Hypertension Among Adults With HIV Initiating Antiretroviral Therapy in Freetown, Sierra Leone: A Cross-sectional Study

Abstract

ABSTRACTBackgroundHypertension is a major contributor to cardiovascular morbidity and mortality in people with HIV (PWH). However, screening and identification among PWH initiating antiretroviral therapy (ART) in sub-Saharan Africa is understudied.We aimed to assess the prevalence of hypertension and its associated factors among newly diagnosed PWH in Freetown, Sierra Leone.MethodsWe used a cross-sectional study design to assess the baseline characteristics of newly diagnosed ART-naïve PWH at Connaught Hospital in Freetown from March 2021 to March 2022. We categorized patients as having normal blood pressure (<120/80mmHg), pre-hypertension (systolic 120-139 mmHg or diastolic 80-89 mmHg), and hypertension (systolic ≥140 mmHg or diastolic ≥90 mmHg). We used logistic regression models to identify factors independently associated with hypertension.Results918 PWH were studied (55.0% female, median age 33 years). The prevalence of hypertension was 20.0% and 29.5% were pre-hypertensive. In univariate analysis, hypertension prevalence increased with age, body mass index (BMI), smoking, alcohol consumption, and being Christian (all p < 0.05). In multivariate logistic regression analysis, ages 40-49 years (aOR 2.15, 95% CI 1.30-3.57), 50-59 years (aOR 2.30, 95% CI 1.26-4.18), ≥ 60 years (aOR 3.08, 95% CI 1.28-7.41), BMI ≥ 30 kg/m2(aOR 2.34, 95% CI 1.11-4.93), identifying as a Christian (aOR 1.45, 95% CI 1.01-2.11), and smoking (aOR 1.67, 95% CI 1.04-2.69) were significantly associated with hypertension.ConclusionsWe observed a significant burden of hypertension among ART-naïve PWH in Sierra Leone, emphasizing the importance of early identification and management to help reduce cardiovascular morbidity and mortality.