Department of Emergency Medicine (C.-C.L., M.-t.G.L., S.-C. Chen), National Taiwan University Hospital, Taipei.
Center of Intelligent Healthcare, National Taiwan University Hospital, Taipei (C.-C.L.).
Hypertension. 2021 Feb;77(2):328-337. doi: 10.1161/HYPERTENSIONAHA.120.15534. Epub 2020 Dec 14.
Calcium channel blockers (CCBs) are known to reduce the availability of iron-an important mineral for intracellular pathogens. Nonetheless, whether the use of CCBs modifies the risk of active tuberculosis in the clinical setting remains unclear. To determine whether CCBs may modify the risk of active tuberculosis disease, we conducted a nested case-control study using the National Health Insurance Research Database of Taiwan between January 1999 and December 2011. Conditional logistic regression and disease risk score adjustment were used to calculate the risk of active tuberculosis disease associated with CCB use. Subgroup analyses investigated the effect of different types of CCBs and potential effect modification in different subpopulations. A total of 8164 new active tuberculosis cases and 816 400 controls were examined. Use of CCBs was associated with a 32% decrease in the risk of active tuberculosis (relative risk [RR], 0.68 [95% CI, 0.58-0.78]) after adjustment with disease risk score. Compared with nonuse of CCBs, the use of dihydropyridine CCBs was associated with a lower risk of tuberculosis (RR, 0.63 [95% CI, 0.53-0.79]) than nondihydropyridine CCBs (RR, 0.73 [95% CI, 0.57-0.94]). In contrast, use of β-blockers (RR, 0.99 [95% CI, 0.83-1.12]) or loop diuretics (RR, 0.88 [95% CI, 0.62-1.26]) was not associated with lower risk of tuberculosis. In subgroup analyses, the risk of tuberculosis associated with the use of CCBs was similar among patients with heart failure or cerebrovascular diseases. Our study confirms that use of dihydropyridine CCBs decreases the risk of active tuberculosis.
钙通道阻滞剂（CCB）已知可降低铁的含量——一种对细胞内病原体很重要的矿物质。尽管如此，在临床环境中，CCB 的使用是否会改变活动性结核病的风险尚不清楚。为了确定 CCB 是否可能改变活动性肺结核病的风险，我们使用台湾国家健康保险研究数据库在 1999 年 1 月至 2011 年 12 月期间进行了一项嵌套病例对照研究。使用条件逻辑回归和疾病风险评分调整来计算与 CCB 使用相关的活动性肺结核病的风险。亚组分析调查了不同类型的 CCB 的影响以及不同亚群中的潜在效应修饰。共检查了 8164 例新发活动性肺结核病例和 816400 例对照。经疾病风险评分调整后，CCB 的使用与活动性肺结核的风险降低 32%相关（相对风险 [RR]，0.68 [95%CI，0.58-0.78]）。与未使用 CCB 相比，使用二氢吡啶 CCB 与结核病风险降低相关（RR，0.63 [95%CI，0.53-0.79]），而非二氢吡啶 CCB（RR，0.73 [95%CI，0.57-0.94]）。相比之下，β受体阻滞剂（RR，0.99 [95%CI，0.83-1.12]）或袢利尿剂（RR，0.88 [95%CI，0.62-1.26]）的使用与结核病风险降低无关。在亚组分析中，在心力衰竭或脑血管疾病患者中，与 CCB 使用相关的结核病风险相似。我们的研究证实，使用二氢吡啶 CCB 可降低活动性肺结核的风险。
