Beta-Blockers May Alter Cardiovascular Disease Risk in Patients With HIV, Hypertension

April 6, 2021
Patients with HIV and hypertension who are treated with beta-blockers for initial blood pressure management appear to have high rates of cardiovascular disease events, according to a study published in Hypertension. “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 senior author Jordana B. Cohen, MD, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. “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,” The researchers reviewed records of 8,041 veterans with HIV (mean age 53 years) who developed high blood pressure between 2000 and 2018, of which 6,516 had never been diagnosed with heart or blood vessel problems. At baseline, 74% were on antiretroviral therapy and 82% were prescribed single antihypertensive medication therapy, including beta blockers (13%), calcium channel blockers (11%), angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARBs, 24%), or diuretics (23%). During the mean 6.5 years 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 with veterans taking ACEi/ARBs. The increased risk was present whether or not blood pressure was under control. Thiazide diuretics and calcium channel blockers did not increase risk. Among veterans with HIV who did not have chronic kidney disease, the use of ACEi/ARBs was associated with a lower risk of developing heart failure, compared with patients taking other medications who were found to have about a 50% higher risk of heart failure. “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,” said Dr. Cohen. “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.” Reference: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.120.16263 SOURCE: American Heart Association