Abstract PR15: Longitudinal characterization of hypertension in childhood cancer survivors: A report from the St. Jude Lifetime Cohort Study
Authors: Gibson Todd M. , Ness Kirsten K. , Armstrong Gregory T. , Green Daniel M. , Mulrooney Daniel A. , Ojha Rohit P. , Srivastava Deo Kumar , Hudson Melissa M. , Robison Leslie L. 
Published: May 2016

Abstract
Objective: Hypertension markedly increases the risk for heart failure and cardiovascular disease in childhood cancer survivors exposed to cardiotoxic treatments (chest radiation, anthracyclines). Characterization of longitudinal patterns of hypertension in aging survivors can inform prevention and control interventions in this high risk group.
Materials and Methods: We examined hypertension in 2807 participants (52% male; mean age 32.3 ± 8.4 years) in the St. Jude Lifetime Cohort (SJLIFE), an ongoing longitudinal follow-up study of childhood cancer survivors who were ≥18 years old and had survived at least 10 years after childhood cancer. Resting blood pressure was measured by standardized protocol at each SJLIFE visit and categorized as normal (&lt;120/&lt;80 mm Hg), prehypertensive (120-139/80-89 mm Hg), or hypertensive (≥140/≥90 mm Hg, or prescription of anti-hypertensive medication). Changes in blood pressure status were examined among 878 participants with multiple SJLIFE visits (median interval between visits 3.2 ± 1.1 years), and multivariable logistic regression models including sex, race/ethnicity, age, follow-up time, and receipt of cardiotoxic treatment were used to determine odds ratios and 95% confidence intervals (OR, 95% CI) for associations between participant characteristics and blood pressure status.
Results: The cumulative prevalence of hypertension was 15% by age 30, 44% by age 40, and 78% by age 50, with no statistically significant difference between those exposed and unexposed to cardiotoxic treatments during childhood. The overall prevalence of prehypertension and hypertension was 42% and 29%, respectively. Undiagnosed hypertension was found in 351 (13%) participants. Characteristics significantly associated with undiagnosed hypertension included male sex (OR 3.4, 95% CI 2.6-4.4), black race (1.8, 1.3-2.4), older age (1.4, 1.3-1.5 per 5 years), and receipt of cardiotoxic treatment (0.8, 0.6-1.0). Of 472 participants previously diagnosed with hypertension, 195 (41%) were uncontrolled on SJLIFE evaluation. Uncontrolled hypertension was also associated with male sex (1.5, 1.0-2.2) and black race (2.1, 1.3-3.5). Among survivors with multiple visits, 115 (32%) of the 361 who were identified as prehypertensive at the first visit developed subsequent incident hypertension; 88 of the 115 (77%) were undiagnosed prior to the second visit. Incident hypertension among those with prehypertension was associated with male sex (2.1, 1.3-3.4), and older age (1.3, 1.1-1.5 per five years).
Conclusion: The observed high prevalence of hypertension among childhood cancer survivors increases sharply with age. Screening identifies a significant proportion of previously undiagnosed and uncontrolled hypertension. Diagnosis of prehypertension identifies a population of survivors who are at high risk for near-term progression to hypertension and are thus candidates for screening and intervention.
This abstract is also presented as Poster A49.
Citation Format: Todd M. Gibson, Kirsten K. Ness, Gregory T. Armstrong, Daniel M. Green, Daniel A. Mulrooney, Rohit P. Ojha, Deo Kumar Srivastava, Melissa M. Hudson, Leslie L. Robison. Longitudinal characterization of hypertension in childhood cancer survivors: A report from the St. Jude Lifetime Cohort Study. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Pediatric Cancer Research: From Mechanisms and Models to Treatment and Survivorship; 2015 Nov 9-12; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Res 2016;76(5 Suppl):Abstract nr PR15.