Prevalence of arterial hypertension and risk factors among people with acquired immunodeficiency syndrome

ABSTRACT Objectives: to verify the prevalence of arterial hypertension and its risk factors among people with acquired immunodeficiency syndrome under antiretroviral therapy. Method: cross-sectional study with 208 patients. Data collection was conducted through interviews using a form containing data on sociodemographic, clinical and epidemiological aspects, hypertension risk factors, blood pressure, weight, height, body mass index and abdominal circumference. Mean, standard deviation, odds ratio and confidence interval were calculated, t-test and Chi-square test were used, considering P < 0.05 as statistically significant. Hypertension associated variables were selected for logistic regression. Results: patients were male (70.7%), self-reported as mixed-race (68.2%), had schooling between 9 and 12 years of study (46.6%), had no children (47.6%), were single (44.2%), in the sexual exposure category (72.1%) and heterosexual (60.6%). The prevalence of people with acquired immunodeficiency syndrome and arterial hypertension was 17.3%. Logistic regression confirmed the influence of age greater than 45 years, family history of hypertension, being overweight and antiretroviral therapy for more than 36 months for hypertension to occur. Conclusion: the prevalence of hypertension was 17.3%. Patients with acquired immunodeficiency syndrome and hypertension were older than 45 years, had family history of hypertension, were overweight and under antiretroviral therapy for more than 36 months.

A sample was scaled to estimate the prevalence of aids patients served in the outpatient clinic and who had hypertension and its risk factors, with 95% confidence that the estimation error does not exceed 5%, considering Cunha GH, Lima MAC, Galvão MTG, Fechine FV, Fontenele MSM, Siqueira LR. that such prevalence is unknown in the population, being stipulated in 50% (presumed prevalence) -as it provides the largest sample size -, and that there were period. For such, the following expression was used: In this formula, z 2 is equal to the value of the z statistic (1.96) for the adopted degree of confidence (95%) and p, N and ε correspond to the assumed prevalence (0.50), to the population (450) and to the tolerable error (0.05), respectively. Thus, a sample of 208 patients was calculated.
Inclusion criteria were people with aids of both genders, aged 18 years or older, who were under ART for at least three months and who were in outpatient follow-up. Exclusion criteria were pregnancy, mental illness, persons deprived of their liberty, people living in collective shelters or any other condition capable of interfering in an individual's participation in the research.
The sampling strategies adopted were nonprobability and convenience. Patients were invited to participate in the study when they attended to routine consultations in the outpatient clinic. Those who agreed to participate in the research signed an informed consent form, and were interviewed for approximately 40 minutes in a private environment. Part I of the form had already been validated in previous studies (14)(15) , the data on hypertension and its risk factors were added to it. Prior to data collection, the complete form was applied to 20 aids patients whom were not part of the sample. The study researchers were trained to apply the form, considering subjective and objective data, using standard operating procedures for measuring blood pressure, weight, height, BMI and waist circumference and to set the normality parameters of the findings (16) .
The mean and standard deviation were calculated in the statistical analysis. For comparisons between hypertensive and normotensive subjects, the t-test was used for unpaired variables. A P < 0.05 was considered a statistically significant value. Absolute and relative frequencies were determined. The association of sociodemographic and clinical factors and the occurrence of hypertension, which is the primary outcome, were evaluated by the Chi-square test, considering P < 0.05 as statistically significant. The strength of such association also was evaluated by determining the odds ratio and its 95% confidence interval.
Explanatory variables associated with hypertension at 20% significance level (P < 0.2) were selected to be part of the logistic regression model, identifying those that, independently, were factors associated with hypertension. For such, the stepwise backward method was used. The criterion for removing variables from  This study also considered the STROBE Statement guidelines.
Rev. Latino-Am. Enfermagem 2018;26:e3066.  The association between sex and hypertension was evaluated by the Chi-square test. The t-test was used for unpaired data to compare the two strata in relation to other variables. It was found that people with aids and hypertension had higher mean age (P < 0.001), greater waist circumference (P < 0.001), longer time of infection (P = 0.005) and longer time of use of ART (P = 0.002) ( Table 3).

The association between the risk factors for
hypertension and the occurrence of hypertension was evaluated by the Chi-square test, and by determining the odds ratio and its respective 95% confidence interval (95% CI). Table 4 shows the data expressed as number of cases (n) and percentage (%). It was observed that people with aids had higher chances of presenting hypertension when the age was greater than 45 years (P = 0.003), had family history of hypertension (P = 0.003), were overweight (P = 0.024), had increased waist circumference (P = 0.013) and time of use of ART greater than 36 months (P < 0.001) ( Table 4).

Discussion
Most of the sample of this study were men, corroborating with other studies, showing that HIV is still affecting more men than women (17)(18) . People of darker skin color were highlighted in the analyses, and in this regard, a study conducted in the United States also pointed that the absolute number of Caucasians with an aids diagnosis is much lower when compared to African Americans; however, there is a tendency in the number of people with aids increasing among Caucasian individuals when compared to African Americans (19) .
The patients' schooling was relatively high, similar to the findings of other studies (20)(21) . People with higher education level may have more access to relevant health information, presenting a broader perception on cardiovascular risk factors and the need to maintain a healthy lifestyle (22) . Singles were the majority of patients and, given this, our study showed that single people are more likely to have multiple partners, thus becoming more vulnerable to HIV (23) . However, the increase in the number of HIV infection cases among people in stable relationships must be highlighted; this derives from the lack of negotiation about condom use, especially by females (24) .
Participants whom did not had children were the majority. On this aspect, a study showed that the care demands of several children, especially if they are young, can lead to problems in the treatment routine, due to competing needs from the children's routine (25) .
Regarding religion, most participants reported to be Catholic. Regardless of belief, this study found that religion helps people with aids in adhering to the ART and in the fight against the disease, but it must be noted that mistakes can happen and some patients may start assigning the treatment and cure of aids to religion, not properly adhering to the ART and other health guidelines (26) .
Most patients were employed during the study period. Having a steady job can help people with aids to replace their identity as patients, since those who work report significant improvements in their quality of life when compared to those who are unemployed; however, usually the main cause of cessation of work is the stigma resulting from the disease (27) . Sexual exposure and heterosexuality were relevant in the analyses, contrasting the beginnings of the epidemic, when most people affected were homosexuals, users of intravenous drugs and people who underwent blood transfusions (1) .
A considerable number of patients had lipodystrophy.
Considering this information, a research showed that adherence to ART tends to decrease over time after the lipodystrophy diagnosis (28) .
The antiretroviral drugs used the most were lamivudine, tenofovir efavirenz and zidovudine. In another study, the prevalence ranged from 4.7% and 54.4% in high-income countries and from 8.7% to 45.9% in middle-income countries (6) . Another research found prevalence of hypertension in 38% of people with aids under ART, and 19% in people whom were not under such therapy (4) .
In this study, the antihypertensive drugs most frequently used by people with aids were losartan, hydrochlorothiazide and enalapril.It was found that We can assume that the incidence of cardiovascular diseases in people with aids increases due to the profile of high risk factors and increased the survival rate of these patients. Therefore, the estimation of cardiovascular risk and the management of these risk