Effect of antitubercular medications on blood pressure control in chronic kidney disease patients with tuberculosis: a prospective cohort study.

BACKGROUND: Previous anecdotal reports suggested a decrease in antihypertensive medication potency after starting antitubercular medications. This interaction could be unpredictable in presence of renal failure due to increased half-lives of most commonly used antihypertensive medications. METHODS: In a cohort study involving 135 patients with chronic kidney disease (CKD), 62 patients with tuberculosis star-ted on antitubercular medications (TB group) were prospectively compared with 73 CKD controls (with no TB and not on antitubercular medications) for a change in antihypertensive medications. Antihypertensive dose was converted to unit score. RESULTS: The TB group had a greater increase in antihypertensive medication dose as compared with controls (89% vs. 54%, p<0.0001). In absolute terms an overall increase in antihypertensive medications was observed in 60% of pa-tients in the TB group, with a 2-fold dose increase from the baseline (p<0.0001). Four patients from the TB group de-veloped a hypertensive emergency. In multivariate linear regression, the association between TB group and increase in antihypertensives remained significant ( beta =0.38; p<0.0001). CONCLUSIONS: In CKD patients, antihypertensive medication potency is reduced in TB patients on antitubercular the-rapy in a significant number of patients, to a clinically significant degree with a potential risk for hypertensive emergency.