The Impact of Hypertension and Use of Calcium Channel Blockers on Tuberculosis Treatment Outcomes
The Impact of Hypertension and Use of Calcium Channel Blockers on Tuberculosis Treatment Outcomes
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DOI：
10.1093/cid/ciaa1446
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发表时间：
2021-11-01
影响因子：
11.8
通讯作者：
Karakousis, Petros C.
中科院分区：
文献类型：
--
作者：
Chidambaram, Vignesh;Gupte, Akshay;Karakousis, Petros C.
背景。高血压会引起全身炎症，但其对结核病 (TB) 等传染病结果的影响尚不清楚。钙通道阻滞剂（CCB）可改善临床前模型中的结核病治疗结果，但其对结核病患者的作用仍不清楚。方法。这项回顾性队列研究包括 2000 年至 2016 年在国立台湾大学医院接受培养证实的药物敏感性结核病治疗的所有年龄 > 18 岁的患者，评估了结核病治疗前 9 个月期间高血压和 CCB 使用与全因死亡率和感染相关死亡率之间的关系，以及第 2 个月和第 6 个月时的痰涂片镜检和痰培养阳性结果。在 2894 名患者中，1052 名（36.4%）患有高血压。多变量分析显示，高血压与各种原因（风险比[HR]，1.57；95%置信区间[CI]，1.23-1.99）和感染（HR，1.87；95% CI，1.34-2.6）导致的死亡率增加相关，但根据高血压组分层时，微生物学结果没有统计学差异。根据单变量 Cox 回归，二氢吡啶-CCB (DHP-CCB) 的使用仅与全因死亡率降低相关（HR，0.67；95% CI，.45-.98）。在单变量或多变量回归分析中，DHP-CCB 使用与感染相关死亡率（HR，0.78；95% CI，.46-1.34）或微生物学结果之间没有关联。结论。在开始结核病治疗后的 9 个月内，高血压患者的全因死亡率和感染相关死亡率增加。使用 DHP-CCB 可以降低患有高血压的结核病患者的全因死亡率。高血压的存在或 CCB 的使用不会导致微生物结果的显着变化。
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.