Abstract Body: Introduction: Patients with HIV are at high risk for hypertension (HTN) and its associated adverse cardiovascular (CV) outcomes. It is attributed to metabolic risk factors from HIV and antiretroviral therapy (ART).

Hypothesis: We compare CV outcomes of HTN in patients with HIV.
Methods: This retrospective cohort study using TriNetX, analyzed patients aged ≥18 years from 1/1/2007 to 5/25/2025. After propensity matching, the study included 76,610 patients in each group. The mean age was 48 years (70% male, 29% female, 1% unknown). Risk Ratios (RR), Hazard Ratios (HR), 95% confidence intervals (CI), and p-values were computed for various outcomes. The outcomes including all-cause mortality, HF, acute myocardial infarction (AMI), stroke, kidney failure, atrial fibrillation/flutter (AF), ventricular tachycardia (VT) and ventricular fibrillation (VF) in two cohorts.
Results: All-cause mortality risk was slightly lower in cohort 1 at 7.818% vs 7.859% in cohort 2 with RR 0.995, 95% CI: 0.961, 1.029, p-value 0.7610, HR of 0.787, 95% CI: 0.759, 0.816, p-value less than 0.0001. The incidence of HF was significantly higher in cohort 1 (8.726%) vs cohort 2 (3.45%), with an RR of 2.529 (95% CI: 2.421, 2.643) and HR of 2.146 (95% CI: 2.051, 2.245), both with p-values <0.0001. AMI incidence was also higher in cohort 1 (4.228%) vs cohort 2 (1.231%), with RR 3.435, 95% CI: 3.197, 3.69, HR of 2.816, 95% CI: 2.619, 3.028, both with p-values <0.0001. The incidence of stroke was higher in cohort 1 (5.079%) versus cohort 2 (1.632%), with RR of 3.113 (95% CI: 2.923, 3.315) and HR of 2.601 (95% CI: 2.44, 2.772), both with p-values <0.0001. Kidney failure also showed a significantly higher risk in cohort 1 (RR = 2.222, 95% CI: 2.168, 2.276; HR = 2.018, 95% CI: 1.965, 2.071), p-value <0.0001. For AF, the RR was 2.102 (95% CI: 1.982, 2.229) and HR was 1.739 (95% CI: 1.639, 1.846), both with p-values <0.0001.VT showed an RR of 2.943 (95% CI: 2.602, 3.33) and HR of 2.357 (95% CI: 2.082, 2.668), with p-values <0.0001. The incidence of VF was higher in cohort 1 (0.251%) than cohort 2 (0.076%), with RR of 3.31 (95% CI: 2.468, 4.44) and HR of 2.636 (95% CI: 1.965, 3.537), p-value = 0.0078.
Conclusion: This study highlights the significantly higher risks of cardiovascular and renal complications in HIV patients with hypertension. Further research is needed to explore the underlying mechanisms and interventions to mitigate the impact of hypertension in this high-risk group.