{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T21:25:36Z","timestamp":1768857936900,"version":"3.49.0"},"posted":{"date-parts":[[2026,1,15]]},"group-title":"HIV\/AIDS","reference-count":36,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,1,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are established antihypertensive treatments that reduce cardiovascular disease (CVD) risk. However, their comparative effectiveness in people with HIV (PWH) is not well examined. This study evaluated the comparative effectiveness of ACEIs and ARBs head-to-head and versus no antihypertensive treatment in preventing primary CVD.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using a target trial emulation framework and data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD), we estimated observational analogs of intention-to-treat (ITT) and per-protocol (PP) effects of antihypertensive treatments in preventing primary CVD (myocardial infarction, non-MI coronary artery disease, stroke, transient ischemic attack, peripheral vascular disease, cardiovascular death) among hypertensive PWH, with subgroup analyses for Black and White PWH.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared with no antihypertensive treatment, ACEIs and ARBs were both associated with lower CVD risk in PWH, with similar effect sizes in ITT and PP analyses (ACEI ITT adjusted hazard ratio (HR): 0.79, 95% CI [0.70-0.89]; ACEI PP: 0.71 [0.55-0.90]; ARB ITT: 0.87 [0.65-1.16]; ARB PP: 0.37 [0.18-0.76]). Race-stratified ITT and PP analyses suggested somewhat greater risk reductions in White than Black PWH, although differences were not statistically significant. In head-to-head comparisons, ACEIs and ARBs showed comparable effectiveness overall (ITT: 1.14 [0.84-1.55]; PP: 0.54 [0.25-1.18]), and within race strata.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our study found that both ACEIs and ARBs were effective in reducing CVD risk among PWH, with similar effectiveness observed for both medications. The analysis did not reveal statistically significant differences in effectiveness between Black and White PWH for either drug.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.01.12.26343966","type":"posted-content","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T16:00:12Z","timestamp":1768492812000},"source":"Crossref","is-referenced-by-count":0,"title":["Comparative Effectiveness of ACE Inhibitors and Angiotensin Receptor Blockers for Cardiovascular Disease Prevention in People Living with HIV and Hypertension"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4393-0836","authenticated-orcid":false,"given":"Tom","family":"Forzy","sequence":"first","affiliation":[{"name":"Epidemiology, Biostatistics and Prevention Institute, Department of Epidemiology, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henock G.","family":"Yebyo","sequence":"additional","affiliation":[{"name":"Epidemiology, Biostatistics and Prevention Institute, Department of Epidemiology, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory M.","family":"Lucas","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huldrych F.","family":"G\u00fcnthard","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland"},{"name":"Institute of Medical Virology, University of Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1717-2592","authenticated-orcid":false,"given":"Catherine R.","family":"Lesko","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent C.","family":"Marconi","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Emory University School of Medicine and Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy R.","family":"Sterling","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Silverberg","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Pleasanton, CA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maile Y.","family":"Karris","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Horberg","sequence":"additional","affiliation":[{"name":"Kaiser Permanente and Care Management Institute, Mid-Atlantic Permanente Medical Group, Washington DC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia","family":"Napravnik","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5068-6595","authenticated-orcid":false,"given":"Keri N.","family":"Althoff","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Milo A.","family":"Puhan","sequence":"additional","affiliation":[{"name":"Epidemiology, Biostatistics and Prevention Institute, Department of Epidemiology, University of Zurich, Zurich, Switzerland"},{"name":"Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026011900051288000_2026.01.12.26343966v1.1","doi-asserted-by":"crossref","unstructured":"Jamerson K , Weber MA , Bakris GL , Dahl\u00f6f B , Pitt B , Shi V , et al. 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