Tuberculosis infection and hypertension: Prevalence estimates from the US National Health and Nutrition Examination Survey
Authors: Salindri Argita D. , Auld Sara C. , Gujral Unjali P. , Urbina Elaine M. , Andrews Jason R. , Huaman Moises A. , Magee Matthew J. 
Published: May 2023

Objectives

Latent Tuberculosis infection (LTBI) is marked by dynamic host-pathogen interactions with persistent low-grade inflammation and is associated with increased risk of cardiovascular diseases (CVD) including acute coronary syndrome, myocardial infarction, and stroke. However, few studies assess the relationship between LTBI and hypertension, an intermediate of CVD. We sought to determine the association between LTBI and hypertension using data representative of the adult US population.

Methods

We performed cross-sectional analyses using data from the 2011–2012 US National Health and Nutrition Examination Survey (NHANES). Eligible participants included adults with valid QuantiFERON-TB Gold In-Tube (QFT-GIT) test results who also had blood pressure measures and no history of TB disease. LTBI was defined by a positive QFT-GIT. We defined hypertension by either elevated measured blood pressure levels (i.e., systolic ≥130mmHg or diastolic ≥80mmHg) or known hypertension indications (i.e., self-reported previous diagnosis or use of antihypertensive medications). Analyses were performed using robust quasi-Poisson regressions and accounted for the stratified probability sampling design of NHANES.

Results

The overall prevalence of LTBI was 5.7% (95%CI 4.7–6.7) and hypertension was present among 48.9% (95%CI 45.2–52.7) of participants. The prevalence of hypertension was higher among those with LTBI (58.5%, 95%CI 52.4–64.5) than those without LTBI (48.3%, 95%CI 44.5–52.1) (prevalence ratio [PR]=1.2, 95%CI 1.1–1.3). However, after adjusting for confounders, the prevalence of hypertension was similar for those with and without LTBI (adjusted PR=1.0, 95%CI 0.9 –1.1). Among individuals without CVD risk factors of elevated BMI (PRnormalBMI=1.6, 95%CI 1.2–2.0), hyperglycemia (PReuglycemia=1.3, 95%CI 1.1–1.5), or cigarette smoking (PRnon-smokers=1.2, 95%CI 1.1–1.4), the unadjusted prevalence of hypertension was higher among those with LTBI vs. no LTBI.

Conclusions

More than half of adults with LTBI in the US had hypertension. Importantly, we observed a relationship between LTBI and hypertension among those without established CVD risk factors.

Strengths and limitations

Strengths

-

These analyses were conducted using data representative of civilian, non-institutionalized US adults, and thus, provide a robust population estimate of the prevalence of latent tuberculosis infection and hypertension in the US

-

Comprehensive definitions and different cut-offs of hypertension were used (i.e., measured blood pressure level, previous diagnosis hypertension by healthcare providers) to model the association between latent tuberculosis infection and hypertension

Limitations

Our findings may not be representative to other regions with higher burdens of tuberculosis

-

The cross-sectional study design of NHANES prevented us from assessing the temporal relationship between latent tuberculosis infection and hypertension

The prevalence of hypertension was high (59%) among adults with tuberculosis infection in the U.S. In addition, we found that the prevalence of hypertension was significantly higher among adults with positive QFT without established hypertension risk factors.