ACE inhibitors/ARBs best bet for managing hypertension in HIV patients

In the treatment of hypertension in HIV-positive patients, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) show some benefit while beta-blockers are potentially harmful, according to a study.

The study included 8,041 veterans with HIV and incident hypertension. Propensity-score matching facilitated assessment of the risk of incident/recurrent cardiovascular disease (CVD) or death, incident CVD, and incident heart failure by antihypertensive class.

Of the participants, 24 percent received ACE inhibitor/ARB, 23 percent thiazide/thiazide-like diuretic, 13 percent beta-blocker monotherapy, and 11 percent calcium channel blocker. Over a median of 6.5 years, 25 percent of the population had a CVD event.

Among the blood pressure-lowering medications, only beta-blockers contributed to an increased risk of incident CVD compared with ACEs/ARBs (hazard ratio [HR], 1.90, 95 percent confidence interval [CI], 1.24–2.89). Neither calcium channel blockers (HR, 1.02, 95 percent CI, 0.77–1.34) nor diuretics (HR, 1.06, 95 percent CI, 0.86–1.31) were associated with a risk increase. Similar estimates were seen for incident/recurrent CVD or death.

In the subgroup of veterans without chronic kidney disease, ACE inhibitor/ARBs conferred a protective benefit for incident heart failure relative to all other classes (vs beta blockers: HR, 1.52, 95 percent CI, 1.11–2.09; vs calcium channel blockers: HR, 1.48, 95 percent CI, 1.00–2.19; vs diuretics: HR, 1.52, 95 percent CI, 1.07–2.16).

Further prospective and randomized trials are warranted to confirm the findings.