Hypertension Prevalence and Control at Trial Entry in the REPRIEVE Study Population: Results From a Secondary Analysis

Q: What is the clinical evidence from this study?

Study design: Observational. Population: HIV with low to moderate cardiovascular disease risk (n=7769). Intervention: Hypertension at baseline vs. No hypertension at baseline. Primary outcome: Major adverse cardiovascular events (MACE) (HR 2.00, 95% CI 1.57-2.55).

Q: What does this research mean for the field?

Baseline hypertension in people with HIV is associated with an increased hazard of major adverse cardiovascular events (HR 2.00; 95% CI 1.57-2.55). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Risa M. Hoffman; Maya Watanabe; Estebán Martínez; Markella V. Zanni; Anton Pozniak; Saate Shakil; Sara McCallum; Sarah M Chu; Suman Srinivasa; Carlos Malvestutto; Carl J. Fichtenbaum; Gerald S. Bloomfield; Alex B Lu; Judith A. Aberg; Judith S. Currier; Michael T. Lu; Pamela S. Douglas; Heather J. Ribaudo; Steven Grinspoon

doi:10.1093/ofid/ofag507

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Why the study?

Baseline hypertension prevalence, control, and associated risk of MACE needed evaluation among people with HIV who had low to moderate traditional CVD risk.

Does baseline hypertension increase the risk of major adverse cardiovascular events in people with HIV who have low to moderate traditional cardiovascular disease risk?

Study Design

Type

Observational (n=7,769)

Multicenter

Yes

Structured PICO

Does baseline hypertension increase the risk of major adverse cardiovascular events in people with HIV who have low to moderate traditional cardiovascular disease risk?

P

Population

7,769 people with HIV aged 40 to 75 years with low to moderate cardiovascular disease risk, evaluated for baseline hypertension prevalence and its association with major adverse cardiovascular events.

E

Exposure

Presence of baseline hypertension (preexisting diagnosis or blood pressure ≥140/90 mm Hg)

C

Comparator

No baseline hypertension

O

Outcome

Prevalence of hypertension and hypertension control at baseline, and incidence of major adverse cardiovascular events (MACE: composite of cardiac ischemia or myocardial infarction, stroke or transient ischemic attack, cardiovascular death, cardiac catheterization or revascularization, peripheral arterial revascularization, peripheral arterial ischemia, or death of undetermined cause)composite

Main Result

Hazard Ratio: 2 (95% CI 1.57–2.55)

Limitations

The undiagnosed hypertension subgroup was categorized by only a single blood pressure measurement.
Subgroups classifying blood pressure control were based on a single blood pressure reading, likely misclassifying some participants.
Analyses of statin effect modification by baseline hypertension subgroup lacked precision given the relatively small sample sizes within each group.
Findings cannot be generalized to people with HIV in higher-risk cardiovascular categories.
Significant heterogeneity in prevalence and control data likely reflects unmeasured differences in health care access and social/behavioral factors.
Small enrollment from some regions, including South Asia
Unable to disentangle contributions of ART versus weight to hypertension
Small sample sizes across groups for statin effect modification analysis

Implication

In a global cohort of people with HIV at low-to-moderate CVD risk, baseline hypertension was highly prevalent (36%), frequently suboptimally controlled, and independently associated with a near two-fold increased risk of major adverse cardiovascular events.

Abstract

Background: We evaluated baseline hypertension prevalence and control and risk of major adverse cardiovascular events (MACEs) among people with HIV in REPRIEVE who had low to moderate traditional cardiovascular disease (CVD) risk. Methods: Hypertension at baseline was defined by (1) a preexisting diagnosis regardless of antihypertensive treatment or (2) systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg 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 7769 participants enrolled from 5 regions, the median age was 50 years, and 2419 (31%) were women. The prevalence of baseline hypertension was 36% (n = 2780) with geographic variation. Among these, 1911 (69%) individuals had a preexisting hypertension diagnosis; the remainder (n = 869, 31%) were undiagnosed. Region and traditional CVD risk factors were associated with hypertension prevalence, with obese and overweight body mass index 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 preexisting hypertension, 40% were uncontrolled, with regional variation. Hypertension at baseline was associated with an increased hazard of MACE (hazard ratio, 2.00; 95% CI, 1.57-2.55) and key components of MACE, including myocardial infarction and stroke. Conclusions: Approximately 1 in 3 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 people with HIV.

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Cite This Study

Hoffman et al. (2026) conducted an observational in HIV with low to moderate cardiovascular disease risk (n=7,769). Hypertension at baseline vs. No hypertension at baseline was evaluated on Major adverse cardiovascular events (MACE) (HR 2.00, 95% CI 1.57-2.55).

synapsesocial.com/papers/6aa92ccbf8b27f8ac662e679 https://doi.org/10.1093/ofid/ofag507

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Hypertension Prevalence and Control at Trial Entry in the REPRIEVE Study Population: Results From a Secondary Analysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Hypertension Prevalence and Control at Trial Entry in the REPRIEVE Study Population: Results From a Secondary Analysis

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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