Antihypertensive Class and Cardiovascular Outcomes in Patients With HIV and Hypertension.
Antihypertensive Class and Cardiovascular Outcomes in Patients With HIV and Hypertension.
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DOI：
10.1161/hypertensionaha.120.16263
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发表时间：
2021-06
期刊：
影响因子：
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通讯作者：
Cohen JB
中科院分区：
文献类型：
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作者：
Rethy LB;Feinstein MJ;Achenbach CJ;Townsend RR;Bress AP;Shah SJ;Cohen JB
鉴于HIV感染者（PWH）中导致高血压的独特途径，我们试图确定抗高血压药物类别是否与PWH中的心血管疾病（CVD）事件相关。在患有艾滋病毒和高血压的退伍军人中（2000-2018年），我们使用倾向评分匹配来评估1）发生/复发性心血管疾病或死亡、2）发生心血管疾病和3）按抗高血压类别发生心力衰竭的风险。在补充分析中，我们按人种和CKD状态进行分层分析。在8041名退伍军人中，24%开始接受血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEi/ARB）单药治疗，23%开始接受噻嗪类/噻嗪样利尿剂单药治疗，13%开始接受β受体阻滞剂单药治疗，11%开始接受钙通道阻滞剂（CCB）单药治疗。在中位数为6.5年的时间里，25%的人经历了CVD事件。与ACE/ARB相比，β受体阻滞剂（而非CCB或利尿剂）与CVD事件风险增加相关（HR [95% CI]：β受体阻滞剂1.90 [1.24，2.89]; CCB 1.02 [0.77，1.34];利尿剂1.06 [0.86，1.31]）;观察到CVD事件/复发或死亡的HR相似。在无CKD的退伍军人中，与所有其他类别相比，ACEi/ARB与较低的心力衰竭事件风险相关（HR [95% CI]：β受体阻滞剂1.52 [1.11，2.09]; CCB 1.48 [1.00，2.19];利尿剂1.52 [1.07，2.16]）。总之，我们观察到PWH伴高血压患者的CVD事件发生率较高，β受体阻滞剂用于初始高血压管理的患病率较高，即使在无适应症的患者中也是如此。我们的研究结果强调了β受体阻滞剂的潜在危害和ACEI/ARB在PWH高血压管理中的潜在益处。需要前瞻性和随机试验来证实这些发现。
Given unique pathways contributing to hypertension among People with HIV (PWH), we sought to determine whether antihypertensive class was associated with cardiovascular disease (CVD) events among PWH. Among veterans with HIV and incident hypertension (2000-2018), we used propensity score-matching to evaluate risk of 1) incident/recurrent CVD or death, 2) incident CVD and 3) incident heart failure by antihypertensive class. In supplementary analyses, we performed stratified analyses by race and CKD status. Among 8041 veterans, 24% were initiated on angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACEi/ARB) monotherapy, 23% on thiazide/thiazide-like diuretic monotherapy, 13% on β-blocker monotherapy, and 11% on calcium channel blocker (CCB) monotherapy. Over a median of 6.5 years, 25% experienced a CVD event. β-blockers, but not CCBs or diuretics, were associated with an increased risk of incident CVD compared with ACEs/ARBs (HR [95% CI]: β-blockers 1.90 [1.24, 2.89]; CCBs 1.02 [0.77, 1.34]; diuretics 1.06 [0.86,1.31]); similar HR were noted for incident/recurrent CVD or death. In veterans without CKD, ACEi/ARBs were associated with a lower risk of incident heart failure compared with all other classes (HR [95% CI]: β-blockers 1.52 [1.11, 2.09]; CCBs 1.48 [1.00, 2.19]; diuretics 1.52 [1.07, 2.16]). In conclusion, we observed high rates of CVD events in PWH with hypertension and a high prevalence of β-blocker use for initial hypertension management, even among those without indications. Our findings highlight the potential harm associated with β-blockers and the possible benefit associated with ACEI/ARBs for hypertension management in PWH. Prospective and randomized trials are needed to confirm these findings.