Beta-blockers raise the risk of heart disease, stroke among people with HIV

HIV patients who develop high blood pressure may face a heightened risk of heart disease, stroke or heart failure if given beta-blockers instead of other antihypertensive medications, according to new findings published in Hypertension.

“We suspected there could be differences in risk based on which medications providers select to treat hypertension among people with HIV due to potential interactions between blood pressure medications and some therapies used to treat the virus,” senior author Jordana B. Cohen, MD, an assistant professor within the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, said in a statement. “Additionally, factors such as how the body handles salt, inflammation and the accelerated aging of blood vessels may affect the risk of cardiac events in people with HIV differently than people who do not have HIV, which could be influenced by which blood pressure medication is used.”

The study included data from more than 8,000 U.S. veterans with HIV who developed high blood pressure from 2000 to 2018. At baseline, 74% of patients were already on antiretroviral medication therapy. Also, while 24% of patients were prescribed an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blockers (ARB) after the initial diagnosis, 23% were prescribed thiazide or other diuretics and 13% were prescribed beta-blockers.

“We were surprised by the high rates of beta-blockers prescribed for first-line hypertension treatment since they are not recommended as first-line agents,” Cohen said. “We suspect this may be due to the fact that many people with HIV receive primary care from their infectious disease team, who do an amazing job at managing HIV but may not be focused on blood pressure treatment guidelines and contraindications. Ideally, a patient’s primary care and infectious disease team should work together for the best possible outcomes.”

Patient outcomes were tracked for a mean follow-up period of 6.5 years. One in four patients experienced a cardiovascular event during that time.

Overall, patients on beta-blockers who had not yet been diagnosed for heart disease were more likely to develop heart disease, stroke or heart failure than patients prescribed other medications. Also, ACE inhibitors and ARBs were associated with a lower heart failure risk among patients who did not have chronic kidney disease.

“Patients with HIV need heightened attention to their elevated risk of heart disease,” Cohen added. “More dedicated research studying the unique needs for people with HIV and those taking antiretroviral medication therapy is needed in order to optimize cardiovascular prevention.”

The full analysis is available here.