Beta-Blockers May Raise Heart Risks for HIV Patients With Hypertension

By Matthew Phelan

April 21, 2021

NEW YORK (Reuters Health) - The use of beta-blockers as a blood pressure treatment could increase the risk of heart disease for HIV patients, according to an analysis of data from the U.S. Veterans Health Administration.

Researchers reviewed records for more than 8,000 veterans with HIV, of whom three-quarters were on antiretroviral medications, which are known to raise the likelihood of hypertension and related cardiac issues.

"Our findings highlight the potential harm associated with beta-blockers and the possible benefits associated with" angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor blockers (ACEi/ARBs) "for hypertension management in people with HIV," the team writes in the journal Hypertension.

"A lot of infectious-disease doctors do a great job managing their patients with HIV," lead author Dr. Jordana Cohen of the University of Pennsylvania's Perelman School of Medicine, in Philadelphia, told Reuters Health by phone. "Then they take on the role of needing to be their patient's primary-care doctor, because that's the nature of HIV. It's just such an all-encompassing disease."

"Many of these doctors may have been trained years, decades ago, back when beta-blockers were thought to be a good first-line agent," she said. "But we've learned since then that they're not."

At baseline, 82% of the 8,041 veterans in the study had been prescribed a single antihypertensive medication. Thirteen percent of these patients were given beta blockers; 11% were prescribed calcium-channel blockers; 24%, ACEi/ARBs; and 23%, diuretics.

The average age of the total group was 53 years, nearly all were men and half were Black. All had developed high blood pressure between 2000 and 2018, and 81% had not been previously diagnosed with cardiovascular problems.

Dr. Cohen's team tracked the appearance of ischemic heart disease (myocardial infarction, angina, percutaneous coronary intervention or coronary artery bypass), stroke or heart failure over a median of 6.5 years.

Within this timeframe, a quarter of the patients experienced one of these events. Compared with ACEi/ARBs, beta-blockers were associated with significantly greater risks of incident or recurrent cardiovascular disease (CVD) or death (adjusted hazard ratio, 1.54), incident CVD or death (aHR, 1.79) and incident CVD (aHR, 1.90) after propensity-score matching.

The risks with calcium-channel blockers and diuretics were not significantly different from that seen with ACEi/ARBs.

For the subset of HIV patient-veterans without chronic kidney disease, ACEi/ARBs therapy was linked to a significantly lower risk of heart failure than when other another antihypertensive was used.

"I think the strengths are the numbers," Dr. Priscilla Hsue, chief of the cardiology division at Zuckerberg San Francisco General Hospital, told Reuters Health by phone. "It looks like they tried to do a lot of propensity-score weighting. They did look at some HIV disease characteristics."

However, Dr. Hsue, who has founded an HIV cardiology clinic in the Bay Area, noted that the researchers did not compare their HIV patients to the pool of veteran-patients without HIV who were also prescribed beta-blockers.

"Was the risk associated with the initiation of beta-blocker therapy more enhanced in HIV as opposed to all the patients who don't have HIV? They have that data; they're not presenting it here. So, we don't know if it's an HIV-specific effect," she said.

While the authors note that prospective and randomized trials will be needed to confirm their findings, Dr. Cohen anticipates that any HIV-specific effects are likely to stem from "inflammation and fibrosis that happen with high blood pressure and are accelerated with HIV."

"Those just aren't as well targeted by beta-blockers," Dr. Cohen said.

SOURCE: Hypertension, online April 5, 2021.