ORIGINAL RESEARCH Effects of HIV status and antiretroviral therapy on blood pressure SL Wilson, 1 G Scullard, 2 SJ Fidler, 3 JN Weber 3 and NR Poulter 1 1 International Centre for Circulatory Health, Imperial College London, London, UK, 2 Department of GU Medicine and Communicable Diseases, St Mary’s NHS Trust, London, UK and 3 Department of GUM and HIV, Division of Medicine, Imperial College London, London, UK Objective High blood pressure is a major risk factor for cardiovascular disease and concerns have been raised over its possible association with antiretroviral drugs. The objective of this study was to explore the associations among blood pressure, HIV status and two predefined highly active antiretroviral therapy (HAART) regimens: treatment with and without nonnucleoside reverse transcriptase inhibitors (NNRTIs) (NNRTI- and non-NNRTI-based HAART). Method A cross-sectional survey was conducted among 612 adults attending the Sexual Health Outpatient Department at St Mary’s NHS Hospital Trust, London. Results HIV-infected patients treated with NNRTIs had a blood pressure that was 4.6/4.2 mmHg higher than those who were HIV positive but treatment naı ¨ve. The diastolic difference remained statistically significant after adjusting for potential confounders of this association (2.4 mmHg; P 5 0.03). There was no difference in blood pressure between those treated with non-NNRTI-based regimens and those who were HIV positive but treatment naı ¨ve. Conclusion NNRTIs may be associated with an increase in blood pressure. Pending further more robust evidence from randomized clinical trials it would be prudent for clinicians to monitor blood pressure in all HIV-infected patients, particularly after initiating treatment with NNRTIs, and to commence antihypertensive therapy whenever appropriate. Keywords: antiretroviral therapy, blood pressure, epidemiology, HAART, HIV Accepted 22 January 2009 Introduction Deaths from AIDS have declined dramatically since the introduction of highly active antiretroviral therapy (HAART) in patients infected with HIV [1]. However, the incidence of myocardial infarction has increased fourfold and cardiovascular disease is now one of the major causes of death in HIV-infected patients in Western industrialized countries [2,3]. Anecdotal reports from the Peart-Rose (hypertension) Clinic at St Mary’s NHS Hospital Trust, Paddington, London, raised awareness of an increasing number of young HIV-positive adults being referred with hypertension, a major risk factor for cardiovascular disease. This raised the possibility that HIV and/or its treatment may be associated with raised blood pressure. However, the published evidence concerning these associa- tions is both limited and conflicting [4–15]. While the current studies do provide useful insights into a potentially emerging problem, methodological problems, including the choice of control group [4–10], inadequate blood pressure measurement [11–15] and crude categorical outcome measures [4,5,7,14,15], may have generated bias and confounded results. Another potential problem is the consideration of HAART as a single entity, despite it being an umbrella term for different combinations of antiretro- viral drugs [4,5,11,13–15]. Standard HAART consists of a backbone of two nucleoside reverse transcriptase inhibitors Correspondence: Dr Sarah Wilson, International Centre for Circulatory Health, Imperial College London, London W2 1PG, UK. Tel: 1 44 7979 612593; fax: 1 44 207 594 1145; e-mail: sarahpartridge.home@gmail.com DOI:10.1111/j.1468-1293.2009.00699.x HIV Medicine (2009), 10, 388–394 r 2009 British HIV Association 388