Classes of antihypertensive drugs show different outcomes in patients with HIV

Scientists from the United States have identified the potential harm of beta blockers for patients with HIV infection and hypertension: in a study, they increased the risk of cardiovascular disease compared to other antihypertensive drugs. At the same time, drugs from other groups may benefit such patients, the authors believe.

The drugs chosen at the beginning of treatment for hypertension in people with HIV infection may influence the risk of developing other cardiovascular diseases. These are the findings of a new publication in Hypertension, a journal of the American Heart Association (AHA).

The authors analyzed the medical records of 8,041 veterans with HIV infection who developed hypertension between 2000 and 2018. The average age of the sample was 53 years, and 97% were men.

Patients began treatment with various groups of antihypertensive drugs. Monotherapy with an angiotensin-converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARB) was initiated by 24%, a thiazide or thiazide-like diuretic by 23%, a beta blocker by 13%, and a calcium channel blocker by 11%.

During follow-up, which averaged 6.5 years, 25% of the sample experienced a cardiovascular event. The risk of coronary artery disease, heart failure or stroke was 90% higher among those taking beta blockers compared to ACE inhibitors/ARBs. This effect was evident even with well-controlled hypertension.

Observations of patients without chronic kidney disease led to another important finding. In this subgroup, use of ACE inhibitors or ARBs was associated with a lower risk of heart failure compared with the other drug classes examined—by approximately 50%.

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