BACKGROUND: Following the WHO recommendations in 2019, dolutegravir (DTG) replaced efavirenz as the preferred first-line third drug co-administered with tenofovir and lamivudine/emtricitabine. DTG has been associated with hypertension (HTN).
METHODS: We abstracted blood pressure (BP), age, sex, and HTN diagnoses records from routinely collected data at Newlands Clinic, Harare, Zimbabwe. We included adult participants who routinely transitioned from tenofovir+lamivudine+efavirenz (TLE) to tenofovir+lamivudine+DTG (TLD). We aggregated data by month (from 12 months prior to 35 months after transitioning), HTN status and sex. For each aggregated data cell, we calculated median systolic and diastolic pressure (SBP, DBP) among participants contributing BP measurements to the data cell. We then fitted separate additive models to describe trends in median SBP and DBP by sex and baseline HTN diagnosis.
RESULTS: We analysed 57,970 BP records from 5,487 participants (3,648 [66.5%] female), and 1,023 (18.6%) had a diagnosis of HTN at baseline. Among the non-hypertensive at baseline, there was strong evidence for an increase in median SBP, which was more pronounced in males compared to females and some evidence for a slight increase in DBP as well (Figure).Among hypertensive participants, there was evidence for both increasing SBP and DBP, with similar estimated median DBP for both sexes, but higher SBP among males both before and after baseline. The increase in BP among hypertensive participants peaked at 18 months post baseline with an estimated median of 133 (95% CI 131-134) mmHg SBP and 87 (86-89) mm DBP in females and 139 (95% CI 137-141) mmHg SBP and 88 (87-89) mm DBP in males and plateaued thereafter.
CONCLUSIONS: Among non-hypertensive participants we observed smaller increase in SBP after transitioning from TLE to TLD and a larger increase in both SBP and DBP all hypertensive participants. Males and those with HTN on TLD could benefit from vigilant BP monitoring.