Lipodystrophy and Hypertention
Sep 30, 2002
Keith, why do you write about hypertention not being related to HAART when articles like this are published?
Hypertension Is Common Among HIV-Infected Patients with Lipodystrophy
WESTPORT, CT (Reuters Health) - High blood pressure is a common finding among HIV-infected patients with lipodystrophy, according to the results of a recent report.
Many features of syndrome X--abdominal obesity, insulin resistance, and lipid abnormalities--are also found with HIV-associated lipodystrophy. However, it has been unclear whether hypertension, a key finding with syndrome X, was also common with HIV-associated lipodystrophy.
Dr. Fred R. Sattler from the University of Southern California at Los Angeles and colleagues measured and compared the blood pressures of 42 HIV-infected patients with lipodystrophy, 42 infected control patients without lipodystrophy, and 13 HIV-negative control subjects.
Thirty-one patients in the lipodystrophy group had elevated blood pressures on three or more readings compared with only 20 patients in the HIV-positive control group, the authors note in the October 19th issue of AIDS. In addition, systolic and diastolic blood pressures were higher in the lipodystrophy group than in the HIV-positive control group.
While a family history of hypertension was more common among lipodystrophy patients than others, it only accounted for 13 of the elevated blood pressures seen in this group, the authors note. Systolic blood pressure was directly related to waist-to-hip ratios in the lipodystrophy group but not in the HIV-positive control group. In HIV-positive patients, systolic blood pressure tended to increase as fasting triglyceride levels increased.
Hypertension occurs in a significant number of patients with HIV-associated lipodystrophy, the investigators note. As with syndrome X, certain features of HIV-associated lipodystrophy are tied to accelerated atherosclerosis. "The occurrence of hypertension per se also portends an increased risk for myocardial infarction, stroke, renal failure, and peripheral arterial disease," the authors add.
HIV-infected patients with lipodystrophy and hypertension are at high risk for serious morbidity and premature mortality. Lipodystrophy-associated "risk factors should be identified early and managed by appropriate interventions, particularly in patients who have responded well to their antiretroviral therapy," Dr. Sattler's team concludes.
AIDS 2001; 15:2001-2010.
Response from Dr. Henry
The link between lipodystrophy and hypertension is far from established despite some intriguing pilot studies such at the article by Fred Sattler that you quoted. Larger trials have failed to link HIV treatment with hypertension (indinavir most often suggested as a cause for hypertension). Hypertension is common in the general population particularly in some groups with higher HIV infection rates (such as African Americans). Blood pressure is checked routinely in HIV clinics and clinical trials and a link between either certain types of treatment and/or lipodystrophy has not been firmly established. To further complicate matters, aging and increasing obesity rates also increase the changes for hypertension which can be superimposed upon the HIV situation for individual patients. KH
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