Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV

• DOI: 10.1001/jamanetworkopen.2023.56445
• Publication Date: 2024-03-05T16:16:23Z
• Authors: Christopher T. Lo...; Kelley A. Jones; Corrilynn O. Hileman; Nwora Lance Okeke; Barbara M. Gripsh...; Angela Aifah; Gerald S. Bloomfield; Charles Muiruri; Valerie A. Smith; Rajesh Vedanthan; Allison R. Webel; Hayden B. Bosworth
• Keywords: Male; Infant, Newborn; Blood Pressure; Middle Aged; Atherosclerosis; Nurse's Role; 0302 clinical medicine; Cardiovascular Diseases; Hypertension; Humans; Female; Original Investigation; Aged

Importance Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of primary care. Objective To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non–high-density lipoprotein (HDL) cholesterol level in diverse population PWH receiving antiretroviral therapy (ART). Design, Setting, Participants This randomized clinical trial enrolled at 3 academic clinics the US from September 2019 January 2022 conducted follow-up for 12 months until 2023. Included patients were 18 years or older had confirmed diagnosis, an HIV-1 viral load less than 200 copies/mL, both hypertension hypercholesterolemia. stratified by site 1:1 either EXTRA-CVD (A Nurse-Led Intervention Extend Treatment Cascade Cardiovascular Disease Prevention) intervention group control group. Primary analyses according intention-to-treat principle. The received home BP monitoring guidance management dedicated prevention nurse 4 in-person visits (baseline 4, 8, months) frequent telephone check-ins up every 2 weeks needed. general education sessions each visits. Main Outcomes Measures Study-measured SBP was outcome, non–HDL secondary outcome. Measurements taken over assessed linear mixed models. Prespecified moderators tested sex birth, baseline site. Results A total 297 arm (n = 149) 148). median (IQR) age 59.0 (53.0-65.0) included 234 males (78.8%). Baseline mean (SD) 135.0 (18.8) mm Hg 139.9 (44.6) mg/dL. At months, participants clinically significant 4.2-mm (95% CI, 0.3-8.2 Hg; P .04) lower 16.9-mg/dL 8.6-25.2 mg/dL; < .001) compared arm. There meaningful but not statistically difference effect females (11.8–mm greater 9.6 8 5.9 months; overall joint .06). Conclusions Relevance this indicate that effectively reduced should inform future implementation multifaceted programs PWH. Trial Registration ClinicalTrials.gov Identifier: NCT03643705