Hypertension and TB

Tuberculosis infection (TBI), commonly referred to as latent TBI (LTBI), is a complex clinical state marked by low-grade inflammation and dynamic host–pathogen interactions. The prevalence of hypertension is higher among individuals with TBI (58.5%) compared to those without (48.3%), but this difference diminishes after adjusting for confounders such as age, sex, socioeconomic status, and comorbidities (adjusted prevalence ratio [aPR] 1.0). Subgroup analyses showed the association between TBI and hypertension is influenced by factors like BMI, smoking status, and glycemic control, with the effect more pronounced among those with normal BMI, euglycemia, and non-smoking status, though these associations weakened after adjustment. Notably, HIV status modifies this relationship, with individuals with both TBI and HIV showing significantly higher hypertension prevalence compared to those without HIV.[1] See also: TB and kidney function impairment

Further analyses revealed that individuals with TBI and high antigen-nil (Ag-NIL) values had the highest prevalence of hypertension. Among those with known hypertension, controlled hypertension without medication was significantly lower in individuals with positive QFT results compared to those with negative QFT, although this difference was not significant after adjustment. Hypertension prevalence was highest in those with confirmed TBI (positive QFT and TST), compared to those without infection or with discordant test results. These findings highlight the nuanced relationship between TBI and hypertension, suggesting that factors like infection status, HIV, and immune response metrics may shape cardiovascular risk in this population.[1] See also: https://tbreadingnotes.blogspot.com/2024/10/genetic-causality-between-type-2.html

Non-dihydropyridine calcium channel blockers (non-DHP-CCBs) like verapamil enhance the efficacy of bedaquiline against Mycobacterium tuberculosis by inhibiting efflux pumps and reducing bacillary load in macrophages. Hypertensive TB patients exhibit higher all-cause (HR 1.57, 95% CI 1.23–1.99) and infection-related mortality (HR 1.87, 95% CI 1.34–2.61) during the first 9 months of treatment, even after adjusting for factors such as sex, BMI, sputum acid-fast bacilli (AFB) smear positivity, cavitary disease, transplantation history, and Charlson Comorbidity Index (CCI). Male sex, lower BMI, positive sputum AFB smear, and higher CCI scores are also associated with increased mortality risk. While hypertensive and normotensive groups show similar microbiological outcomes, hypertensives have a higher baseline incidence of positive smears and cavitary disease. Notably, the use of non-DHP-CCBs is linked to improved 9-month all-cause mortality in hypertensive TB patients, underscoring the need for routine hypertension screening, particularly among elderly TB patients, to optimize treatment outcomes.[2] See also: https://tbreadingnotes.blogspot.com/2024/10/sex-differences-in-impact-of-diabetes.html

References:

1. Salindri AD, Auld SC, Gujral UP, et al. Tuberculosis Infection and Hypertension: Prevalence Estimates from the US National Health and Nutrition Examination Survey. BMJ Open. 2024;14:e075176.

2. Chidambaram, V., Gupte, A., Wang, J.Y., Golub, J.E. and Karakousis, P.C., 2021. The impact of hypertension and use of calcium channel blockers on tuberculosis treatment outcomes. Clinical Infectious Diseases, 73(9), pp.e3409-e3418.