Adopting new US blood pressure targets for HIV positive people could reduce cardiovascular-related deaths

A review of management of HIV positive people with high blood pressure (BP) in a large London hospital showed 42% were not well controlled but care was improved after move to new US guidelines.

This prospective audit was presented at BHIVA 2019 as a poster by G Manmathan and colleagues from the Royal Free Hospital. The audit results on 111 HIV positive patients were initially presented to staff at the clinic and 125 patients were later reaudited.

As background, hypertension is the leading risk for cardiovascular disease and in 2018 US guidelines lowered the threshold for treatment from 140/90 mmHg to 130/80 mmHg.

Mean age of 111 patients in the initial audit was 49 years (+/– 11) and 77% were men. Current ART was not linked to higher PB.

Approximately 1 in 4 (23%) were on BP treatment but only 58% were well controlled: 38% had BP >140 mmHg and 56% had > 130 mmHg. Although only 21% had a diastolic BP >90mmHg, this increased significantly to 63% when using new US guideline threshold of >80 mmHg.

The authors reported that using new guidelines resulted in more patients achieving current UK targets, although some post-audit outcomes were only slightly improved with changes unlikely to be statistically significant (26% vs 23% on medication and 36% vs 42% poorly controlled).

The authors still strongly recommended moving to new guidelines to more aggressively manage BP in HIV positive people given higher rates of hypertension and cardiaovascular risk in this younger cohort compared to the general UK population. They also concluded: “Many cardiovascular related deaths could be averted by the simple application of basic knowledge about blood pressure for which there has been broad consensus for decades”.