Abstract Body (Do not enter title and authors here): Introduction: Uncontrolled hypertension substantially increases the risk for cardiovascular disease and is a major cause of mortality among people living with HIV in many countries in sub-Saharan Africa, including Malawi. Despite previous studies showing low rates of blood pressure (BP) control among individuals with comorbid HIV and hypertension in these settings, few have focused on identifying potentially modifiable factors for improving BP control. This study examined contextual and self-management behaviors associated with BP control.
Methods: This is a cross-sectional analysis of baseline data from participants in Healthy Hearts, a cohort study of persons with HIV and cardiometabolic conditions in Malawi. Participants were adults aged ≥18 years with HIV and hypertension (n=202), recruited from HIV care clinics at 3 hospitals. Multiple logistic regression was used to examine factors associated with BP control, defined as mean systolic BP <140mmHg and diastolic BP <90mmHg based on the 2020 International Society of Hypertension guidelines. Independent variables included age, gender, education level, access to healthcare, presence of comorbid conditions, body mass index, multimorbidity illness perceptions, hypertension-related knowledge, and self-management behaviors (self-reported physical activity, salt intake, fruit and vegetable intake, and antihypertensive medication adherence).
Results: All participants were on antiretroviral therapy, 83.1% were on antihypertensive medication, and only 37.3% had controlled BP. Having a higher score in hypertension-related knowledge was positively associated with BP control (odds ratio [OR], 2.44; 95% CI 1.14–5.23). Factors negatively associated with BP control included increasing age (OR, 0.92; 95% CI 0.89–0.96), low antihypertensive medication adherence (OR, 0.32; 95% CI 0.11–0.89) or not being on antihypertensives (OR, 0.30; 95% CI 0.11–0.82), and perceiving multimorbidity as having greater negative impact on health (OR, 0.54; 95% CI 0.30–0.98).
Conclusions: Age and potentially modifiable factors such as hypertension-related health literacy, medication adherence, and multimorbidity illness perceptions were independently associated with BP control at baseline in a cohort of Malawian adults with comorbid HIV and hypertension. These insights can help guide the development of tailored interventions for promoting BP control in persons with HIV at high risk for cardiovascular disease living in low-income countries.