The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients

Elizabeth Louw; Nicola Baines; Gerald Maarman; Muhammad Osman; Lovemore Sigwadhi; Elvis Irusen; Coenraad Koegelenberg; Anton Doubell; Steven Nathan; Richard Channick; Brian Allwood

doi:10.1002/pul2.12184

The prevalence of pulmonary hypertension after successful tuberculosis treatment in a community sample of adult patients

Pulm Circ. 2023 Jan 1;13(1):e12184. doi: 10.1002/pul2.12184. eCollection 2023 Jan.

Authors

Affiliations

¹ Division of Pulmonology, Department of Medicine Stellenbosch University & Tygerberg Hospital Cape Town South Africa.
² Division of Medical Physiology, Department of Biomedical Sciences, CARMA: Centre for Cardio-Metabolic Research in Africa, Faculty of Medicine & Health Sciences Stellenbosch University Stellenbosch South Africa.
³ Department of Paediatrics and Child Health, Desmond Tutu TB Centre Stellenbosch University Cape Town South Africa.
⁴ Public Health, School of Human Sciences University of Greenwich London UK.
⁵ Division of Epidemiology and Biostatistics Stellenbosch University Stellenbosch South Africa.
⁶ Division of Statistics Biomedical Research and Training Institute, Zimbabwe Harare Zimbabwe.
⁷ Division of Cardiology, Department of Medicine Stellenbosch University & Tygerberg Hospital Cape Town South Africa.
⁸ The Advanced Lung Disease and Transplant Program Inova Fairfax Hospital Falls Church Virginia USA.
⁹ Pulmonary and Critical Care Division David Geffen School of Medicine Los Angeles California USA.

Abstract

There are an estimated 155 million survivors of tuberculosis (TB). Clinical experience suggests that post tuberculosis lung disease (PTLD) is an important cause of Group 3 pulmonary hypertension (PH). However, TB is not listed as a cause of PH in most guidelines. A cross-sectional, community-based study was conducted in nonhealthcare seeking adults who had successfully completed TB treatment. Subjects underwent questionnaires, spirometry, a 6-min walk distance test (6MWD) and transthoracic echocardiography (TTE). Screen probable PH was defined on TTE as an estimated pulmonary artery peak systolic pressure (PASP) of ≥40 mmHg. One hundred adults (71 males) were enrolled, with a mean age of 42 years (SD 13.8 years) and a median of one TB episode (interquartile range: 1-2). Co-morbidities included hypertension (21%), diabetes (16%), human immunodeficiency virus (10%) and asthma/COPD (5%). Only 25% had no residual symptoms after TB. Probable PH was found in 9%, while 7% had borderline raised PASP values (PASP 35-40 mmHg). An association was found between PH and the number of previous TB episodes, with each additional episode of TB increasing the odds of PH-postTB 2.13-fold (confidence interval [CI]: 1.17-3.88; p = 0.013). All of those found to have PH were smokers or ex-smokers yielding an unadjusted odds ratio for PH-postTB of 3.67 (95% CI: 0.77-17.46). There was no statistical difference in spirometry or 6MWD, between those with and without PH. Neither symptoms nor co-morbidities demonstrated significant association with PH. PH after TB was a common finding in this community-based population. Further research is needed to confirm and determine the significance of these findings.

Keywords: chronic lung disease; echocardiography; ethnic racial or social disparities in lung disease and treatment; post tuberculosis lung disease; pulmonary hypertension.