Gender differences in the association of hazardous alcohol use with hypertension in an urban cohort of people living with HIV in South Florida.
TL;DR: Excessive hypertension burden in this population and its association with HAU and sub-optimal care indicate the need for preventive and educational intervention in PLWH.
Abstract: Objective
Industrialized countries are currently experiencing an epidemic of high blood pressure (HBP) extending to people living with HIV (PLWH). Given the prevalence of hazardous alcohol use (HAU), this study examines the relationship between alcohol consumption and hypertension in PLWH. Including a gender analysis is critical, given the high rates of HAU and HIV among females.
Method
We followed PLWH including both HAU and non-HAU (200 each). Participants were assessed twice for body weight, blood pressure, alcohol consumption, and other BP-associated lifestyle factors. High blood pressure (defined as systolic/diastolic blood pressure above 140/90 mmHg and/or treatment of HBP) was the primary outcome.
Results
Overall prevalence of hypertension was 38% and higher among HAU compared to non-HAU (42% vs. 34%, p = 0.02). Less than half with HBP (42%) were receiving treatment for hypertension. Overall, males had a 50% higher risk of HBP than women (odds ratio: 1.5, 95% CI: 1–2.6, p = 0.05). However among HAU, females were twice as likely to suffer HBP as their male counterparts (95% CI: 1–3.9, p = 0.02). Those HAU who preferred liquor, versus wine, had higher adjusted mean BP (132.6±18 vs. 122.3±14 mm Hg, p = 0.05). Additional analyses indicated that consumption of >1 standard drink of liquor or beer/day was associated with HBP. Risk of hypertension was noted in those with daily consumption of >3 glasses of wine. For those reporting <1 drink per day, the odds ratio of having HBP was 0.97 (CI: 0.6–0.99, p = 0.05). Factors associated with hypertension in the multivariate model included increased age, gender, BMI, HAU particularly of liquor, and smoking.
Conclusions
Excessive hypertension burden in this population and its association with HAU and sub-optimal care indicate the need for preventive and educational intervention in PLWH. Analyses highlight the necessity of gender and type-of-beverage specific approaches.
Citations
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TL;DR: The burden of hypertension among people living with HIV is high and its pathophysiology most likely multifactorial, and efforts should be made to improve hypertension management as per existing clinical guidelines in order to safeguard cardiovascular health and quality of life in PLHIV.
Abstract: Purpose of reviewThis review describes what is known concerning the burden of hypertension among people living with HIV (PLHIV), and also addresses relevant topics with respect to its risk factors and clinical management.Recent findingsHypertension is highly prevalent in HIV-positive populations, an
41 citations
Cites result from "Gender differences in the associati..."
...Though many studies – mostly cross-sectional in design – did not confirm the association between cART use and hypertension to be significant [7,9, 11,14,15,25,28,59,80,81,88,114], a recent metaanalysis described that hypertension was more prevalent among antiretroviral therapy-exposed PLHIV compared with antiretroviral therapy-naı̈ve PLHIV [115]....
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Journal Article•
TL;DR: The clinical management of hypertension in HIV-positive patients is similar to those with hypertension in the general population; however, additional considerations should be given to potential drug interactions between antihypertensive agents and antiretroviral drugs to inform the clinician's selection of these therapies.
Abstract: Hypertension among HIV-positive populations has emerged as a new threat to the health and well being of people living with HIV, particularly among those receiving antiretroviral therapy. We reviewed the global evidence on the burden of disease (including prevalence and incidence), determinants of hypertension among HIV-positive populations, and the pharmacological management of hypertension in HIV-positive patients. We systematically searched PubMed-MEDLINE and EMBASE from January 2000 through February 2015 for relevant studies and traced their citations through the ISI Web of Science. We also searched the websites of the World Health Organisation, the International Society of Hypertension, and the International AIDS Society and constructed a narrative data synthesis. Hypertension is common in HIV-positive populations, with prevalence estimates ranging from 4.7 to 54.4% in high-income countries, and from 8.7 to 45.9% in low- and middle-income countries. The role of HIV-specific factors including disease severity, duration of disease, and treatments on the presence of hypertension in HIV-positive patients is reported, but patterns remain unclear. The clinical management of hypertension in HIV-positive patients is similar to those with hypertension in the general population; however, additional considerations should be given to potential drug interactions between antihypertensive agents and antiretroviral drugs to inform the clinician's selection of these therapies. Hypertension is common in HIV-positive populations and remains an important comorbidity affecting mortality outcomes. Further research examining the development of hypertension and its associated care in HIV-positive patients is required to optimize management of the dual conditions.
35 citations
TL;DR: Overall data depict that moderate alcohol intake is also hepatotoxic and decreases intestinal absorption, however, TCE treatment effectively increased the intestinal absorption and retaining power of liver that regulated alcohol-induced multivitamin deficiency.
Abstract: Aims Heavy alcohol intake depletes the plasma vitamins due to hepatotoxicity and decreased intestinal absorption. However, moderate alcohol intake is often thought to be healthy. Therefore, effects of chronic moderate alcohol intake on liver and intestine were studied using urinary vitamin levels. Furthermore, effects of Tinospora cordifolia water extract (TCE) (hepatoprotective) on vitamin excretion and intestinal absorption were also studied.
Methods In the study, asymptomatic moderate alcoholics ( n = 12) without chronic liver disease and healthy volunteers ( n = 14) of mean age 39 ± 2.2 (mean ± SD) were selected and divided into three groups. TCE treatment was performed for 14 days. The blood and urine samples were collected on Day 0 and 14 after treatment with TCE and analyzed.
Results In alcoholics samples, a significant increase in the levels of gamma-glutamyl transferase, aspartate transaminase, alanine transaminase, Triglyceride, Cholesterol, HDL and LDL ( P < 0.05) was observed but their level get downregulated after TCE intervention. Multivariate analysis of metabolites without missing values showed an increased excretion of 7-dehydrocholesterol, orotic acid, pyridoxine, lipoamide and niacin and TCE intervention depleted their levels ( P < 0.05). In contrast, excretion of biotin, xanthine, vitamin D2 and 2- O - p -coumaroyltartronic acid (CA, an internal marker of intestinal absorption) were observed to be decreased in alcoholic samples; however, TCE intervention restored the CA and biotin levels. Vitamin metabolism biomarkers, i.e. homocysteine and xanthurenic acid, were also normalized after TCE intervention.
Conclusion Overall data depict that moderate alcohol intake is also hepatotoxic and decreases intestinal absorption. However, TCE treatment effectively increased the intestinal absorption and retaining power of liver that regulated alcohol-induced multivitamin deficiency.
33 citations
TL;DR: There is no conclusive evidence for spirits being associated with more harm, but some evidence supports for certain outcomes such as injuries and poisonings a potential excess risk for spirits consumption due to rapid ethanol intake and intoxication.
27 citations
TL;DR: Investigating the relationship between HIV viral load and hypertension using viremia copy-years (VCY), a cumulative measure of HIV plasma viral burden, supports the significance of continuous viral suppression in hypertension prevention among PLWH.
Abstract: Background Evidence regarding the association between HIV viral load (VL) and hypertension is inconsistent. In this study, we investigated the relationship using viremia copy-years (VCY), a cumulative measure of HIV plasma viral burden. Methods Data were analyzed for 686 PLWH in the Florida Cohort Study, who had at least five years of VL data before the baseline. VL data were extracted from Enhanced HIV/AIDS Reporting System (eHARS) and used to define peak VL (pVL), recent VL (rVL), and undetectable VL (uVL: rVL 5.7) for analysis. Hypertension was determined based on hypertension diagnosis from medical records. Multivariable logistic regression was used for association analysis. Results Of the total sample, 277 (40.4%) participants were hypertensive. Compared to the participants with lowest VCY (≤2.7 log10 copy × years/mL), the odds ratios (OR) and 95% confidence interval [95% CI] for hypertension of the remaining four groups, in order, were 1.91 [1.11, 3.29], 1.91 [1.03, 3.53], 2.27 [1.29, 3.99], and 1.25 [0.65, 2.42], respectively, controlling for confounders. The association was independent of pVL, rVL, and uVL, each of which was not significantly associated with hypertension. Conclusion Persistent HIV infection is a risk factor for hypertension among PLWH. Information provided by VCY is more effective than single time-point VL measures in investigating HIV infection- hypertension relationship. The findings of this study support the significance of continuous viral suppression in hypertension prevention among PLWH.
7 citations
References
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TL;DR: The relationship between blood pressure and alcohol intake was examined in 2434 male and 1608 female London civil servants and it was found that in those with hypertension, alcohol may have been the cause in between 4 and 9%.
Abstract: The relationship between blood pressure and alcohol intake was examined in 2434 male and 1608 female London civil servants. These subjects had been selected from 24,000 office workers on the basis of responses to a health questionnaire. The men had an average blood pressure of 134/80 mmHg and consumed a mean of 62 g alcohol/week as beer, 28 g/week as wine or fortified wine and 18 g/week as spirits (a total of 11.8 drinks/week). The women had an average blood pressure of 133/79 mmHg and consumed 7 g alcohol/week as beer, 25 g/week as wine and 11 g/week as spirits (a total of 4.4 drinks/week). Twenty-five per cent of men and 24% of women had a casual diastolic pressure equal to or greater than 90 mmHg and were considered to have diastolic hypertension on the one occasion. There was no increase in either systolic or diastolic pressure in men until total alcohol intake exceeded 50 drinks/week. However, 1% of all men had hypertension associated with drinking alcohol and in those with hypertension, alcohol may have been the cause in between 4 and 9%. Defining 'hypertension' as a diastolic blood pressure of 90 mmHg or above on one occasion, 12-14% of people drinking more than 50 drinks of alcohol per week had hypertension associated with this intake of alcohol, and similarly, of those with both 'hypertension' and this level of intake, 36% could attribute their high blood pressure to their alcohol consumption.(ABSTRACT TRUNCATED AT 250 WORDS)
45 citations
TL;DR: Results from the and other laboratories support the unifying hypothesis that the improvements in risk factors after red wine consumption are mediated by endothelial nitric oxide synthase (eNOS), which would be ethanol and mainly polyphenols.
Abstract: The positive health effects derived from moderate wine consumption are pleiotropic. They appear as improvements in cardiovascular risk factors such as plasma lipids, haemostatic mechanisms, endothelial function and antioxidant defences. The active principles would be ethanol and mainly polyphenols. Results from our and other laboratories support the unifying hypothesis that the improvements in risk factors after red wine consumption are mediated by endothelial nitric oxide synthase (eNOS). Many genes are involved, but the participation of eNOS would be a constant feature. The metabolic syndrome is a cluster of metabolic risk factors associated with high risk of cardiovascular disease (CVD). The National Cholesterol Education Programmmes Adult Treatment Panel III (NCEPATP III) clinical definition of the metabolic syndrome requires the presence of at least three risk factors, from among abdominal obesity, high plasma triacylglycerols, low plasma HDL, high blood pressure and high fasting plasma glucose. The molecular mechanisms responsible for the metabolic syndrome are not known. Since metabolic syndrome apparently affects 10-30% of the population in the world, research on its pathogenesis and control is needed. The recent finding that eNOS knockout mice present a cluster of cardiovascular risk factors comparable to those of the metabolic syndrome suggests that defects in eNOS function may cause human metabolic syndrome. These mice are hypertensive, insulin resistant and dyslipidemic. Further support for a pathogenic role of eNOS comes from the finding in humans that eNOS polymorphisms associate with insulin resistance and diabetes, with hypertension, with inflammatory and oxidative stress markers and with albuminuria. So, the data sustain the hypothesis that eNOS enhancement should reduce metabolic syndrome incidence and its consequences. Therefore red wine, since it enhances eNOS function, should be considered as a potential tool for the control of metabolic syndrome. This hypothesis is supported by epidemiological observations and needs experimental validation in human intervention studies.
45 citations
"Gender differences in the associati..." refers background in this paper
...Leighton and colleagues[27] attributed the vascular differences among liquor, beer, and wine to flavonoids and polyphenols, which enhance endothelial nitric oxide synthase expression and subsequent nitric oxide release from endothelial cells [27–28]....
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TL;DR: Data from a community-based random sample of black adults living in eastern North Carolina are consistent with a graded association between alcohol and blood pressure in black adults and suggest the importance of social factors underlying this association.
Abstract: While there is a clear consensus in the epidemiologic literature on the direct association between alcohol consumption and blood pressure, the shape of this relation and its strength in blacks are uncertain. Therefore, the association between alcohol and blood pressure was examined in a community-based random sample of 1,784 black adults aged 25 to 50 years living in eastern North Carolina. These individuals were interviewed in 1988 for a study of psychosocial and dietary risk factors for elevated blood pressure. Alcohol consumption was estimated from responses to a food frequency questionnaire and was divided into four categories, which ranged from abstention (52% of the sample) to greater than or equal to seven drinks/week (12%). After adjustment for age and body mass, the systolic blood pressure of adults reporting greater than or equal to seven drinks/week exceeded that of nondrinkers by 6.8 mmHg for men and women (p less than 0.001). There was no evidence of a threshold effect, and similar patterns were observed for diastolic blood pressure. Being in the highest category of alcohol consumption was related to low socioeconomic status, lower social integration, and higher levels of socioeconomic stressors. These data are consistent with a graded association between alcohol and blood pressure in black adults and suggest the importance of social factors underlying this association.
33 citations
TL;DR: This research presents a novel and scalable approach called “informed decision-making” that aims to provide real-time information about the physical and mental health of veterans aged 65 and over.
Abstract: aDivision of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA bHarvard Medical School, Boston, MA, USA cMassachusetts Veterans Epidemiology and Research Information Center (MAVERIC) and Geriatric Research, Education, and Clinical Center (GRECC), Boston Veterans Affairs Healthcare System, Boston, MA, USA dDivision of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA EDiToRiAl
29 citations
TL;DR: The evidence of cardiovascular risk associated with HIV infection and antiretroviral therapy is explored and discussed in this article.
Abstract: The life expectancy of people living with HIV infection has improved dramatically since the use of highly active antiretroviral therapy (HAART). Now that patients with HIV infection are living longer, the focus of its treatment should shift to long-term management spanning decades. Diseases of ageing, including cardiovascular disease (CVD), have now become more important. The evidence of cardiovascular risk associated with HIV infection and antiretroviral therapy is explored and discussed in this article.
20 citations