Abstract
Background: We evaluated baseline hypertension prevalence and control and risk of major adverse cardiovascular events (MACE) among low-to-moderate traditional cardiovascular (CVD) risk people with HIV (PWH) in REPRIEVE.
Methods: Hypertension at baseline was defined by (1) a pre-existing diagnosis, regardless of antihypertensive treatment or (2) systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg without a prior diagnosis. We estimated the prevalence of the composite hypertension and control outcomes and calculated adjusted prevalence ratios controlling for traditional CVD risk factors using log binomial regression. We explored the relationship between hypertension and MACE using cause-specific Cox proportional hazards models.
Results: Of 7,769 participants enrolled from five regions, median age was 50 years, and 2,419 (31%) were women. The prevalence of baseline hypertension was 36% (n=2,780), with geographic variation. Among these, 1,911 (69%) individuals had a pre-existing hypertension diagnosis; the remainder (n=869, 31%) were undiagnosed. Region and traditional CVD risk factors were associated with hypertension prevalence, with obese and overweight BMI having the highest adjusted prevalence ratios (1.80, 95% CI 1.67, 1.95 and 1.38, 95% CI 1.28, 1.49, respectively). Among those with pre-existing hypertension, 40% were uncontrolled, with regional variation. Hypertension at baseline was associated with an increased hazard of MACE (HR 2.00, 95% CI 1.57,2.55) and key components of MACE including myocardial infarction and stroke.
Conclusions: Approximately one in three REPRIEVE participants had hypertension at baseline. Hypertension was frequently suboptimally controlled. These findings highlight the need for improved screening and optimized treatment of hypertension in PWH.