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Hypertension Prevalence and Control at Trial Entry in the REPRIEVE Study Population: Results From a Secondary Analysis
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Open Forum Infectious Diseases, 20 August 2026
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The prevalence of the composite hypertension outcome at REPRIEVE trial baseline was 36% (2780/7769; 95% CI, 35%-37%). Among these, 1911 (69%) individuals had preexisting hypertension, of whom 1549 were taking antihypertensive medications and 362 were not. There was a higher prevalence of uncontrolled hypertension among those not prescribed antihypertensive medications (180/362, 50% [95% CI, 45%-55%]) as compared with those taking medications (583/1549, 38% [95% CI, 35%-40%]; Table 3).
Baseline hypertension was associated with an increased risk of all MACE outcomes (Figure 4). After adjustment for region and traditional risk factors, baseline hypertension was associated with a 1.8-fold higher hazard of primary MACE (95% CI, 1.4-2.3), a 2-fold higher hazard of hard MACE (myocardial infarction, stroke, or cardiovascular death; 95% CI, 1.5-2.8), and a 2.5-fold higher hazard of stroke (95% CI, 1.5-4.1).
Abstract
Background
We evaluated baseline hypertension prevalence and control and risk of major adverse cardiovascular events (MACEs) among people with HIV in REPRIEVE who had low to moderate traditional cardiovascular disease (CVD) risk.
Methods
Hypertension at baseline was defined by (1) a preexisting diagnosis regardless of antihypertensive treatment or (2) systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg without a prior diagnosis. We estimated the prevalence of the composite hypertension and control outcomes and calculated adjusted prevalence ratios controlling for traditional CVD risk factors using log binomial regression. We explored the relationship between hypertension and MACE using cause-specific Cox proportional hazards models.
Results
Of 7769 participants enrolled from 5 regions, the median age was 50 years, and 2419 (31%) were women. The prevalence of baseline hypertension was 36% (n = 2780) with geographic variation. Among these, 1911 (69%) individuals had a preexisting hypertension diagnosis; the remainder (n = 869, 31%) were undiagnosed. Region and traditional CVD risk factors were associated with hypertension prevalence, with obese and overweight body mass index having the highest adjusted prevalence ratios (1.80 [95% CI, 1.67-1.95] and 1.38 [95% CI, 1.28-1.49], respectively). Among those with preexisting hypertension, 40% were uncontrolled, with regional variation. Hypertension at baseline was associated with an increased hazard of MACE (hazard ratio, 2.00; 95% CI, 1.57-2.55) and key components of MACE, including myocardial infarction and stroke.
Conclusions
Approximately 1 in 3 REPRIEVE participants had hypertension at baseline. Hypertension was frequently suboptimally controlled. These findings highlight the need for improved screening and optimized treatment of hypertension in people with HIV.
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