Certain High Blood Pressure Medications May Alter Heart Risk in People With HIV

The type of high blood pressure medication chosen for people with HIV as their initial treatment may influence their risk of heart disease, stroke and heart failure, according to research published in the American Heart Association journal Hypertension.

The current study is the first to examine how the choice of blood pressure medications influences the long-term risk of heart disease, stroke, and heart failure in the population who has a higher risk of cardiovascular disease.

“We suspected there could be differences in risk based on which medications providers select to treat hypertension among people with HIV due to potential interactions between blood pressure medications and some therapies used to treat the virus,” said the study’s senior author Jordana B. Cohen, MD, MSCE, assistant professor of medicine and epidemiology in the renal-electrolyte and hypertension division in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, in the press release. “Additionally, factors such as how the body handles salt, inflammation and the accelerated aging of blood vessels may affect the risk of cardiac events in people with HIV differently than people who do not have HIV, which could be influenced by which blood pressure medication is used.”

In the current study, the researchers reviewed records of 8401 veterans with HIV who developed high blood pressure between 2000 and 2018, with 6516 never being diagnosed with heart or blood vessel problems. At baseline, 5979 were on antiretroviral medication therapy and 6582 were prescribed single antihypertensive medication therapy; 1025 were on beta blockers, 848 on calcium channel blockers (CCBs), 1095 on angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers (ACEi/ARBs), and 1865 on diuretics, according to the study.

The occurrence of heart disease, stroke, or heart failure over the next 6.5 years was compared among the study participants based on the different types of blood pressure medications.

In this study, 13% of veterans with HIV were prescribed beta-blockers as their initial hypertension treatment. Single-medication treatment was started with ACEi/ARBs in 24% of patients; thiazide or similar diuretics in 23%; and CCBs in 11%.

During the 6.5 year follow-up period, 25% of the veterans experienced a cardiovascular event. Among veterans who had not been diagnosed with heart disease at the beginning of the study, the risk of developing heart disease, heart failure, or stroke for the first time was 90% higher among those taking beta-blockers compared to the veterans who were taking ACEi/ARBs, which was the most frequently prescribed type of high blood pressure medication, according to the study.

The increased risk was present whether or not blood pressure was under control, whereas thiazide diuretics and CCBs did not increase risk.

Among veterans with HIV who did not have chronic kidney disease, the use of ACEis/ARBs was associated with a lower risk of developing heart failure, compared to patients taking other medications who were found to have approximately a 50% higher risk of heart failure.

“Blood pressure and heart disease risk in patients who have HIV can be safely managed with first-line treatment of hypertension with ACEis, ARBs, CCBs and thiazide diuretics and may have added benefit from initial treatment with ACEis and ARBs,” Cohen said in the press release.

Although CCBs are among the medications recommended for the initial treatment of hypertension, this study found beta-blockers being prescribed more frequently than CCBs, according to the study.

“We were surprised by the high rates of beta-blockers prescribed for first-line hypertension treatment since they are not recommended as first-line agents,” Cohen said in the press release. “We suspect this may be due to the fact that many people with HIV receive primary care from their infectious disease team, who do an amazing job at managing HIV but may not be focused on blood pressure treatment guidelines and contraindications. Ideally, a patient’s primary care and infectious disease team should work together for the best possible outcomes.”

Cohen added that the results also highlight that there is possible harm from using beta-blockers as first-line treatment for hypertension whether a person has HIV or not.

“While many people are appropriately treated with beta-blockers for various reasons, if you think you are taking them only for hypertension and aren’t on any other blood pressure medications, I’d recommend talking to your doctor to make sure it’s the best medication for you,” Cohen said in the press release.

The study results may have limitations, such as being affected by factors the researchers were unable to measure, such as sociodemographic factors and patient preferences in medication choice, according to the authors. Results were the same in men and women, but the large proportion of men in the sample limits the ability to generalize the findings to women.

Results from this study of veterans receiving care through the Veterans Health Administration also may not be generalizable to non-veterans or people who do not have health insurance or access to routine medical care, according to the study.

“Patients with HIV need heightened attention to their elevated risk of heart disease. More dedicated research studying the unique needs for people with HIV and those taking ARTs is needed in order to optimize cardiovascular prevention,” Cohen said in the press release.

REFERENCE

Certain high blood pressure medications may alter heart risk in people with HIV. American Heart Association. Published April 5, 2021. Accessed April 6, 2021. https://newsroom.heart.org/news/certain-high-blood-pressure-medications-may-alter-heart-risk-in-people-with-hiv