Hypertension may compromise anti-HCV therapy success

Among patients chronically infected with hepatitis C virus (HCV), presenting with elevated blood pressure during initiation of antiviral therapy is associated with treatment failure, according to a study presented at the Asian Pacific Society of Cardiology (APSC) Congress 2019.

Furthermore, failure to achieve sustained virologic response (SVR) is correlated with the presence of high viral load, the authors said.

The study included 440 treatment-naïve chronic HCV (CHC) patients, among whom 118 (26.8 percent) had high blood pressure or actively used antihypertensive drugs.

Hypertensive and normotensive patients differed significantly in terms of age (57.5 vs 51.6 years), proportion of men (40.7 percent vs 53.4 percent), body mass index (BMI; 25.9 vs 24.2 kg/m²) and triglyceride levels (107.4 vs 95.3 mg/dl), fibrosis scores (3.8 vs 3.1), comorbidity with hyperlipidaemia (17.8 percent vs 4.7 percent) and diabetes (21.2 percent vs 12.1 percent), and SVR rate (75.4 percent vs 84.5 percent).

Multivariable logistic regression models showed that hypertension in CHC was significantly associated with older age (odds ratio [OR], 1.06, 95 percent CI, 1.03–1.09; p<0.001), high BMI (OR, 1.13, 1.05–1.20; p<0.001) and hyperlipidaemia (OR, 4.48, 2.05–9.80; p<0.001). [APSC 2019, poster 26]

The presence of hypertension at antiviral therapy initiation almost halved the chances of achieving SVR (OR, 0.56, 0.33–0.94; p=0.030). Other significant predictors of treatment failure in CHC were higher HCV RNA log (OR, 0.67, 0.57–0.79; p<0.001), higher total cholesterol levels (OR, 0.99, 0.98–0.99; p=0.030), nongenotype 1 HCV (OR, 0.67, 0.57–0.79; p<0.001) and diabetes (OR, 0.45, 0.24–0.82; p=0.009).

Of note, higher HCV RNA log was confirmed to be associated with reduced odds of SVR among hypertensive CHC patients (OR, 0.71, 0.53–0.95; p=0.025).

“It is reported that patients with CHC are more likely to have high blood pressure and other diseases related to glucose and lipid metabolism. High blood pressure is considered as an extrahepatic manifestation of CHC,” the authors noted.

The present data indicate that hypertension may compromise the success of antiviral therapy in CHC patients, especially among those with high viral load, they added.