Abstract Body (Do not enter title and authors here): Background Longitudinal blood pressure (BP) trajectories are associated with cardiovascular disease (CVD) but have not been characterized in a sub-Saharan African (SSA) cohort. We identified distinct BP trajectories and evaluated their association with HIV and preclinical CVD.

Research question Is HIV associated with lower or higher BP trajectory in SSA? Is BP trajectory associated with preclinical CVD, and does HIV change the association?

Methods Our longitudinal cohort study included 437 people with HIV (PWH) and 473 HIV-uninfected adults recruited from public HIV clinics in Mwanza, Tanzania. Echocardiography was performed in 772 participants. Group-based multi-trajectory modeling identified trajectories based jointly on systolic and diastolic BP. Multivariable multinomial logistic regression determined the association between HIV and BP trajectory group. Multivariable linear regression evaluated the association between BP trajectory group and echocardiographic measurements, including average E/e’, left atrial volume index (LAVI), and left ventricular mass index (LVMI).

Results The mean age was 36 years and 68% (N = 623) were female. Four BP trajectories were identified (Figure 1), numbered from group 1 (lowest BP) to group 4 (highest BP). Compared to BP trajectory group 2, PWH had higher odds of being classified to group 1 (aOR: 1.71; 95% CI: 0.97-3.02) and lower odds of being classified to group 3 (aOR: 0.51, 95% CI: 0.36-0.71) and group 4 (aOR: 0.45, 95% CI: 0.29-0.71). Participants in group 4 had significantly higher average E/e’, LAVI, and LVMI compared to group 2 (Figure 2). The association between BP trajectory and preclinical CVD did not differ by HIV status. HIV was associated with higher LAVI and LVMI after adjusting for age, sex, traditional CVD risk factors, and BP trajectory.

Conclusion BP trajectory and HIV were independently associated with preclinical CVD. Integrating CVD prevention with routine HIV care is urgently needed in HIV clinics across SSA.