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Clinical Trial
. 2025 Mar 1;39(3):261-269.
doi: 10.1097/QAD.0000000000004065. Epub 2024 Nov 13.

Treatment of prehypertension among adults with HIV

Lily D Yan  1   2 , Vanessa Rouzier  1   3 , Rodney Sufra  3 , Reichling St Sauveur  3 , Colette Guiteau  3 , Myung Hee Lee  1 , Anju Ogyu  1 , Nour Mourra  1   2 , Suzanne Oparil  4 , Michel Théard  5 , Jean Pierre Brisma  5 , Jean Patrick Alfred  6 , Marie D Deschamps  3 , Jean W Pape  3 , Margaret L McNairy  1   2
Affiliations
Clinical Trial

Treatment of prehypertension among adults with HIV

Lily D Yan et al. AIDS. .

Abstract

Objective: Elevated blood pressure (BP), even at prehypertensive levels, increases cardiovascular disease risk among people with HIV (PWH); yet international guidelines in low-income countries recommend treatment initiation at BP at least 140/90 mmHg. We determined the efficacy, feasibility, and acceptability of treating prehypertension in PWH in Haiti.

Design: An unblinded randomized clinical trial (enrolled April 2021-March 2022) with 12-month follow-up.

Setting: GHESKIO Centres, Port-au-Prince, Haiti.

Participants: Two hundred fifty adults with HIV with prehypertension (SBP 120-138 or DBP 80-89) not on medication, aged 18-65 years, virally suppressed, and without pregnancy, diabetes, or kidney disease.

Intervention: Participants were randomized to treatment (amlodipine 5 mg) or control (no amlodipine unless two BP ≥140/90 mmHg).

Main outcome measure: Primary outcome was mean change in SBP between intervention versus control groups from enrollment to 12 months.

Results: Among 250 adults, median age was 49 years, 40.8% were women. Baseline median BP was 129/78 mmHg intervention versus 128/77 mmHg control. After 12 months, the difference in mean change between study groups for SBP was -5.9 mmHg [95% confidence interval (95% CI) -8.8 to -3.0] and for DBP was -5.5 mmHg (95% CI -7.9 to -3.2). At 12 months, 5.6% intervention and 23.0% control participants developed incident hypertension (hazard ratio 0.18; 95% CI 0.07-0.47). There were no differences in viral load suppression at 12 months or drug-related serious adverse events. Intervention acceptability was high among providers and participants in qualitative interviews.

Conclusion: In PWH in a resource-poor setting, prehypertension treatment was feasible, acceptable, and effective in reducing mean SBP and incident hypertension.

Registration: Clinicaltrials.gov NCT04692467.

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Conflict of interest statement

L.Y., V.R., M.H.L., J.W.P., M.L.M. report a grant R01HL143788. R.S., R.S.S., J.W.P., M.L.M. report a grant D43TW011972. M.L.M. reports a grant K24HL163393. J.W.P. reports grants UM1AI069421 and D43TW011295. The remaining authors declare no conflicts of interest.

Figures

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Graphical abstract
Fig. 1
Fig. 1
Blood pressure trends in intervention versus control groups.
Fig. 2
Fig. 2
Incident hypertension over 12 months.
See this image and copyright information in PMC

References

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    1. Feinstein MJ, Hsue PY, Benjamin LA, Bloomfield GS, Currier JS, Freiberg MS, et al. . Characteristics, prevention, and management of cardiovascular disease in people living with HIV: a scientific statement from the American Heart Association. Circulation 2019; 140:e98–e124. - PMC - PubMed
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