Young adult cancer survivors show high incidence of high blood pressure

Presenter: Ericka Miller, BS, BA, of William & Mary College, Williamsburg, VA

High blood pressure appears to be common in young adult cancer survivors, according to a study conducted by Ericka Miller, BS, BA, and colleagues at William & Mary College, Williamsburg, VA, and presented at the 2023 American College of Cardiology annual meeting.1

High blood pressure is common among cancer survivors and is a leading modifiable risk factor for adverse cardiovascular outcomes in these patients.2,3 In the general population, it affects 14% of those between age 12 and 19 and 22% of those between age 18 and 39. However, its burden has not been fully examined among survivors of childhood, adolescent, or young adult-onset cancer.

Miller et al used established guidelines to examine blood pressure in a group of young adult-onset cancer patients diagnosed at up to age 18 years who received anthracycline-based chemotherapy at Virginia Commonwealth University. Patients with causes for secondary hypertension were excluded. Cumulative doxorubicin isotonic equivalent dose, outpatient clinical blood pressure measurements, and blood pressure medication usage were manually extracted from patients’ clinical records.

Based on congruence between pediatric and adult blood pressure definitions, blood pressure measurements recorded after completion of all cancer therapy and at or above 13 years of age were included. A minimum of 2 abnormal blood pressure readings within a 12-month period were required to make the diagnosis of elevated blood pressure. Prevalence of abnormal blood pressure was stratified based on race, sex, and age.

The incidence of high blood pressure (categorized as elevated blood pressure [120–129/< 80 mm Hg], stage 1 hypertension [130–139/80–89 mm Hg], and stage 2 hypertension [≥ 140/≥ 90 mm Hg] were determined. Mixed effects regression was used to identify clinical factors associated with blood pressure.

Out of 206 patients, 142 had at least 2 post-treatment blood pressure measurements within 12 months and between the ages of 13 and 39. The median age of cancer diagnosis was 20.5 years. Median doxorubicin isotonic equivalent dose was 200 mg/m2.

All told, 87 (61%) of the patients had abnormal blood pressure: 15.5% had elevated blood pressure, 30% had stage 1 hypertension, and 15.5% had stage 2 hypertension. One-third of patients developed abnormal blood pressure before age 20. There was no statistically significant difference in the prevalence of abnormal blood pressure based on sex or race. Twenty-nine of the 142 patients (20.4%) were taking antihypertensive medication.

Ms. Miller concluded: “The incidence of abnormal blood pressure is increased among young adult-onset cancer patients compared with the general population at a similar age. The onset occurs at a very young age (under 20 years) in a large number of young adult-onset cancer patients. Antihypertensive medication appears to be underutilized in this population.”

Recognition that blood pressure abnormalities may be common among young survivors can allow for early detection and cardiovascular risk reduction, she added.

Ms. Miller noted some limitations of the study. This retrospective analysis did not account for all risk factors for hypertension, including obesity, smoking, and sedentary lifestyle, as well as socioeconomic factors and additional cardiovascular risk factors. Future studies should include a larger cohort and account for these other risk factors, she said.

“Blood pressure screening and treatment may reduce the future cardiovascular disease burden in these patients,” said Ms. Miller. 

References

  1. Miller E, Hang Y, Menachery S, et al. Incidence of elevated/hypertensive blood pressure among young adults previously treated for cancer (abstract). J Am Coll Cardiol 2023 Mar; 81(8 Suppl):2218. doi:10.1016/S0735-1097(23)02662-1
  2. Cohen JB, Brown NJ, Brown SA, et al; American Heart Association Council on Hypertension; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on the Kidney in Cardiovascular Disease. Cancer therapy-related hypertension: a scientific statement from the American Heart Association. Hypertension 2023; 80(3):e46–e57. doi:10.1161/HYP.0000000000000224
  3. Cohen JB, Geara AS, Hogan JJ, et al. Hypertension in cancer patients and survivors: epidemiology, diagnosis, and management.  JACC CardioOncol 2019; 1(2):238–251. doi:10.1016/j.jaccao.2019.11.009

Disclosures:

Ericka Miller: Nothing to disclose

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