Ambulatory Blood Pressure Monitoring in Individuals with HIV: A Systematic Review and Meta-Analysis

INTRODUCTION: Abnormal diurnal blood pressure (BP) rhythms may contribute to the high cardiovascular disease risk in HIV-positive (HIV(+)) individuals. To synthesize the current literature on ambulatory BP monitoring (ABPM) in HIV(+) individuals, a systematic literature review and meta-analysis were performed. METHODS: Medical databases were searched through November 11, 2015 for studies that reported ABPM results in HIV(+) individuals. Data were extracted by 2 reviewers and pooled differences between HIV(+) and HIV-negative (HIV(-)) individuals in clinic BP and ABPM measures were calculated using random-effects inverse variance weighted models. RESULTS: Of 597 abstracts reviewed, 8 studies with HIV(+) cohorts met the inclusion criteria. The 420 HIV(+) and 714 HIV(-) individuals in 7 studies with HIV(-) comparison groups were pooled for analyses. The pooled absolute nocturnal systolic and diastolic BP declines were 3.16% (95% confidence interval [CI]: 1.13%, 5.20%) and 2.92% (95% CI: 1.64%, 4.19%) less, respectively, in HIV(+) versus HIV(-) individuals. The pooled odds ratio for non-dipping systolic BP (nocturnal systolic BP decline <10%) in HIV(+) versus HIV(-) individuals was 2.72 (95% CI: 1.92, 3.85). Differences in mean clinic, 24-hour, daytime, or nighttime BP were not statistically significant. I(2) and heterogeneity chi-squared statistics indicated the presence of high heterogeneity for all outcomes except percent DBP dipping and non-dipping SBP pattern. CONCLUSIONS: An abnormal diurnal BP pattern may be more common among HIV(+) versus HIV(-) individuals. However, results were heterogeneous for most BP measures, suggesting more research in this area is needed.