Independently CVD-related beta-blockers, HIV veterans die

Among HIV and newly developed hypertensive veterans, beta-blockers are independently associated with an increased risk of accidental CVD or death compared to ACE inhibitors or angiotensin receptor blockers. The researchers reported that it was.

According to the data published in High blood pressure, Calcium channel blockers and diuretics were not associated Increased risk of incident CVD Compared to ACE inhibitors or angiotensin receptor blockers.

“Risks based on which drug providers choose to treat hypertension among HIV patients because of the potential interaction between blood pressure drugs and several therapies used to treat the virus In addition, factors such as how the body handles salt, inflammation, and accelerated aging of blood vessels are different from people who are not infected with HIV. It can affect the risk of heart events in an infected person. ” Jordan B. Cohen, MD, MSCE, Associate Professor of Medicine and Epidemiology, Department of Renal Electrolytes and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, said in a press release.

In this analysis, researchers found that antihypertensive drug classes were associated with CVD events in the population, including 8,041 veterans with HIV and accidental hypertension (mean age 53 years, 97% male, 49% black). I decided if I was there. Results of interest included incident / recurrent CVD or death due to antihypertensive classes, incident CVD and incident HF. The median follow-up was 6.5 years.

Of the cohort, 24% received ACE inhibitors or angiotensin receptor monotherapy and 23% received thiazide or thiazide-like diuretic monotherapy. 13% were on beta blocker monotherapy And 11% were on monotherapy with calcium channel blockers.

“I was surprised at the high proportion of beta-blockers prescribed for first-line hypertension because it is not recommended as a first-line treatment,” Cohen said in a statement. “It says that many people living with HIV do a great job of managing HIV, but receive primary care from an infectious disease team that does not focus on blood pressure treatment guidelines or contraindications. It seems to be a fact. Ideally, the patient’s primary care and the infectious disease team should work together to get the best possible results. “

CVD related to antihypertensive drugs

During the study period, 25% of the cohort experienced CVD events.

In a propensity score matching analysis, beta blockers were of accidental / recurrent CVD or death (HR = 1.54; 95% CI, 1.19-2), accidental CVD or death (HR = 1.79; 955 CI, 1.31). It was associated with increased risk. -2.44) and accidental CVD (HR = 1.9; 95% CI, 1.24-2.89) are associated with accidental HF (HR = 1.46; 95% CI, 0.98-2.19) compared to ACE inhibitors or angiotensin receptor blockers. )is not it.

Both calcium channel blockers (HR = 1.02; 95% CI, 0.77-1.34) and diuretics (HR = 1.06; 95% CI, 0.86-1.31) are CVD compared to ACE inhibitors / angiotensin receptor blockers. It was not associated with a high risk of developing the disease.

Black Chronic Kidney Disease Subgroup Analysis

Studies have shown that beta-blockers, calcium channel blockers, and diuretics have been associated with an increased risk of developing CVD or death compared to ACE inhibitors or angiotensin receptor blockers in non-black individuals. ..

• Beta blocker HR = 1.23; 95% CI, 1.03-1.48;
• Calcium channel blockers HR = 1.29; 95% CI, 1.01-1.65; and
• Diuretic HR = 1.4; 95% CI, 1.14-1.71.

However, researchers observe an increased risk of accidental CVD or death in black individuals with calcium channel blockers or diuretics compared to those initiated with ACE inhibitors or angiotensin receptor blockers. did not do it.

In patients with chronic kidney disease, calcium channel blockers and diuretics were associated with an increased risk of developing CVD or death compared to ACE inhibitors or angiotensin receptor blockers (calcium channel blockers). HR = 1.79; 95% CI, 1.11-2.9; HR for diuretics = 2.4; 95% CI, 1.4-4.1).

“The mortality rate of people living with HIV has improved significantly with the spread of effective antiretroviral therapies, but the morbidity and mortality rate of CVD remains higher than that of the general population,” the researchers say. Is writing. “Given the important link between blood pressure control and CVD, further research is needed to understand the mechanism and clinical importance of treatment decisions regarding antihypertensive drug selection in this high-risk patient population.”