The Impact of Hypertension and Use of Calcium Channel Blockers on Tuberculosis Treatment Outcomes. (24th September 2020)

• Record Type: Journal Article
• Authors: Chidambaram, Vignesh; Gupte, Akshay; Wang, Jann-Yuan; Golub, Jonathan E; Karakousis, Petros C
• Is Part Of: Clinical infectious diseases. Volume 73:Number 9(2021)
• Page Start: e3409
• Page End: e3418
• Publication Date: 2020-09-24
• Subjects: tuberculosis -- hypertension -- calcium channel blockers -- mortality -- treatment outcomes; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1446
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Hypertension induces systemic inflammation, but its impact on the outcome of infectious diseases like tuberculosis (TB) is unknown. Calcium channel blockers (CCB) improve TB treatment outcomes in preclinical models, but their effect in patients with TB remain unclear. Methods: This retrospective cohort study, including all patients > 18 years receiving treatment for culture-confirmed, drug-sensitive TB from 2000 to 2016 at the National Taiwan University Hospital, assessed the association of hypertension and CCB use with all-cause and infection-related mortality during the first 9 months of TB treatment, as well as sputum smear microscopy and sputum culture positivity at 2 and 6 months. Results: Of the 2894 patients, 1052 (36.4%) had hypertension. A multivariable analysis revealed that hypertension was associated with increased mortality due to all causes (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.23–1.99) and infections (HR, 1.87; 95% CI, 1.34–2.6), but there were no statistical differences in microbiological outcomes when stratified based on hypertensive group. Dihydropyridine-CCB (DHP-CCB) use was associated only with reduced all-cause mortality (HR, 0.67; 95% CI, .45–.98) by univariable Cox regression. There were no associations between DHP-CCB use and infection-related mortality (HR, 0.78; 95% CI, .46–1.34) or microbiological outcomes in univariable or multivariable regression analyses. Conclusions: Patients with hypertension have increased all-cause mortality and infection-related mortality during the 9 months following TB treatment initiation. DHP-CCB use may lower all-cause mortality in TB patients with hypertension. The presence of hypertension or the use of CCB did not result in a significant change in microbiological outcomes. Abstract : Hypertension is associated with increased all-cause and infection-related mortality during the first 9 months after tuberculosis treatment initiation, with no significant change in microbiological outcomes. Calcium-channel blocker (CCB) use may lower all-cause mortality in tuberculosis patients with hypertension.