Target organ damage in people with chronic heart failure infected with human immunodeficiency virus depending on blood pressure control

Abstract

Objective. To study target organ damage in patients with chronic heart failure (CHF) infected with the human immunodeficiency virus (HIV), depending on the control of blood pressure (BP) in a single-stage clinical study. Design and methods. We examined 240 patients with HIV infection in a multidisciplinary hospital. The diagnosis of CHF was confirmed by the plasma level of the N-terminal fragment of the brain natriuretic peptide (NT-proBNP), echocardiographic criteria, and clinical signs. Subsequently, patients with CHF and elevated BP ≥ 140/90 mm Hg (40 people) and with BP from 91/61 to 139/89 mm Hg (76 people) were selected. In all patients we assessed serum levels of tissue inhibitor of metalloproteinases-1 (TIMP-1) and cystatin C to assess renal filtration function. We also performed non-invasive arteriography with the determination of daytime BP for 3 hours using TensioMed ArterioGraph 24 (Great Britain). The data were processed using the Statistica 13.0 program. Results. In patients with CHF and HIV infection BP ≥ 140/90 mm Hg was associated with subclinical arterial disease, manifested by an increase in augmentation indices and pulse wave velocity, as well as an increase in serum level of TIMP-1. It was also accompanied by a decrease in the renal filtration function, which was confirmed by a higher serum level of cystatin C and a lower glomerular filtration rate calculated on the basis of cystatin C using the CKD-EPIcys. Myocardial remodeling in patients with CHF, HIV and elevated BP ≥ 140/90 mm Hg is presented by a more frequent left ventricular diastolic dysfunction, left ventricular hypertrophy (LVH), and left atrial dilatation. In patients with CHF and HIV infection, BP ≥ 140/90 mm Hg is associated with a higher incidence of heart failure, thrombocytopenia and a history of serum iron deficiency, as well as the intake of protease inhibitors and nucleoside reverse transcriptase inhibitors. Conclusions. In patients with HIV infection and CHF, an increase in BP ≥ 140/90 mm Hg is associated with the subclinical damage of arterial wall, kidneys and myocardium (mainly diastolic dysfunction, LVH and left atrial dilatation). The use of protease inhibitors and nucleoside reverse transcriptase inhibitors is more common in individuals with elevated BP ≥ 140/90 mm Hg.