Nurse-led strategy reduces blood pressure, cholesterol in patients with HIV

Nurse-led care and management may help lower the risk for cardiovascular events in patients with HIV infection receiving antiretroviral therapy (ART), according to study results published in JAMA Network Open.

Researchers conducted a randomized clinical trial (ClinicalTrials.gov Identifier: NCT03643705) to evaluate the effects of a multicomponent nurse-led care strategy on systolic blood pressure (BP) and non-high-density lipoprotein cholesterol (non-HDL-C) levels in patients with HIV infection receiving ART. Study patients were enrolled at 3 academic HIV clinics in the United States between September 2019 and January 2022. Eligible patients were those with undetectable HIV viral loads (<200 copies/mL) within the past year, hypertension, and hypercholesterolemia. Patients were randomly assigned 1:1 to intervention and control groups. The intervention consisted of home BP monitoring guidance and BP and cholesterol management from a dedicated prevention nurse. Patients in the control group underwent general education sessions led by a prevention nurse. Linear mixed models were used to evaluate systolic blood pressure and non-HDL-C measurements from patients in both groups, with adjustments for sex at birth, baseline atherosclerotic cardiovascular disease risk, and study site.

Among patients assigned to the intervention (n=149) and control (n=148) groups, the median age was 59 (IQR, 53-65) years, 78.8% were men, 59.3% were Black, the mean (SD) systolic BP level at baseline was 135.0 (18.8) mm Hg, and the mean non-HDL-C level at baseline was 139.9 (44.6) mg/dL.

Compared with patients in the control group, those in the intervention group exhibited significantly lower levels of systolic BP (mean difference, -4.2 mm Hg; 95% CI, -8.2 to -0.3; P =.04) and non-HDL-C (mean difference, -16.9 mg/dL; 95% CI, -25.2 to -8.6; P <.001) at 12 months. Between-group differences in systolic BP were evident as early as 4 months, whereas differences in non-HDL-C grew steadily over the 12-month follow-up period.

Further analysis of patients in the intervention group showed that women experienced clinically meaningful but not significantly greater reductions in systolic BP levels than men at 4, 8, and 12 months (all P =.06).

A total of 232 adverse events occurred among 115 patients in the total population, of which 225 (97.0%) were considered to be unrelated or unlikely to be related to study. The distribution of AEs was similar between the groups. Of 7 AEs classified as possibly, probably, or definitely related to the study, 4 occurred among patients in the intervention group. These AEs included emergency department or inpatient admission for high BP, hypotension due to mild acute kidney injury, possible angioedema due to lisinopril use, myalgia after statin reintiation, and emergency department admission for angina.

Study limitations include potential low generalizability to other populations as the analysis occurred at well-resourced academic HIV clinics, as well as potential bias due to the higher rate of attrition in the intervention arm.

According to the researchers, “[N]urse-led cardiovascular risk factor management in academic HIV clinics may lead to fewer cardiovascular events and should inform implementation of prevention programs for people with HIV.”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

By Janelle Barowski, MSN RN

References:

Longenecker CT, Jones KA, Hileman CO, et al. Nurse-led strategy to improve blood pressure and cholesterol level among people with HIV. JAMA Netw Open. 2024;7(3):e2356445. doi:10.1001/jamanetworkopen.2023.56445