EXTRA-CVD
Trial question
What is the role of nurse-led strategy for ASCVD prevention in patients with HIV infection?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
21.0% female
79.0% male
N = 297
297 patients (62 female, 234 male)
Inclusion criteria: adult patients with confirmed HIV infection diagnosis, viral load < 200 copies/mL, and both hypertension and hypercholesterolemia
Key exclusion criteria: receipt of antihypertensive medication for a non-hypertension reason or cholesterol-lowering medication with evidence of premedication non-HDL-C level < 100 mg/dL
Interventions
N=149 nurse-led strategy (nurse-led care coordination, home BP monitoring guidance, use of treatment algorithms)
N=148 general prevention education (nurse-led education on a topic of patient choice)
Primary outcome
Systolic blood pressure at 12 months
129.7
133.9
133.9 mmHg
100.4 mmHg
67.0 mmHg
33.5 mmHg
0.0 mmHg
Nurse-led
strategy
General prevention
education
Significant
decrease ▼
Significant decrease in SBP at 12 months (129.7 mmHg vs. 133.9 mmHg; MD -4.2, 95% CI -8.2 to -0.3)
Secondary outcomes
Significant decrease in non-high density lipoprotein cholesterol at 12 months (114.7 mg/dL vs. 132.1 mg/dL; MD -16.9, 95% CI -25.2 to -8.6)
Borderline significant increase in hypertension treatment cascade-at treatment goal (59.9% vs. 39.8%; OR 2.9, 95% CI 1 to 8.3)
Significant increase in hypercholesterolemia treatment cascade-at treatment goal (91.1% vs. 58.7%; OR 7.3, 95% CI 2.3 to 23.3)
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients with confirmed HIV infection diagnosis, viral load < 200 copies/mL, and both hypertension and hypercholesterolemia, nurse-led strategy was superior to general prevention education with respect to SBP at 12 months.
Reference
Christopher T Longenecker, Kelley A Jones, Corrilynn O Hileman et al. Nurse-Led Strategy to Improve Blood Pressure and Cholesterol Level Among People With HIV: A Randomized Clinical Trial. JAMA Netw Open. 2024 Mar 4;7(3):e2356445.
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