Can statin therapy influence the risk and cardiovascular outcomes in patients with HIV? A prespecified secondary analysis of the REPRIEVE trial, published in The Lancet HIV, evaluated the incidence of hypertension and its association with cardiovascular outcomes among people with HIV receiving pitavastatin for primary prevention. 

REPRIEVE was a global, randomized, double-blind, placebo-controlled trial enrolling adults aged 40-75 years with HIV on stable antiretroviral therapy and low-to-moderate atherosclerotic cardiovascular risk. This analysis included 4989 participants without hypertension at baseline, excluding those with prior hypertension, antihypertensive use, or elevated baseline blood pressure (systolic ≥140 mm Hg or diastolic ≥90 mm Hg). The primary outcome was incident hypertension, and its association with major adverse cardiovascular events (MACE) was evaluated using time-updated models.

Participants had a median age of 49 years, and 29% were women. Over a median follow-up of 5.0 years, 668 participants (13%) developed hypertension. Pitavastatin was associated with a lower incidence of hypertension compared with placebo (24.7 vs 29.6 per 1000 person-years), corresponding to a 17% relative risk reduction (hazard ratio [HR] 0.83; 95% CI 0.71-0.97; p=0.017).

Risk factors for incident hypertension included older age, higher body mass index, metabolic syndrome, reduced estimated glomerular filtration rate, and Black race in high-income regions. Among participants who developed hypertension, 87% initiated antihypertensive therapy, and 74.6% achieved control at 4 years. Incident hypertension was associated with a higher risk of MACE (subdistribution HR 2.16; 95% CI 1.32-3.52).

Pitavastatin was associated with a lower incidence of hypertension, and incident hypertension was associated with a higher cardiovascular risk during follow-up.