The impact of hypertension and use of CCBs on TB treatment outcomes

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.

  • Non-dihydropyridine calcium channel blockers (non-DHP-CCBs) like verapamil enhance the effectiveness of bedaquiline against Mycobacterium tuberculosis by inhibiting efflux pumps, reducing bacillary load in macrophages.
  • Hypertensive patients show higher all-cause mortality compared to normotensive patients, with a hazard ratio (HR) of 1.57 (95% CI, 1.23–1.99) after adjusting for factors like sex, BMI, sputum acid-fast bacilli (AFB) smear positivity, cavitary disease, past transplantation history, and Charlson Comorbidity Index (CCI).
  • Increased 9-month all-cause mortality is also associated with male sex, lower BMI, positive sputum AFB smear, and higher CCI score.
  • Patients with hypertension also have a significantly higher hazard of infection-related mortality (HR, 1.87; 95% CI, 1.34–2.61) during the first 9 months of TB treatment, indicating hypertension as an independent predictor of poor outcomes.
  • Despite similar microbiological outcomes between hypertensive and normotensive groups, hypertensives had a higher incidence of positive smears and cavitary disease at baseline.
  • The use of non-DHP-CCBs has been linked to improved 9-month all-cause mortality in hypertensive TB patients.
  • Emphasis on the importance of hypertension screening in TB patients, particularly the elderly, to improve treatment outcomes. 

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