Hypertension is a major risk factor for cardiovascular disease (CVD). The diagnosis and management of hypertension is now an important part of care for these patients living with HIV. The prevalence of hypertension is high and depending on the population studied felt to be higher than in the general population.
Guidelines for the general population have evolved along with thresholds for classification and treatment. The 2017 ACC/AHA Guideline (Brook, Rajagopalan. J Am Soc Hypertens, 2018) has been debated, in particular about the impact of lower thresholds (Muntner, et al. J Am Coll Cardiol 71(2):109–18, 2018; Ioannidis. JAMA 319(2):115–6, 2018). However initiation of lifestyle modification is emphasized for blood pressure 120–129/< 80 mm Hg and lower-risk patients with stage 1 hypertension, 130–139/80–89 mm Hg (Brook, Rajagopalan. J Am Soc Hypertens, 2018).
There are no dedicated and comprehensive guidelines for managing hypertension in people living with HIV. The 2013 Primary Care Guidelines for the Management of Persons Infected with HIV recommend checking blood pressure annually in all HIV-infected patients (Aberg, et al. Clin infect Dis 58(1):e1–34, 2014).
The foundation of treating high blood pressure rests on lifestyle modification including diet, weight control, and physical activity with pharmacologic therapy for those whose blood pressure has not been or cannot be controlled with lifestyle changes.
Pharmacologic therapy consists of several different classes of medication including those that are considered “first line” as well as medications that lower blood pressure and treat a comorbidity.
KeywordsHypertension Lifestyle modification Dietary modification Pharmacologic therapy
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