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Increased CVD Risk With ß-Blockers for HTN in Veterans With HIV

MONDAY, April 5, 2021 -- For veterans with HIV and hypertension, the rate of cardiovascular disease (CVD) events is high and is increased in association with ß-blocker use, according to a study published online April 5 in Hypertension.

Leah B. Rethy, M.D., from the University of Pennsylvania in Philadelphia, and colleagues used propensity matching to examine the risk of incident/recurrent CVD or death, incident CVD, and incident heart failure by antihypertensive class among veterans with HIV and incident hypertension (2000 to 2018).

Of 8,041 veterans, 24, 23, 13, and 11 percent were initiated on angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker (ARB) monotherapy, thiazide/thiazide-like diuretic monotherapy, ß-blocker monotherapy, and calcium channel blocker monotherapy, respectively. The researchers found that 25 percent experienced a CVD event over a median of 6.5 years. Increased risk of incident CVD was seen in association with ß-blockers but not calcium channel blockers or diuretics compared with ACE inhibitors/ARBs (hazard ratio, 1.90 for ß-blockers); similar hazard ratios were seen for incident/recurrent CVD or death. ACE inhibitors/ARBs were associated with a lower risk of incident heart failure compared with all other classes among veterans without chronic kidney disease (hazard ratios, 1.52, 1.48, and 1.52 for ß-blockers, calcium channel blockers, and diuretics, respectively).

"Patients with HIV need heightened attention to their elevated risk of heart disease," a coauthor said in a statement. "More dedicated research studying the unique needs for people with HIV and those taking antiretroviral therapies is needed in order to optimize cardiovascular prevention."

One author disclosed financial ties to the pharmaceutical industry.

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