concluded that the increase in BP in the HIV infected patients was partly attributed to HAART which contributed to improvement in the general state of health of these patients, hence, explained why patients with advanced stage of HIV infection and with previous lower baseline systolic blood pressure had a sudden increase in systolic blood pressure.
61 BMI was found to be independently associated with high blood pressure and the obese are 7.9 times likely to develop high blood pressures (p = 0.00). This is in agreement with a study done by Evanizero et al (2010), who found that hypertension was associated with high BMI values. This was due to the weight gained during treatment on HAART. Amongst the infected patients, the loss of weight enhances the fantasy of appearing ill, and this may be seen as a “taboo”. Nutritional intervention aimed at maintaining a healthy weight should be emphasized as it is likely to offer protection against the onset of hypertension. Sattler et al (2001) in a case –control study done in the USA demonstrated that elevated blood pressure in subjects with lipodystrophy revealed that increased systolic blood pressure was more likely to become elevated in the event of an increased waist-hip-ratio. The authors therefore proposed that intervention to manage hypertension should be instituted in patients with three or more elevated systolic blood pressure readings. This augurs well with this study as 63% of the cases had systolic blood pressure of 140 to≥180 mmHg which signifies poor control of blood pressure. 5.3 Lifestyle/Behavioral Factors Lifestyle factors are critical determinants of blood pressure levels and subsequently in management of hypertension. Excess body fat is a predominant cause of hypertension with additive effects of dietary salt, alcohol, and physical inactivity. According to Appel et al (1997), Dietary Approach to Stop Hypertension (DASH), a diet low in sodium, high in fruits, vegetables, and calcium is helpful in management of hypertension. Also, exercise is equally critical, especially to children and young adults who have heightened sympathetic nervous system activity. The outcomes of this study demonstrated no association with hypertension in respect to alcohol intake (p = 0.498), smoking habit (p = 0.572), exercise (p = 0.111) and salt intake (p = 0.606) between the cases and controls. This finding could be as a result of the counseling classes the patients undergo before they are started on ART (Kenya 2016 edition,
62 HIV guideline). These sessions include education on drug-food, drug-drug, drug-alcohol, and drug-smoking interactions. The other great contributory factors to good lifestyle practices to high blood pressure among the participants in this study can be from the major occupation which is farming that allows them to cultivate and consume a lot of their produce which is mainly fruits and vegetables. The physical activity associated with farming also could be a contributory factor. Patients with elevated blood pressure should follow a weight-reducing diet, take regular exercise, and restrict alcohol and salt intake (Dickson et al, 2006).