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 metaanalysis 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. I² 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.