Clinical and Echocardiographic Characteristics Associated with Hypertension in a Cohort of People Living with and without HIV

Résumé

Background: Hypertension is a major cardiovascular risk factor in sub-Saharan Africa, particularly among people living with HIV (PLWH). The contributions of cardiac structural remodeling, metabolic factors, and the renin-angiotensin-aldosterone system (RAAS) to hypertension in this population remain incompletely understood. This study aimed to provide a detailed characterization of the clinical and echocardiographic determinants of hypertension in a cohort predominantly composed of people living with HIV. Methods: In this cross-sectional study, 366 adults (70.2% female, 73.5% PLWH) attending a tertiary hospital in Zambia were enrolled. Hypertension was defined as systolic/diastolic blood pressure ≥140/90 mmHg or current antihypertensive use. We collected sociodemographic, clinical, biochemical (lipid profile, RAAS markers, inflammatory cytokines), and echocardiographic data. Multivariable logistic regression models were used to identify independent predictors of hypertension, with statistical significance at p<0.05. Results: Hypertension prevalence was 24.3% (n=89). Hypertensive participants were older (median age 59 vs. 45 years, p<0.0001) and had higher BMI, cholesterol, triglycerides, and left ventricular mass index (all p<0.01). In adjusted Model 1 (controlling for age, BMI, waist circumference, HIV), left ventricular septal diameter (IVSD: AOR=25.2, 95% CI: 5.7-110.2), posterior wall diameter (LVPWD: AOR=22.9, 95% CI: 4.3-121.9) and age (AOR=1.08 per year, 95% CI: 1.05-1.11) were associated with hypertension. In Model 2, adjusting for RAAS components, cardiac structural parameters and age remained significant, while RAAS biomarkers showed no independent association. Conclusion: In this HIV-prevalent cohort, hypertension was independently associated with left ventricular structural remodeling and advancing age, but not with circulating RAAS components or HIV status. These findings underscore the importance of echocardiographic assessment in hypertension evaluation and suggest that non-RAAS pathways may contribute to hypertensive cardiac remodeling in this setting.

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