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Hypertension is a major risk factor for cardiovascular diseases and mortality. The introduction of combination antiretroviral therapy for HIV-infected patients has changed their prognosis substantially, but there is an additional cost from the increased risk of cardiovascular diseases. We aimed to assess the prevalence of hypertension in an HIV-infected population and to identify possible predictors.A cohort of 542 unselected HIV-infected individuals had their blood pressure measured at three consecutive clinical visits. They were compared with an age-matched, sex-matched and body mass index-matched population-based control group (n=24 968).The prevalence of hypertension among the white HIV-infected individuals was 36.5%, which was not significantly different from the general population. The mean diastolic blood pressure was higher in HIV-infected individuals. The highest prevalence of hypertension was found in those who had been treated by combination antiretroviral therapy for more than 5 years (44.4%). Patients with hypertension were characterized by older age, male sex, white ethnicity, higher body mass index, total cholesterol and low-density lipoprotein cholesterol, lower glomerular filtration rate, more frequent microalbuminuria, longer time with known HIV-positive status and longer combination antiretroviral therapy duration compared with normotensive individuals. Multivariate analysis revealed age, sex, body mass index, cholesterol, combination antiretroviral therapy duration and microalbuminuria as independent predictors of hypertension.Diastolic blood pressure was increased in these white HIV-infected patients compared with the general population, but there was no difference in the prevalence of hypertension. However, the duration of combination antiretroviral therapy predicted hypertension independently.

The metabolic cardiovascular syndrome is the label given to the clustering of unfavourable levels of a number of coronary risk factors in subjects with high resting blood pressures. We found recently that exercise blood pressure had a strong independent prognostic value.To search for possible similar associations between exercise blood pressure levels and coronary risk factors by studying conventional and recently acknowledged coronary risk factors.The study population comprised 1999 healthy men aged 40-59 years. Age-adjusted coronary risk factor levels and their relation to resting and exercise blood pressures were studied. Resting blood pressure was measured after subjects had rested supine for 5 min. The exercise blood pressure used was the systolic blood pressure measured with the subject sitting on a bicycle ergometer at the end of a work load of 600 kpm/min (100 W) for 6 min.Besides corroborating the relation between the metabolic syndrome and resting blood pressure levels, we observed similar or even stronger associations between levels of various coronary risk factors and exercise blood pressure. We found rather strong, direct associations between exercise blood pressure and total cholesterol level, fasting triglyceride level and body mass index whereas inverse relations were found for glucose tolerance, physical fitness, pulmonary functioning and the ability to increase heart rate during exercise. Virtually all these associations had a level of statistical significance of P0.001.High exercise blood pressure levels are strongly associated with unfavourable levels of a number of important coronary risk factors. A similar metabolic syndrome to that observed in subjects with high resting blood pressures therefore appears to be present in subjects with high exercise blood pressure responses. These associations may considerably amplify the independent risk of high blood pressure responses to moderate exercise.

The health status of 1999 apparently healthy men, aged 40-59 years, was ascertained after 16 years. We found that their systolic blood pressure during an ergometer exercise test added prognostic information beyond that from their blood pressure at rest concerning total cardiovascular mortality and mortality from myocardial infarction.To determine predictors of the change in systolic blood pressure at rest during 7 years and of the change in the prognostically important peak exercise systolic blood pressure at 600 kilopondmetres/min during 7 years.Predictors of the changes in blood pressures were investigated in 1393 middle-aged men who had been healthy without drug treatment for chronic disease or hypertension for 7 years. Twelve potential independent predictors were investigated.Previous blood pressures, age and body mass index were independent predictors and could explain 18% of the change in systolic blood pressure at rest over 7 years. For systolic blood pressure at 600 kilopondmetres/min also smoking was associated with a rise whereas a high body mass index, physical fitness and forced expiratory volume in 1 s (all P0.001) were associated with lower blood pressure, explaining 19% of the variability.Beyond a relatively strong tracking of blood pressures and the expected effect of age, smoking is associated with a 7-year rise in exercise systolic blood pressure whereas relatively higher body mass, physical fitness and pulmonary function are associated with lower exercise systolic blood pressure after 7 years in middle-aged healthy men.

AIM AND METHODS The outcome of 1999 apparently healthy men, aged 40-59 years, initially investigated in the period 1972-1975, has previously been ascertained at 7 and 16 year follow-ups. This has now been repeated after 21 years, to determine whether seated systolic blood pressure (BP) during a bicycle ergometer exercise test adds prognostic information on cardiovascular (CV) mortality beyond that of systolic BP measured after 5 min of supine rest. RESULTS After 21 years, 41 979 years of observation, 470 patients had died, 255 from CV causes. Supine systolic BP [2 SD increase: relative risk (RR) 1.6, 95% confidence interval (CI) 1.3-2.0, P < 0.0001], 6 min exercise systolic BP (2 SD increase: RR 1.6, 95% CI 1.3-2.0, P < 0.0001) on the starting workload of 600 kpm/min (approximately 100 W, 5880 J/min) and maximal systolic BP (2 SD increase: RR 1.5, 95% CI 1.2-1.9, P = 0.0005) during work were all related to CV mortality when adjusting for a large number of variables measured in the present study including age, exercise capacity, heart rates, smoking habits, glucose tolerance and serum cholesterol. When including other systolic BPs in the continuous multivariate analysis, supine systolic BP (2 SD increase: RR 1.4, 95% CI 1.04-1.9, P = 0.029) and 6 min systolic BP at 600 kpm/min (2 SD increase: RR 1.4, 95% CI 1.06-1.9, P = 0.017) were independent predictors of CV death but not maximal systolic BP during exercise (2 SD increase: RR 1.0, 95% CI 0.7-1.2, P = 0.95). CONCLUSION These results are different from the mortality data at 16 years, when the independent predictive effect of supine systolic BP was cancelled out by 6 min exercise systolic BP at 600 kpm/min. Twenty-one years of follow-up of 1999 apparently healthy men disclose independently predictive information on CV death, of both supine systolic BP and 6 min exercise systolic BP taken at an early moderate workload. The influence of maximal exercise systolic BP on CV death is however cancelled out by the two other systolic BPs.