A nurse-led strategy effectively reduced blood pressure and cholesterol levels in people with HIV in a randomized trial.
People with HIV (PWH) have a higher atherosclerotic cardiovascular disease risk, but they face unique barriers to its prevention, such as changing models of HIV primary care. A randomized clinical trial published in JAMA Network Open evaluated whether the EXTRA-CVD trial, a nurse-led intervention to extend the HIV treatment cascade for cardiovascular disease prevention, would improve systolic blood pressure (SBP) and non-high-density lipoprotein (non-HDL) cholesterol levels in PWH.
Patient Characteristics
A total of 297 participants were randomized to the intervention group (n = 149) and control group (n = 148). Baseline characteristics were well-balanced between the groups. The median age was 59 years, and 78.5% were males. The baseline mean SBP was 135 mmHg, and the non-HDL cholesterol level was 139.9 mg/dL.
EXTRA-CVD Strategy Effectively Reduced SBP and Non-HDL Cholesterol Levels
The nurse-led, multicomponent EXTRA-CVD strategy comprised care coordination, home BP monitoring, evidence-based treatment algorithms, and electronic health record tools. At 12 months, participants in the EXTRA-CVD intervention group demonstrated 4.2 mmHg lower SBP (95% confidence interval (CI): 0.3–8.2 mmHg, P = 0.04) and 16.9 mg/dL lower non-HDL cholesterol level (95% CI: 8.6–25.2 mg/dL, P<0.001) compared to participants in the control group. SBP demonstrated a more rapid change than cholesterol, with a 6.4 mmHg (P = 0.002) difference evident at 4 months, while cholesterol demonstrated a slow and steady change over the 12 months.
Although the intervention group demonstrated improvements in both hypertension and cholesterol treatment cascades across all time points, the 95% confidence intervals for the point estimates were wide. The odds of control in the intervention group versus the control group were only significant for cholesterol at 12 months (odds ratio: 7.3, P<0.001). The reduction in non-HDL cholesterol was primarily driven by a decrease in triglycerides of 29.5 mg/dL (P = 0.02), while the change in low-density lipoprotein was not statistically significant.
Clinically Meaningful Sex-Based Difference in SBP Effect Observed
A clinically meaningful but not statistically significant difference in SBP effect was observed in females versus males (11.8 mmHg greater difference at 4 months, 9.6 mmHg at 8 months, and 5.9 mmHg at 12 months, overall P = 0.06). Other intervention effects were similar by sex.
Post Hoc Analysis Revealed Consistency in Intervention Outcomes
After adjusting for patient factors (sex at birth, race and ethnicity, mental health history, smoking status, insurance status, and employment status) in a post hoc sensitivity analysis, the point estimates for the outcomes remained similar to the primary analysis, although 95% confidence intervals were wider and the intervention effect did not remain significant for SBP at 12 months (P = 0.08).
Source:
Longenecker, C. T., Jones, K. A., Hileman, C. O., Okeke, N. L., Gripshover, B., Aifah, A., Bloomfield, G. S., Muiruri, C., Smith, V. A., Vedanthan, R., Webel, A. R., & Bosworth, H. B. (2024). Nurse-Led strategy to improve blood pressure and cholesterol level among people with HIV. JAMA Network Open, 7(3), e2356445. https://doi.org/10.1001/jamanetworkopen.2023.56445
