24-h-Blutdruckmessung bei HIV⁺-Patienten in Malawi: Ergebnisse einer Pilotstudie

ZUSAMMENFASSUNG

Kardiovaskuläre Erkrankungen wie die arterielle Hypertonie gewinnen in Subsahara-Afrika neben infektiösen Erkrankungen zunehmend an Bedeutung. Die ambulante 24-h-Blutdruck-Langzeitmessung (24-h-ABDM) ist das Verfahren der Wahl zur Diagnosesicherung einer Hypertonie. Als Teil der LighTen Cohort Study hat diese Untersuchung das Ziel, die Machbarkeit einer 24-h-ABDM und ihre Bedeutung für Diagnose und Management des Hochdrucks bei HIV⁺-Patienten unter antiretroviraler Therapie zu bestimmen. Analysiert wurden die Praxis-Blutdruckwerte und 24-h-ABDM-Daten 34 erwachsener HIV⁺-Patienten sowie die Daten von 20 HIV^--Kontrollpersonen. Bei einem Viertel der antihypertensiv behandelten Patienten und Kontrollen war der Blutdruck kontrolliert. Die 24-h-ABDM-Untersuchung erwies sich unter den Bedingungen eines Entwicklungslandes als machbar und identifizierte Patienten mit prognostisch ungünstigem nächtlichem Blutdruckverhalten sowie Patienten mit Weißkittelhypertonie und wahrscheinlich guter Prognose.

ABSTRACT

Cardiovascular diseases such as arterial hypertension contribute substantially to morbidity and mortality in sub-Saharan Africa. 24-hour ambulatory blood pressure monitoring (24-h-ABPM) is the most accurate method for confirming a diagnosis of hypertension. As part of the ongoing prospective LighTen Cohort Study we sought to determine the feasibility of 24-h-ABPM in HIV⁺-patients on antiretroviral therapy and its role in diagnosing and managing hypertension. Office blood pressure values and 24-h-ABPM data of 34 adult HIV⁺-patients and 20 HIV^--controls were analyzed. Despite taking antihypertensive medication, blood pressure was controlled in only one fourth of patients and controls. 24-h-ABPM turned out to be feasible in resource-limited settings like Malawi. It allowed the identification of patients with unfavourable cardiovascular prognosis due to disturbed nocturnal blood pressure dipping as well as patients with white-coat hypertension and probably low cardiovascular risk.

Key words

24-h-ABPM - arterial hypertension - sub-Saharan Africa - HIV - non-dipping - white-coat hypertension

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