Immune markers, diurnal blood pressure profile and cardiac function in virologically suppressed HIV-infected patients

Figures & data

Table 1. Characteristics of 108 HIV-infected patients with and without diurnal non-dipping blood pressure pattern.

Characteristics	All (n = 108)	Dip (n = 53)	Non-dip (n = 55)	p
Age (y)	48.6 ± 10.7	48.6 ± 10.2	48.5 ± 11.3	0.970
Male gender (%)	81.5	81.1	81.8	0.927
Caucasian ethnicity (%)	75.0	72.7	77.3	0.578
Current smoking (%)	33.3	37.7	29.0	0.341
BMI (kg/m^2)	24.5 ± 3.6	24.8 ± 3.2	24.2 ± 3.9	0.244
Creatinine (mmol/L)	72 ± 13	72 ± 13	73 ± 14	0.248
eGFR (mL/min)	105 ± 20	105 ± 19	104 ± 20	0.796
CD4 cell count (cells/μL)	470 (360–633)	540 (377–690)	450 (350–564)	0.044
CD8 cell count (cells/μL)	1024 (686–1341)	957 (683–1340)	1100 (688–1372)	0.865
CD4/CD8 ratio	0.5 (0.4–0.7)	0.6 (0.4–0.7)	0.4 (0.3–0.6)	0.029
Nadir CD4 cell count (cells/μL)	130 (73–210)	160 (84–240)	168 (60–220)	0.773
Time since HIV diagnosis (y)	11.3 (8.1–15.1)	11.1 (8.2–18.3)	12.0 (7.9–14.9)	0.519
Duration of ART (y)	7.4 (4.7–9.4)	7.4 (5.6–10.5)	7.4 (3.8–9.0)	0.088
Previous AIDS event (%)	24.1	18.9	29.1	0.214
Hypertensive according to office BP (%)	48.1	47.2	49.1	0.842
Hypertensive according to 24h ABP (%)	46.3	45.3	47.3	0.836
24h SBP (mmHg)	125 ± 17	124 ± 16	127 ± 18	0.277
24h DBP (mmHg)	79 ± 10	79 ± 9	80 ± 11	0.417
Daytime SBP (mmHg)	130 ± 17	130 ± 17	129 ± 18	0.762
Daytime DBP (mmHg)	83 ± 11	84 ± 9	83 ± 12	0.434
Nocturnal SBP (mmHg)	117 ± 18	111 ± 15	123 ± 18	<0.001
Nocturnal DBP (mmHg)	73 ± 11	69 ± 10	76 ± 11	0.001
Decline in SBP (%)	9.7 (6.4–13.9)	14.1 (11.5–17.8)	6.7 (3.1–8.8)	<0.001
Decline in DBP (%)	12.7 (8.1–18.5)	16.6 (13.7–21.5)	8.2 (5.3–11.8)	<0.001

Data are given as percentage, mean ± standard deviation, or median (interquartile range) for skewed distributions.

ART: antiretroviral therapy; BMI: body mass index; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate according to the chronic kidney disease epidemiology collaboration formula; SBP: systolic blood pressure.

Figure 1. Nocturnal decline in systolic BP according to (a) two groups of CD4 cell count and (b) two groups of CD4/CD8 ratio.

Table 2. Univariate and multivariate linear analyses with nocturnal decline in systolic blood pressure as outcome, n = 108.

	Univariate		Multivariate
Characteristics	Unstandardized β (95% CI)	p	Unstandardized β (95% CI)	p
Age, per one year	0.02 (−0.10–0.14)	0.731	0.06 (−0.07–0.18)	0.360
Male gender	−2.06 (−5.01–0.88)	0.168	−1.96 (−5.02–1.11)	0.208
BMI, per one unit kg/m^2	0.35 (−0.02–0.73)	0.066	0.48 (0.10–0.87)	0.015
CD4 cell cell count <470 cells/μL (median)	−2.96 (−5.37–0.56)	0.016	−1.21 (−3.88–1.46)	0.372
CD4/CD8 ratio <0.4	−4.34 (−6.77–1.92)	0.001	−3.55 (−6.25–0.88)	0.010
Nadir CD4 cell count <100 cells/μL	−0.46 (−3.10–2.18)	0.732	−0.33 (−3.12–2.46)	0.816
ART duration, per year	0.35 (0.02–0.72)	0.065	0.04 (−0.40–0.47)	0.872
24h SBP, per mmHg	−0.05 (−0.12–0.02)	0.161	−0.05 (−0.12–0.03)	0.277

ART: antiretroviral therapy; BMI: body mass index; CI: confidence interval; SBP: systolic blood pressure.

Table 3. Characteristics of 51 HIV-infected patients who performed echocardiography.

Characteristics	All (n = 51)	Dip (n = 34)	Non-dip (n = 17)	p
Age (y)	46.2 (41.0–54.2)	46.3 (41.0–55.7)	46.2 (40.2–53.8)	0.920
Male gender (%)	72.5	88.2	64.7	0.102
Caucasian ethnicity (%)	70.6	73.5	64.7	0.514
Current smoking (%)	27.5	32.4	17.6	0.334
BMI (kg/m^2)	24.1 (22.2–26.2)	24.3 (22.0–26.4)	24.0 (22.2–25.6)	0.857
eGFR (mL/min)	102 (96–116)	102 (95–116)	104 (99–119)	0.749
CD4 cell count (cells/μL)	559 (385–658)	559 (426–702)	559 (355–620)	0.231
CD8 cell count (cells/μL)	958 (678–1340)	958 (659–1340)	996 (660–1363)	0.842
CD4/CD8 ratio	0.6 (0.4–0.8)	0.6 (0.4–0.8)	0.5 (0.4–0.8)	0.424
Nadir CD4 cell count (cells/μL)	180 (80–270)	176 (86–273)	180 (65–325)	1.0
Time since HIV diagnosis (y)	10.7 (7.9–19.1)	11.9 (8.0–20.3)	9.8 (7.8–15.2)	0.624
Duration of ART (y)	7.7 (5.4–11.0)	7.9 (5.4–12.2)	7.7 (4.6–9.9)	0.497
Previous AIDS event (%)	27.5	23.5	35.3	0.508
Hypertensive according to office BP (%)	15.7	17.6	11.8	0.703
Hypertensive according to 24h ambulatory BP (%)	27.5	26.5	29.4	1.0
24h SBP (mmHg)	116 (108–124)	114 (109–125)	118 (105–123)	0.795
24h DBP (mmHg)	73 (69–80)	73 (70–80)	74 (67–83)	0.873
Daytime SBP (mmHg)	120 (115–128)	119 (115–131)	122 (109–127)	0.660
Daytime DBP (mmHg)	78 (75–85)	78 (75–85)	78 (72–86)	0.590
Nocturnal SBP (mmHg)	104 (99–116)	102 (98–110)	113 (99–119)	0.072
Nocturnal DBP (mmHg)	65 (61–73)	64 (60–89)	68 (63–78)	0.080
Decline in SBP (%)	12.3 (8.9–15.6)	15.1 (12.3–17.6)	7.3 (4.3–9.1)	<0.001
Decline in DBP (%)	15.4 (11.4–20.3)	18.5 (14.1–21.4)	10.4 (6.4–14.6)	<0.001
Echocardiography - Two dimensional
Left atrial area, cm^2	17.8 (16.4–19.8)	17.5 (16.0–20.0)	18.6 (17.3–19.3)	0.379
Right atrial area, cm^2	16.7 (14.5–18.7)	17.2 (14.0–19.9)	16.2 (15.0–17.8)	0.712
LV ejection fraction (%)	66 (60–71)	67 (61–71)	65 (60–71)	0.384
Echocardiography M-mode
Long-axis strain (%)	17.2 (16.1–18.1)	17.3 (16.1–18.4)	17.0 (16.0–17.9)	0.396
IVS diastole (mm)	8.0 (8.0–9.0)	8.0 (7.7–9.0)	9.0 (8.0–9.5)	0.277
PW diastole (mm)	9.0 (8.0–9.0)	8.0 (7.0–9.3)	9.0 (8.0–9.5)	0.241
LVID diastole (mm)	51 (48–53)	51 (47–53)	51 (49–53)	0.644
LVID systole (mm)	33 (30–35)	32 (30–35)	34 (31–36)	0.489
FS (%)	35 (32–39)	37 (33–38)	35 (31–39)	0.696
Relative wall thickness	0.33 (0.30–0.38)	0.33 (0.29–0.38)	0.36 (0.30–0.37)	0.522
LV mass index (g/m^2)	79 (72–87)	78 (68–86)	84 (73–92)	0.129
Echocardiography -Conventional doppler
E (m/s)	0.66 (0.58–0.77)	0.65 (0.58–0.77)	0.71 (0.59–0.79)	0.653
E/A ratio	1.31 (1.16–1.45)	1.31 (1.17–1.46)	1.30 (1.03–1.45)	0.826
AV peak velocity (m/s)	1.19 (1.08–1-32)	1.22 (1.10–1.33)	1.14 (1.02–1.28)	0.286
Echocardiography - Tissue doppler
e’ (cm/s)	9.0 (7.4–9.9)	9.1 (7.7–9.9)	8.3 (6.7–9.9)	0.379
E/e’ ratio	7.6 (6.7–8.7)	7.8 (6.4–8.8)	7.6 (7.5–8.7)	0.646

Data are given as percentage or median (interquartile range).

A: late diastolic transmitral flow; ART: antiretroviral therapy; AV: aortic valve; BMI: body mass index; DBP: systolic blood pressure; E: early diastolic transmitral flow; e’: early diastolic tissue velocity; FS: fractional shortening; eGFR: estimated glomerular filtration rate according to the chronic kidney disease epidemiology collaboration formula; IVS: interventricular septum; LAS: long-axis strain; LV: left ventricle; LVID: left ventricular internal diameter; PW: posterior wall; SBP: systolic blood pressure.

Table 4. Correlations between selected echocardiographic parameters and immunological markers as well as nocturnal blood pressure decline.

	LAS		RWT		e’
Characteristics	r	p	r	p	r	p
Age	−0.06	0.664	0.20	0.169	−0.56	<0.001
Decline in SBP	0.06	0.694	−0.11	0.454	0.28	0.049
Decline in DBP	0.08	0.560	−0.04	0.762	0.36	0.011
	rsp	p	rsp	p	rsp	p
CD4 cell count	0.06	0.702	0.12	0.405	0.07	0.642
CD4/CD8 ratio	0.29	0.035	0.16	0.270	0.07	0.644
Nadir CD4 cell count	−0.08	0.596	−0.37	0.007	0.38	0.006

e’: early diastolic tissue velocity; LAS: long-axis strain; r_sp: Spearman’s correlation coefficient; r: Pearson’s correlation coefficient; RWT: relative wall thickness.