Hypertension is associated with increased mortality in patients with tuberculosis in Guinea-Bissau

•Tuberculosis (TB) is associated with several non-communicable diseases.•In Guinea-Bissau, 12.8% of patients with TB have high blood pressure.•Patients with both TB and high blood pressure have higher mortality.•The highest mortality rate is seen in female patients and older patients. Tuberculosis (TB) is associated with a number of non-communicable co-morbidities, which can complicate treatment and impair outcome. The aim of this study was to assess the impact of hypertension on disease severity, treatment outcome and survival in a cohort of patients with TB. A retrospective cohort study was conducted in Guinea-Bissau. Patients newly diagnosed with TB between November 2003 and June 2016 were included. Hypertension was defined as blood pressure ≥140/90 mmHg. Disease severity was assessed using the Bandim TBscore. Survival was assessed at the end of treatment and 2 years after treatment initiation. In total, 1544 patients were included in this study. Hypertension was present in 12.8% of patients at inclusion. Patients with hypertension had slightly less severe TB, but were less likely to have a successful treatment outcome and had 64% higher mortality at 2-year follow-up (adjusted hazard ratio 1.64, 95% confidence interval 1.15–2.34). Mortality rates were highest in hypertensive female patients and patients aged ≥ 45 years. Patients with high blood pressure at the start of TB treatment had a higher mortality rate at 2-year follow-up. Mortality rates were highest in hypertensive females and patients aged ≥ 45 years.