Can a Nurse-Led Intervention Strategy Improve Blood Pressure and Cholesterol Levels for People With HIV?

A randomized clinical trial found that a nurse-led intervention to extend the HIV treatment cascade for cardiovascular disease prevention (EXTRA-CVD) can effectively improve systolic blood pressure (SBP) and non-high-density lipoprotein (HDL) cholesterol in patients with HIV receiving antiretroviral therapy.

People with HIV are at high risk of atherosclerotic cardiovascular disease (ASCVD). However, they often face barriers to ASCVD prevention, such as changing models of HIV primary care.

The researchers set out to determine whether EXTRA-CVD intervention could help reduce blood pressure (BP) and cholesterol. To answer this question, they enrolled 297 patients with HIV at three academic HIV clinics in the US from September 2019 to January 2022, with follow-up conducted until January 2023. Participants were 18 years or older, had a confirmed HIV diagnosis, an HIV-1 viral load less than 200 copies/mL, and both hypertension and hypercholesterolemia. The primary outcome of the study was study-measured SBP, and the secondary outcome was non-HDL cholesterol.

Participants were randomized to the EXTRA-CVD intervention group (n = 149) or the control group (n = 148). Patients in the EXTRA-CVD intervention group received home BP monitoring, as well as BP and cholesterol management from a dedicated prevention nurse at in-person visits at baseline and 4, 8, and 12 months . Participants also received telephone check-ins up to every two weeks as needed. The control group attended four in-person visits at baseline and 4, 8, and 12 months to receive general prevention education sessions from the prevention nurse.

The researchers found that participants in the EXTRA-CVD intervention group had a clinically significant 4.2-mm Hg (95% CI, 0.3-8.2 mm Hg; P = .04) lower SBP and 16.9-mg/dL (95% CI, 8.6-25.2 mg/dL; P < .001) lower non-HDL cholesterol level compared with participants in the control group. There was also a clinically meaningful but not statistically significant difference in the effect on SBP in females compared with males (11.8-mm Hg greater difference at 4 months, 9.6 mm Hg at 8 months, and 5.9 mm Hg at 12 months; overall joint test P = .06).

This study had limitations, most notably, that the trial was performed at well-resourced, major academic HIV clinics, leading to the possibility that the results may not be widely generalizable to smaller community-based clinics or HIV care outside the United States.

“Results of this trial indicate that the EXTRA-CVD strategy effectively reduced BP and cholesterol level over 12 months and should inform future implementation of multifaceted ASCVD prevention programs for people living with HIV,” the study authors concluded.

Reference

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.