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

Male Infant, Newborn Blood Pressure Middle Aged Atherosclerosis Nurse's Role 03 medical and health sciences 0302 clinical medicine Cardiovascular Diseases Hypertension Humans Female Original Investigation Aged
DOI: 10.1001/jamanetworkopen.2023.56445 Publication Date: 2024-03-05T16:16:23Z
ABSTRACT
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
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