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Hypertension management outcomes in people with HIV (PWH) are not well characterized, despite high hypertension burden. We assessed hypertension prevalence, incidence, treatment, and outcomes among patients with HIV at a clinical center in the southeastern US, from 2014 to 2019. To identify characteristics associated with treatment and outcomes, we estimated adjusted risk ratios (aRR) and 95% confidence intervals (CI). Among 2274 patients, 72% were cisgender men, 56% non-Hispanic Black, median age 47 years, 48% MSM, 12% had CD4 cell count &lt;200 cells/μl, 72% HIV RNA level &lt;400 copies/mL and 39% prevalent hypertension. Hypertension incidence rate was 6.3/100 person-years (95% CI, 5.6–7.0). Among incident hypertension cases ( n  = 275), 16% (95% CI, 11–20) initiated an antihypertensive within one year. Compared to non-Hispanic white patients, Hispanic (aRR, 6.68; 95% CI, 1.50–29.74) and non-Hispanic Black patients (aRR, 2.18; 95% CI, 0.91–5.24) were more likely to initiate an antihypertensive. Among patients initiating an antihypertensive ( n  = 178), 63% (95% CI 56–70) experienced blood pressure control within one year. Patients with HIV experienced a high burden of hypertension with notable delays in antihypertensive initiation, as well as gaps in achieving blood pressure control, highlighting opportunities for interventions designed to minimize delays in controlling hypertension in this vulnerable population.

Hypertension burden, treatment, and control among people with HIV at a clinical care center in the Southeastern US, 2014–2019