New Insights Into Hypertension and MACE Reduction in HIV: Steven Grinspoon, MD

Cardiovascular disease prevention in people living with HIV is entering a more nuanced phase—one that goes beyond cholesterol management alone. New findings from a randomized, placebo-controlled trial suggest that statins may reduce cardiovascular risk through multiple mechanisms, including a 17% reduction in incident hypertension.¹ Because hypertension is a major driver of myocardial infarction, cerebrovascular accident, and coronary revascularization, this additional effect may help explain the broader reductions in major adverse cardiovascular events (MACE) observed with statin therapy.²

In an interview at CROI 2026, Steven Grinspoon, MD, chief of the Metabolism Unit at Massachusetts General Hospital, director of the Nutrition Obesity Research Center, and professor of medicine at Harvard Medical School, discussed how these data expand understanding of statins’ role in HIV care. While statins are well established for lowering LDL cholesterol—and were associated in the trial with a 36% reduction in MACE—the reduction in new-onset hypertension introduces an additional pathway through which cardiovascular protection may occur.

Grinspoon noted that even incremental reductions in blood pressure incidence can translate into meaningful declines in cardiovascular events at the population level. In people living with HIV, who face elevated cardiometabolic risk due to chronic immune activation and inflammation, this added blood pressure effect may be particularly consequential.

At the same time, he emphasized that statins are not sufficient on their own. Residual inflammation persists in many patients despite lipid-lowering and contributes independently to cardiovascular risk. Chronic immune activation remains a defining feature of treated HIV infection, reinforcing the need for comprehensive risk-reduction strategies that address lipids, blood pressure, inflammation, and lifestyle factors simultaneously.

Future research, Grinspoon explained, will explore how statins interact with specific antihypertensive agents—particularly angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Investigators are especially interested in whether these combinations influence aldosterone-mediated pathways and further reduce cardiovascular events.

He also highlighted the importance of systematically identifying and treating hypertension within HIV care programs. Community-based implementation studies could help determine how structured blood pressure management strategies affect cardiovascular outcomes in real-world settings.

Clinically, Grinspoon advocated for statin therapy as a foundational preventive strategy for adults aged 40 to 75 living with HIV, with additional targeted approaches for those with excess inflammation or uncontrolled blood pressure. The evolving framework places statins at the center of care—while reinforcing that durable cardiovascular risk reduction in HIV will require coordinated, multidimensional management.

References

1. Grinspoon S, Watanabe M, Hoffman R, et al. Incident hypertension in REPRIEVE: risk factors, pitavastatin effect & cardiovascular consequences. Presented at: Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO. Poster 118.

2. Grinspoon S, Umbleja T, deFillippi C, et al. Relationship of inflammatory, cardiac, and lipid biomarkers to cardiovascular events in REPRIEVE. Presented at: Conference on Retroviruses and Opportunistic Infections; February 22-25, 2026; Denver, CO. Poster 117.