Developing high blood pressure doubled the risk of experiencing a cardiovascular event, such as a stroke or heart attack, in the REPRIEVE study of statin treatment in people with HIV, and being assigned to pitavastatin significantly reduced the risk of developing high blood pressure, study investigators reported at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) in Denver on Monday.
Most studies in HIV-negative people show that statins reduce blood pressure. Their effect on blood pressure is stronger in people with higher blood pressure or lower HDL cholesterol levels. Statins affect blood pressure by relaxing the walls of blood vessels, reducing inflammation and lowering levels of a chemical that constricts blood vessels.
Raised blood pressure can lead to a heart attack or stroke, particularly in people with coronary artery disease.
The REPRIEVE study tested the effect of a daily dose of pitavastatin on the incidence of major cardiovascular events, such as stroke and heart attack, in people with HIV who had a low-to-moderate predicted risk of these serious events at study entry.
REPRIEVE followed 7769 people with HIV randomised to receive pitavastatin or placebo for a median of five years and found that pitavastatin reduced the risk of major cardiovascular events by 36%. More than one in three participants (36%) had high blood pressure when they joined the study – it was not itself considered a major cardiovascular event – and just over half of those with high blood pressure were already taking medication to control it.
At CROI 2026, Dr Esteban Martinez of Barcelona’s Hospital Clinic presented the results of a secondary analysis looking at the impact of pitavastatin treatment on the incidence of new-onset hypertension during the REPRIEVE study. The analysis also looked at the relationship between developing high blood pressure during the study and subsequent cardiovascular events during the follow-up period.
A new diagnosis of high blood pressure (hypertension) was defined as two systolic blood pressure measurements above 140 mmHg, two diastolic blood pressure measurements above 90 mmHg, or initiation of medication to control blood pressure. Blood pressure was measured at annual visits.
The analysis was confined to 4989 REPRIEVE participants without hypertension at study entry; 30% were female, the median age was 49, just over half (51%) were taking part at study sites in high-income countries, and approximately 36% were Black.
The median systolic blood pressure was 119 mmHg, the median diastolic pressure was 76 mmHg, and 23% had elevated blood pressure, defined as a systolic pressure above 130 or a diastolic pressure above 85.
During the study, 668 participants developed high blood pressure, a rate of 27.1 cases per 1000 person-years of follow-up. The rate was significantly higher in the placebo arm of the study (29.6 vs 24.7 cases per 1000 PY). The likelihood of developing high blood pressure increased with age and body mass index.
The strongest predictor of developing high blood pressure during the study was having elevated blood pressure on study entry. People with elevated blood pressure were almost two-and-a-half times more likely to develop hypertension during the study than those with normal blood pressure, underlining the importance of taking steps such as reducing salt and alcohol intake and exercising regularly to lower blood pressure if it is above the normal range.
Obesity and elevated fasting glucose were also associated with developing high blood pressure, “reinforcing the need for integrated prevention in HIV care,” said Dr Esteban Martinez.
The analysis also showed that study participants in sub-Saharan Africa had an increased risk of developing high blood pressure. In contrast, participants in south-east and east Asia were at significantly lower risk. However, the investigators caution that the number of participants in each region was low. Black race in high-income countries was associated with a modestly increased risk of developing high blood pressure.
Taking pitavastatin reduced the risk of developing high blood pressure by 17% (hazard ratio 0.83, 95% CI 0.71, 0.97). Pitavastatin’s effect on blood pressure was consistent according to age, sex, region and body mass index.
Developing hypertension during the study doubled the risk of experiencing a major cardiovascular event, after adjusting for baseline cardiovascular risk (HR 2.1, 1.3-3.45; p=0.002).
The study investigators say that their findings provide clear information that in people with HIV, developing high blood pressure should be treated as a warning sign of raised cardiovascular risk, even in people taking statins.
Most participants (86%) who developed hypertension during the study started medication to control their blood pressure; 60% achieved blood pressure control targets within a year, and 70% within two to four years of starting antihypertensive medication.
Replying to a question from Dr Jose Arribas, REPRIEVE lead investigator Professor Stephen Grinspoon said that although antiretroviral treatment was not a focus of the analysis presented at CROI, the REPRIEVE investigators will soon publish data showing an association between integrase inhibitor treatment and incident hypertension. Approximately a quarter of participants without hypertension at baseline were taking an integrase inhibitor.
Two poster presentations at CROI 2026 highlighted the potential for increases in blood pressure after switching to an integrase inhibitor. A US study compared 689 people who had switched to an integrase inhibitor after at least six months of taking a protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) with people who continued to take a PI or NNRTI. People who switched to an integrase inhibitor had an 81% higher risk of developing high blood pressure (88.4 cases per 1000 PY vs 53.5 cases per 1000 PY).
A study of 4982 people with HIV in Uganda who had taken other antiretroviral drugs for at least two years before switching to the integrase inhibitor dolutegravir found that the risk of developing high blood pressure increased by 30% after switching. Greater weight gain during the follow-up period was associated with a greater risk of developing hypertension.
References
Grinspoon S et al. Incident hypertension in REPRIEVE: risk factors, pitavastatin effect & cardiovascular consequences. Conference on Retroviruses and Opportunistic Infections, Denver, abstract 118, 2026.
Grinspoon S et al. High baseline prevalence and suboptimal control of hypertension in the REPRIEVE trial. Conference on Retroviruses and Opportunistic Infections, Denver, abstract 676, 2026.
Mallon PW et al. Incident hypertension after switching to integrase strand transfer inhibitors–based ART. Conference on Retroviruses and Opportunistic Infections, Denver, abstract 679, 2026.
Odongpinny EAL et al. Hypertension risk in a large cohort of people living with HIV after a switch to dolutegravir. Conference on Retroviruses and Opportunistic Infections, Denver, abstract 677, 2026.
