Hypertension Burden and Care Cascade Gaps Among People Living With HIV in an Urban HIV Clinic in Cameroon 2024

Abstract

Background: The widespread use of antiretroviral therapy (ART) has significantly increased the life expectancy of people living with HIV (PLWHIV). However, this success is accompanied by a growing burden of non-communicable diseases, particularly hypertension, which has emerged as a leading contributor to morbidity and mortality in sub-Saharan Africa. Despite this growing concern, data on the burden and care cascade of hypertension among PLWHIV in routine care settings remain limited in Cameroon. Objective: To assess the prevalence, associated factors, and care cascade of hypertension among PLWHIV receiving follow-up at Yaoundé Central Hospital in Cameroon in 2024. Methods: We conducted a cross-sectional descriptive study at the Day Hospital of Yaounde Central Hospital, a national referral center for HIV care. PLWHIV aged ≥21 years and under active follow-up were included. Hypertension was defined as systolic and/or diastolic blood pressure ≥140/90 mm Hg or current use of antihypertensive medication. Logistic regression analyses were performed to identify factors associated with hypertension, including clinical and HIV-related parameters. Results: A total of 554 participants were enrolled, of whom 74.0% were women, with a mean age of 50.9 years. The overall prevalence of hypertension was 36.8% (95% CI: 32.9-40.9) and was higher among men than women (45.1% vs 33.9%). Among hypertensive individuals (n = 204), 66.7% had initiated antihypertensive treatment, 45.6% were retained in care, and only 22.6% had controlled blood pressure. Factors independently associated with hypertension included longer ART duration (>16 years) (adjusted OR = 1.88; P = .036), WHO clinical stage II at HIV diagnosis (adjusted OR = 1.56; P = .033), and suppressed viral load (<1000 copies/mL), which was paradoxically associated with a higher risk of hypertension (adjusted OR = 0.42 for unsuppressed viral load; P = .041). No significant association was found with ART regimen lines. Conclusion: Hypertension affects more than one-third of PLWHIV in this urban HIV referral center, yet important gaps persist in treatment initiation, retention, and control. These findings highlight the urgent need for integrated hypertension screening and management strategies within HIV care services in Cameroon to reduce long-term cardiovascular risks.