Background: Some evidence from high-income countries (HICs) suggests that PLHIV experience a higher hypertension prevalence than
HIV-negative individuals. It is unclear whether this is the case in subSaharan Africa (SSA), where large-scale integration of hypertension
services into HIV programmes is being considered. We examined the
hypothesis that living with HIV is associated with higher hypertension
prevalence among adults in SSA.
Materials and methods: A systematic review of MEDLINE, EMBASE,
Global Health, Cochrane Database of Systematic Reviews, Cochrane
Central Register of Controlled Trials and African Journals Online was
performed, following PRISMA guidelines, to identify cross-sectional
studies assessing hypertension prevalence in PLHIV and HIV-negative
individuals >15 years, in SSA. Only studies defining hypertension as
“study-ascertained blood pressure ≥140/90 mmHg”, or as “studyascertained blood pressure ≥140/90 mmHg and/or history of antihypertensive medication usage”, were included. Risk of bias assessments
addressed adequacy of sample sizes, participant selection and HIV and
hypertension status measurement. Random effects models were used
to pool odds ratios (ORs) for prevalent hypertension.
Results: We identified 1431 unique studies, of which 12 were
selected for quantitative analysis, providing data on 107 425 participants (49.4% to 69.6% female). The 12 studies collected data between
2003 and 2015, in South Africa, Tanzania and Uganda. Risk of bias
was low to moderate, with participant selection a key source of bias.
Hypertension prevalence ranged from 5.3% to 51.7% among PLHIV
and 8.2% to 65.4% in HIV-negative individuals. Overall, hypertension
prevalence was 41% lower among PLHIV than HIV-negative individuals when using the ≥140/90 mmHg definition (n = 5, OR 0.59, 95%
CI 0.55 to 0.64) and 34% lower when using the definition that
included medication (n = 7, OR 0.66, 95% CI 0.47 to 0.99).
Conclusions: Robust studies comparing hypertension prevalence in
PLHIV and HIV-negative individuals from SSA are scarce and concentrated in three countries. In contrast to evidence from HICs, our results
suggest hypertension prevalence is lower among PLHIV than HIVnegative individuals in SSA. The disparity between SSA and HICs may
reflect differences in health status of PLHIV and in hypertension risk
behaviours by HIV status, although further evidence from across SSA is
needed to clarify this. If confirmed, these findings should be considered
in decisions around implementing integrated HIV-hypertension services.