–0.76)
Masyuko et al., 2020 [62]	Africa	Kenya	2017–2018	SBP ≥ 130 mmHg or DBP ≥ 85 mmHg	≥ 30	598	Living with HIV 45^a HIV-negative 40^a	50	100	0.64 (0.49–0.84)
Mayer et al., 2018 [4]	North America	USA	2006–2016	Electronic health records	≥ 18	239,849	41	63.6	Not specified	1.22 (1.19–1.24)
Minami et al., 2019 [63]	Asia	Japan	Not specified	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or antihypertensives or electronic health records	≥ 18	472	Living with HIV 39^a HIV-negative 39.5^a	4.4	100	0.86 (0.57–1.29)
Mondy et al., 2007 [64]	North America	USA	2001–2005	SBP ≥ 130 mmHg or DBP ≥ 85 mmHg or use of antihypertensives	Adults^c	942	43.4	34.5	69	0.85 (0.71–1.02)
Monteiro et al., 2012 [65]	South America	Brazil	2009	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	343	42	46.9	89%	0.63 (0.42–0.94)
Mosha et al., 2017 [6]	Africa	Tanzania	2012–2013	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 15	9678	29^a	64.9	Not specified	0.64 (0.47–0.88)
Nakanga et al., 2019 [66]	Africa	Malawi	2013–2016	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 15	3306	Not specified	Not specified	Not specified	0.76 (0.58–0.98)
Nakibuuka et al., 2015 [67]	Africa	Uganda	2012–2013	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	4967	34.7	69.4	Not specified	0.60 (0.48–0.75)
Odden et al., 2007 [68]	North America	USA	Not specified	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	33–45	809	39.7	36.1	Not specified	1.43 (1.04–1.95)
Okello et al., 2017 [7]	Africa	Uganda	2015	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 40	1115	Living with HIV 45^a HIV-negative 46^a	56.6	Not specified	0.75 (0.61–0.92)
Pacheco et al., 2016 [69]	South America	Brazil	2011–2012	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	Adults^c	623	Living with HIV 43.6^a HIV-negative 44.5^a	45.9	89	0.75 (0.57–0.98)
Rucker et al., 2018 [70]	Africa	Malawi	2015–2016	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 30	735	Living with HIV 47^a HIV-negative 52^a	73.7	100	0.76 (0.58–0.98)
Russell et al., 2020 [71]	North America	Canada	2013–2017	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 15	289	44.1	100	92	1.57 (0.83–2.97)
Ryscavage et al., 2019 [72]	North America	USA	2012–2014	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	18–29	324	24^a	58	82.4	2.00 (1.00–4.00)
Sanders et al., 2017 [73]	North America	USA	2000–2016	Electronic health records	≥ 18	15,173	48.2	17.3	Not specified	1.77 (1.67–1.87)
Sarfo et al., 2019 [74]	Africa	Ghana	Not specified	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 30	701	44.6	81.2	55.4	0.65 (0.50–0.84)
Saves et al., 2003 [75]	Europe	France	1995–1999	SBP ≥ 160 mmHg or DBP ≥ 95 mmHg	35–44	1312	Not specified	43	100	0.51 (0.29–0.90)
Savinelli et al., 2020 [76]	Europe	UK	2013–2016	Electronic health records	≥ 50	1361	53.4	19.2	100	1.01 (0.79–1.29)
Scholten et al., 2011 [77]	Africa	Uganda	2009–2010	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 50	511	65.8	61.2	50.8	0.47 (0.34–0.65)
Schutte et al., 2012 [78]	Africa	South Africa	2005–2010	Use of antihypertensives	≥ 30	332	46	65.3	Not specified	0.49 (0.22–1.06)
Touloumi et al., 2020 [79]	Europe	Greece	1996–2014	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 18	10,659	41.6^a	13.1	86.1	1.33 (1.15–1.53)
Triant et al., 2007 [80]	North America	USA	1996–2004	Electronic health records	18–84	1,048,440	Living with HIV 38^a HIV-negative 39^a	59	41	1.34 (1.26–1.42)
van Heerden et al., 2017 [81]	Africa	South Africa	2015	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 18	570	Not specified	69	Not specified	0.64 (0.49–0.85)
van Zoest et al., 2016 [5]	Europe	Netherlands	2010–2012	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg or use of antihypertensives	≥ 45	1044	Living with HIV 52.2^a HIV-negative 52.9^a	12.9	94.7	1.33 (1.15–1.53)
Watson et al., 2017 [82]	North America	USA	Not specified	SBP ≥ 140 mmHg or DBP ≥ 90 mmHg	≥ 60	90	Living with HIV 63^a HIV-negative 65^a	8.9	97	1.29 (0.84–1.97)
Yang et al., 2019 [83]	North America	USA	2007–2016	Electronic health records	≥ 50	9,141,867	64.1	Not specified	Not specified	1.28 (0.94–1.74)
Yu et al., 2019 [84]	North America	USA	2013–2016	SBP ≥ 130 mmHg or DBP ≥ 85 mmHg	35–65	201	50.8	22.9	95.4	1.28 (0.94–1.74)

SBP systolic blood pressure, DBP diastolic blood pressure
^aMedian ages are reported where mean values were not available
^bA risk ratio greater than one indicates that the prevalence is higher in PLHIV, and a risk ratio less than one indicates that the prevalence is lower in PLHIV
^cStudies in Europe, North and South America which reported that they had included only adults were assumed to have only included participants over the age of 14

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