Hypertension and Subclinical Vascular Damage After Allogeneic Hematopoietic Stem Cell Transplantation.

BACKGROUND

Patients with hematological malignancies undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) face a higher risk of premature cardiovascular disease that may partly be explained by hypertension.

OBJECTIVES

The authors studied the prevalence of hypertension in alloHSCT survivors at least 1 year post-transplant.

METHODS

Two hundred survivors were clinically screened for hypertension. Hypertension was defined according to established ambulatory blood pressure monitoring (ABPM) thresholds. Subclinical vascular damage was assessed through carotid intima-media thickness by ultrasonography of the carotid arteries, pulse wave velocity, and renal function.

RESULTS

Of the 200 patients, 168 (84%) completed the 24-hour ABPM. The median age was 57 years (IQR: 46.3-65.0; range: 18-75). Of the 168 patients, 90 patients (53.6%) had hypertension, of which 26 (15.5%) were newly diagnosed, and 56 (33.3%) were untreated. Hypertensive patients by ABPM tended to be older (median 58 [IQR: 49-67] vs 55.5 [IQR: 39.75-64] years; P = 0.060), had a higher intima-media thickness (0.84 ± 0.25 vs 0.76 ± 0.26 mm; P = 0.009), higher pulse wave velocity values (9.0 ± 2.3 vs 7.3 ± 1.6 m/s; P < 0.001), and lower mean estimated glomerular filtration rate (72.3 ± 18.7 vs 80.4 ± 22.5 mL/min/1.73 m2; P = 0.010) compared to normotensive patients. In the logistic regression model, both age in years (OR: 1.03; 95% CI: 1.01-1.05; P = 0.019) and family history of cardiovascular disease and/or premature death (OR: 2.28; 95% CI: 1.17-4.44; P = 0.016) were independently associated with hypertension.

CONCLUSIONS

Hypertension is highly prevalent, underrecognized, and undertreated in alloHSCT survivors and is cross-sectionally associated with subclinical vascular and renal organ damage.