Blood Pressure Classification Using the 2017 ACC/AHA Guideline and Heart Failure in Patients With Cancer

Abstract

Despite the growing recognition of the importance of hypertension in patients with cancer, little is known about whether high blood pressure (BP) among patients with cancer is associated with incident heart failure (HF) and other cardiovascular disease (CVD) events and what BP levels are linked to these events. We examined the association of BP classification on the basis of the 2017 American College of Cardiology/American Heart Association BP guideline with the risk of HF and CVD events in patients with cancer.

We studied 33,991 patients with a history of breast, colorectal, or stomach cancer (median age, 53 years; 34.1% men). Patients receiving treatment with BP-lowering medications or having a history of CVD including HF were excluded. Using BP measurements at baseline, 33,991 participants were categorized as having normal BP (n = 17,444), elevated BP (n = 4,733), stage 1 hypertension (n = 7,502), or stage 2 hypertension (n = 4,312). The primary outcome was HF.

Over a mean follow-up of 2.6 ± 2.2 years, 779 HF events were recorded. After multivariable adjustment, the hazard ratios (HRs) for HF were 1.15 (95% CI, 0.93 to 1.44) for elevated BP, 1.24 (95% CI, 1.03 to 1.49) for stage 1 hypertension, and 1.99 (95% CI, 1.63 to 2.43) for stage 2 hypertension. A stepwise increase in risk with BP categories was also observed in other CVD events. This association was observed even in patients undergoing active cancer treatment. The relationship between hypertension and the risk of developing HF in patients with cancer was confirmed in the Korean National Health Insurance Service database.

Medication-naïve stage 1 and 2 hypertension was associated with a greater risk of HF and other CVD events in patients with cancer. Our results suggest the importance of multidisciplinary collaboration (eg, oncologists and cardiologists) to establish the optimal management strategy for hypertension in patients with cancer.

© 2022 by American Society of Clinical Oncology

CONTEXT

Key Objective

Although hypertension is a common comorbidity in patients with cancer, its clinical significance remains unclear. We aimed to examine the association of hypertension, using the latest US blood pressure (BP) guideline, with cardiovascular events among patients with cancer.

Knowledge Generated

Our analysis of a nationwide population-based database including 33,991 patients with a history of cancer showed that the risk for heart failure and other cardiovascular disease increased with BP categories according to the 2017 American College of Cardiology/American Heart Association BP guideline. This association was observed even in patients undergoing active cancer treatment.

Relevance

Medication-naïve stage 1 and 2 hypertension among patients with cancer was associated with a greater risk of heart failure and other cardiovascular disease events, indicating the clinical importance of BP control among patients with cancer.

SUPPORT

Supported by grants from the Ministry of Health, Labour and Welfare, Japan (21AA2007 and 20AA2005), the Ministry of Education, Culture, Sports, Science and Technology, Japan (20H03907), and Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (HI19C1211).

Conception and design: Hidehiro Kaneko, Yuichiro Yano, Katsuhito Fujiu, Hyeon Chang Kim, Hideo Yasunaga, Issei Komuro

Financial support: Hidehiro Kaneko, Katsuhito Fujiu, Hideo Yasunaga, Issei Komuro

Administrative support: Katsuhito Fujiu, Hideo Yasunaga, Issei Komuro

Provision of study materials or patients: Hideo Yasunaga, Issei Komuro

Collection and assembly of data: Hidehiro Kaneko, Hokyou Lee, Hidetaka Itoh, Satoshi Matsuoka, Hideo Yasunaga

Data analysis and interpretation: Hidehiro Kaneko, Yuichiro Yano, Hokyou Lee, Hyeok-Hee Lee, Akira Okada, Yuta Suzuki, Nobuaki Michihata, Taisuke Jo, Norifumi Takeda, Hiroyuki Morita, Akira Nishiyama, Koichi Node, Hyeon Chang Kim, Hideo Yasunaga

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Blood Pressure Classification Using the 2017 ACC/AHA Guideline and Heart Failure in Patients With Cancer

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

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Hidehiro Kaneko

Honoraria: Novartis

Taisuke Jo

Research Funding: Tsumura & Co

Akira Nishiyama

Honoraria: Daiichi-Sankyo, Bayer, Mochida Pharmaceutical Co, Ltd, Novartis, AstraZeneca, Boehringer Ingelheim, Taisho Pharmaceutical Holdings

Consulting or Advisory Role: AstraZeneca, Boehringer Ingelheim, Bayer

Research Funding: Daiichi Sankyo/UCB Japan, Boehringer Ingelheim, Taisho Pharmaceutical Holdings, Bayer

Issei Komuro

Honoraria: AstraZeneca Japan, Ono Pharmaceutical, Daiichi Sankyo Company, Ltd, Takeda, Nippon Boehringer Ingelheim, Bayer Yakuhin, Bristol Myers Squibb Company, Otsuka, Novartis

Consulting or Advisory Role: Novo Nordisk

Research Funding: Idorsia Pharmaceuticals Japan Ltd, Daiichi Sankyo Company, Ltd, Takeda, Mitsubishi Tanabe Pharma, Teijin Pharma

No other potential conflicts of interest were reported.

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