Impact of HIV on risk of Treatment Resistant Hypertension in Malawian Adults (TREAM Study), version 1.0
Abstract
Type of research study
Case – control study
Problem to be studied
Hypertension is a long-term condition with serious effects on the lives and well-being of
individuals. Africa, a region that is significantly affected by the HIV pandemic, is experiencing a
growing burden of non-communicable diseases such as hypertension. It is now known that HIV
increases the risk of hypertension(1), which presents a significant burden on individuals and
nations alike. Despite its high burden, most individuals suffering from hypertension do not
achieve good blood pressure control. A common emerging cause of inadequate blood pressure
control is treatment resistant hypertension(2). Treatment resistant hypertension (RH) is defined
as uncontrolled blood pressure (≥140/90 mm Hg) despite treatment with ≥3 medications of
different classes (including diuretics) at optimal doses. It is associated with significant risk of
end organ damage (such as myocardial infarction, stroke, and impaired renal function). While
some studies have quantified the burden of resistant hypertension in Africa, there is paucity of
evidence regarding the association of resistant hypertension and HIV. This study seeks to
determine the association of HIV and treatment resistant hypertension and investigate other
modifiable factors that increase the risk of treatment resistant hypertension in Malawian
adults.
Objectives
This research project seeks to investigate the association of HIV infection and treatment
resistant hypertension and determine other modifiable risk factors of treatment resistant
hypertension in Malawian adults.
Specific objectives
1. To determine the association between HIV infection and RH in Malawian adults (primary
objective)
2. To identify other modifiable risk factors associated with RH in Malawian adults
(secondary objective)
Methodology17-Aug-2022
Version 2 26 July 2022 5
Malawi-Liverpool-Wellcome Trust
Clinical Research Programme
P.O. Box 30096, Chichiri, Blantyre 3, Malawi
Study population: Medical patients over 18years of age presenting to hypertension clinic at
Queen Elizabeth Central Hospital
Study place: Queen Elizabeth Central Hospital
Study duration: 8 months
Data management and analysis: Blood pressure will be measured using ambulatory blood
pressure cuffs recorded over 6 hours. Weight and height will be measured using standard
methods. Body mass index (BMI) will be calculated and categorized by age, sex and percentile.
HIV rapid test, creatinine, and total cholesterol will also be measured through chemistry
analysis of blood samples. The odds ratio for the association between HIV as well as the various
modifiable risk factors and treatment resistant hypertension will be generated using statistical
software such as Stata 16.
Expected finding and dissemination:
The results will provide some evidence of the association between HIV and treatment resistant
hypertension, and predictors of the same. This knowledge will add to a larger body of work that
is aimed to ascertain the true burden of resistant hypertension in Malawi. Knowing the risk
factors will aid in early detection and subsequent control of the risk factors.
The results of the study will be disseminated to study participants and through a peer reviewed
scientific journal. Additionally, a final report of this study and findings will be submitted to the
College of Medicine Research and Ethics Committee (COMREC).