Abstract: SA-PO0420
Ambulatory Blood Pressure Phenotypes Among HIV-Positive and -Negative Adults with CKD in Rural Uganda and Kenya: The SEARCH CKD Study
Session Information
- CKM: Clinical - Epidemiology and Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Muiru, Anthony N., University of California San Francisco, San Francisco, California, United States
- Charlebois, Edwin, University of California San Francisco, San Francisco, California, United States
- Kabami, Jane, Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
- Atukunda, Mucunguzi, Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
- Ayieko, James, Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
- Orori, Gordon Omondi, Kenya Medical Research Institute, Nairobi, Nairobi County, Kenya
- Wafula, Erick Mugoma, University of California San Francisco, San Francisco, California, United States
- Adam, Debbie, University of California San Francisco, San Francisco, California, United States
- Petersen, Maya, University of California Berkeley, Berkeley, California, United States
- Kamya, Moses, Makerere University, Kampala, Central Region, Uganda
- Havlir, Diane, University of California San Francisco, San Francisco, California, United States
- Estrella, Michelle M., University of California San Francisco, San Francisco, California, United States
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
Background
Ambulatory blood pressure measurement (ABPM) can detect abnormal blood pressure (BP) phenotypes that are not captured by single-time-point measurements. These phenotypes are particularly important in populations with high burdens of HIV and CKD, where consequences of BP misclassifications may lead to adverse outcomes.
Methods
In 2016-7, we ascertained the CKD prevalence (eGFRcr <60 mL/min/1.73m2 or urine dipstick ≥1+ proteinuria) among a community-based sample of 3,686 adults from 22 rural communities in rural Uganda and Kenya (SEARCH-CKD) (PMID 32130245). In 2023-5, we conducted follow-up home visits among those with CKD for this ABPM sub-study, which involved a single-time-point BP measurement followed by ABPM. We used the Oscar 2 ABPM system, which measured BP every 30 minutes during the 24-hr period. BP phenotypes were defined using 2025 ACC/AHA thresholds: white-coat hypertension (elevated single-point BP ≥130/80 mmHg with normal ABPM), masked hypertension (normal single-point BP <130/80 mmHg with elevated ABPM [mean daytime/awake ABPM ≥130/80 mm Hg or mean 24-hour ABPM ≥125/75 mm Hg]), and sustained hypertension (elevated single-point BP and ABPM). We compared ABPM phenotypes by HIV status using chi-square tests and used multivariable linear regression to assess associations of HIV infection with systolic ABP levels.
Results
Of the 319 participants with CKD at baseline, 219 (69%) were found during follow-up. Among these, 195 (89%) underwent ABPM, of whom 179 (92%) had valid ABPM and were included in this analysis. 53% were HIV-positive, the mean age was 49 years, and 63% were female. The prevalence of white-coat, masked, and sustained hypertension was 20%, 13%, and 36%, respectively. The distribution of ABPM phenotypes did not differ significantly by HIV status (P=0.45), and HIV infection was not associated with systolic ABP levels (β −4 mmHg; 95% CI −10 to 1.3).
Conclusion
Abnormal BP phenotypes are highly prevalent in rural East Africa among those with HIV and CKD, affecting nearly 70% of such individuals. ABPM was feasible in this rural setting and revealed clinically significant misclassification. Continued reliance on single-time-point BP measurements in this high-risk population would miss 1 in 8 individuals with masked hypertension and may lead to overtreatment in those with white-coat hypertension.
Funding
- NIDDK Support