High Rates of Uncontrolled Blood Pressure in Malawian Adults Living with HIV and Hypertension

Risa M. Hoffman, Florence Chibwana, Daniel Kahn, Ben Allan Banda, Linna Phiri, Mayamiko Chimombo, Chiulemu Kussen, Hitler Sigauke, Agnes Moses, Joep J. Van Oosterhout, Sam Phiri, Jesse W. Currier, Judith S. Currier, Corrina Moucheraud

Research output: Contribution to journalArticlepeer-review


Background: Hypertension is among the most commonly diagnosed non-communicable diseases in Africa, and studies have demonstrated a high prevalence of hypertension among individuals with HIV. Despite high prevalence, there has been limited attention on the clinical outcomes of hypertension treatment in this population. Objective: We sought to characterize rates of and factors associated with blood pressure control over one year among individuals on antiretroviral therapy (ART) and antihypertensive medications. Methods: We performed a prospective observational cohort study at an HIV clinic in Malawi. We defined uncontrolled hypertension as a systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg at two or more follow-up visits during the year, while controlled hypertension was defined as <140 mm Hg systolic and <90 mm Hg diastolic at all visits, or at all but one visit. We calculated an antihypertensive non-adherence score based on self-report of missed doses at each visit (higher score = worse adherence) and used rank sum and chi-square tests to compare sociodemographic and clinical factors (including adherence) associated with blood pressure control over the year. Results: At study entry, 158 participants (23.5%) were on antihypertensive medication; participants had a median age of 51.0 years, were 66.5% female, and had a median of 6.9 years on ART. 19.0% (n = 30) achieved blood pressure control over the year of follow-up. Self-reported non-adherence to hypertension medications was the only factor significantly associated with uncontrolled blood pressure. The average non-adherence score for those with controlled blood pressure was 0.22, and for those with uncontrolled blood pressure was 0.61 (p = 0.009). Conclusions: Adults living with HIV and hypertension in our cohort had low rates of blood pressure control over one year associated with self-reported non-adherence to antihypertensive medications. Given the high prevalence and incidence of hypertension, interventions to improve blood pressure control are needed to prevent associated long-term cardio- and cerebrovascular morbidity and mortality.

Original languageEnglish (US)
Article number81
JournalGlobal Heart
Issue number1
StatePublished - 2021


  • Adherence
  • Antiretroviral therapy
  • HIV
  • Hypertension
  • Hypertension control
  • Noncommunicable diseases

ASJC Scopus subject areas

  • Epidemiology
  • Community and Home Care
  • Cardiology and Cardiovascular Medicine


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