The Impact of Hypertension and Use of Calcium Channel Blockers on Tuberculosis Treatment Outcomes.
calcium channel blockers
hypertension
mortality
treatment outcomes
tuberculosis
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
02 11 2021
02 11 2021
Historique:
received:
20
07
2020
pubmed:
25
9
2020
medline:
11
11
2021
entrez:
24
9
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32971534
pii: 5911212
doi: 10.1093/cid/ciaa1446
pmc: PMC8563167
doi:
Substances chimiques
Calcium Channel Blockers
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e3409-e3418Subventions
Organisme : NIAID NIH HHS
ID : K24 AI143447
Pays : United States
Organisme : Taiwan Centers for Disease Control
ID : MOHW-105-CDC-C-114-000103
Organisme : NIAID NIH HHS
ID : UH3 AI122309
Pays : United States
Organisme : National Institute of Allergy and Infectious Diseases
Informations de copyright
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
Références
Jpn J Med. 1989 May-Jun;28(3):341-7
pubmed: 2739143
Int J Infect Dis. 2012 Feb;16(2):e130-5
pubmed: 22185828
Am J Respir Crit Care Med. 2000 Jun;161(6):1786-9
pubmed: 10852745
J Med Virol. 2016 May;88(5):852-8
pubmed: 26399974
Front Med (Lausanne). 2017 Oct 18;4:171
pubmed: 29094039
J Exp Med. 2007 Oct 1;204(10):2449-60
pubmed: 17875676
Hypertension. 2013 Oct;62(4):660-5
pubmed: 23959562
Circ Res. 2015 Aug 28;117(6):547-57
pubmed: 26156232
Am J Hypertens. 2004 Jul;17(7):568-73
pubmed: 15233975
Future Microbiol. 2015;10(8):1257-60
pubmed: 26226503
Am J Respir Crit Care Med. 2011 Jul 15;184(2):269-76
pubmed: 21512166
Clin Microbiol Infect. 2015 Jan;21(1):59-68
pubmed: 25636929
Curr HIV Res. 2020;18(3):143-153
pubmed: 32003696
Parasitol Res. 2018 Mar;117(3):689-695
pubmed: 29349623
Infect Immun. 2007 Feb;75(2):820-9
pubmed: 17145950
Int J Tuberc Lung Dis. 2019 May 1;23(5):587-593
pubmed: 31097067
Hypertens Res. 2004 Aug;27(8):541-4
pubmed: 15492472
Am J Respir Crit Care Med. 2013 Sep 1;188(5):600-7
pubmed: 23805786
Int J Infect Dis. 2019 Jul;84:127-130
pubmed: 31085315
J Immunol. 2010 Jul 1;185(1):569-77
pubmed: 20511556
Epidemiol Infect. 2017 May;145(7):1363-1367
pubmed: 28202093
Int J Tuberc Lung Dis. 2014 Jan;18(1):79-83
pubmed: 24365557
PLoS One. 2016 Feb 26;11(2):e0149326
pubmed: 26919135
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
PLoS One. 2009;4(4):e5305
pubmed: 19390594
Immunology. 2010 Nov;131(3):331-9
pubmed: 20518825
Heart Vessels. 2018 Feb;33(2):198-204
pubmed: 28803419
Dis Markers. 2017;2017:7146290
pubmed: 28757677
J Hypertens. 2003 Jul;21(7):1377-82
pubmed: 12817187
Hypertension. 2003 Dec;42(6):1206-52
pubmed: 14656957
Curr Hypertens Rep. 2016 Mar;18(3):21
pubmed: 26846785
Clin Infect Dis. 2016 Oct 1;63(7):e147-e195
pubmed: 27516382
Circ Res. 2015 Mar 13;116(6):1022-33
pubmed: 25767287
J Infect Dis. 2014 Aug 1;210(3):456-66
pubmed: 24532601
Int J Infect Dis. 2017 Mar;56:54-61
pubmed: 28027993
Antioxid Redox Signal. 2014 Jan 1;20(1):102-20
pubmed: 23472597
J Hum Hypertens. 2018 Feb;32(2):158-164
pubmed: 29289960
Int J Hypertens. 2018 Jan 29;2018:8637101
pubmed: 29623220
Circulation. 2016 Aug 9;134(6):441-50
pubmed: 27502908
Br J Pharmacol. 2014 Dec;171(24):5589-602
pubmed: 25117218