Evaluation of New Hypertension Guidelines on the Prevalence and Control of Hypertension in a Clinical HIV Cohort: A Community-Based Study.

INTRODUCTION The prevalence and control of HTN among people with HIV (PWH) have not been widely studied since the release of newer 2017 ACC/AHA guidelines ("new guidelines"). Hence, we evaluated the prevalence and control of HTN using both 2003 JNC 7 ("old guidelines") and new guidelines. METHODS We identified 3206 PWH with HTN from the DC Cohort study in Washington, D.C, between 01/2018 and 06/2019. We defined HTN using International Classification of Diseases (ICD) -9/-10 diagnosis codes for HTN or ≥2 BP measurements obtained at least one month apart (>139/89 mm Hg per old or >129/79 mm Hg per new guidelines). We defined HTN control based on recent BP (≤129/≤79 mm Hg per new guidelines). We identified socio-demographics, cardiovascular risk factors and co-morbidities associated with HTN control using multivariable logistic regression (adjusted Odds Ratio; 95% CI). RESULTS The prevalence of HTN was 50.9 % per old versus 62.2% per new guidelines. Of the 3,206 PWH with HTN 887 (27.7%) had a recent BP ≤129/≤79 mm Hg, 1,196 (37.3%) had a BP 130-139/80-89 mm Hg and 1,123 (35.0%) had a BP ≥140/≥90mm Hg. After adjusting for socio-demographics, cardiovascular risk factors and co-morbidities, factors associated with HTN control included age 60-69 (vs. <40) years (aOR 1.42; 95 % CI 1.03-1.98), Hispanic (vs. non-Hispanic Black) race/ethnicity (aOR 1.49; 95 % CI 1.04-2.15), receipt of HIV care at a hospital-based (vs. community-based) clinic (aOR 1.21; 95 % CI 1.00-1.47), being unemployed (aOR 1.42; 95% CI 1.11-1.83), and diabetes (aOR 1.35; 95% CI 1.13-1.63). CONCLUSION In a large urban cohort of PWH, nearly two-thirds had HTN and less than one-third of those met new guideline criteria. Our data suggests that more aggressive HTN control is warranted among PWH, with additional attention to younger patients and non-Hispanic Black patients.