Blood pressure status in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study

Todd M. Gibson, Zhenghong Li, Daniel M. Green, Gregory Armstrong, Daniel A. Mulrooney, Deo Kumar Srivastava, Nickhill Bhakta, Kirsten K. Ness, Melissa M. Hudson, Leslie L. Robison

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Hypertension potentiates cardiovascular risk in survivors of childhood cancer previously exposed to cardiotoxic therapies, so it is important to determine the prevalence and risk factors for hypertensive blood pressure in this high-risk group. Methods: Participants included 3,016 adult 10-year survivors of childhood cancer who had resting blood pressure measurements performed at St. Jude Children's Research Hospital (Memphis, TN). We characterized the blood pressure status of participants, calculated standardized prevalence ratios based on U.S. population rates, and examined demographic and treatment factors associated with hypertensive blood pressure using logistic regression. Results: The age-specific cumulative prevalence of hypertension in survivors increased sharply with age, exceeding 70% by age 50, and was substantially higher in all diagnosis groups than expected on the basis of age-, sex-, race/ethnicity-, and BMI-specific population rates. Specific cancer treatments were not significantly associated with hypertension, with the exception of nephrectomy (OR, 1.68; 95% confidence interval, 1.11–2.53). Previously undiagnosed hypertensive blood pressure was identified in 8% of survivors, and uncontrolled hypertension in 22% of those with a previous hypertension diagnosis. In a subset (n = 1,185) with longitudinal blood pressure measurements (mean interval, 3.6 years), 5% and 21% of participants with previously normal blood pressure developed hypertensive and prehypertensive blood pressure, respectively. Conclusions: Survivors of childhood cancer have a higher prevalence of hypertension compared with the general population, and many have uncontrolled hypertension that may exacerbate treatment-related cardiovascular risks. Impact: Our results suggest enhanced clinical attention to blood pressure status is warranted in all survivors, regardless of diagnosis or cancer treatment.

Original languageEnglish (US)
Pages (from-to)1705-1713
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
Volume26
Issue number12
DOIs
StatePublished - Dec 1 2017

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Survivors
Cohort Studies
Blood Pressure
Hypertension
Neoplasms
Population
Therapeutics
Nephrectomy
Logistic Models
Demography
Confidence Intervals
Research

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Oncology

Cite this

Blood pressure status in adult survivors of childhood cancer : A report from the St. Jude Lifetime Cohort Study. / Gibson, Todd M.; Li, Zhenghong; Green, Daniel M.; Armstrong, Gregory; Mulrooney, Daniel A.; Srivastava, Deo Kumar; Bhakta, Nickhill; Ness, Kirsten K.; Hudson, Melissa M.; Robison, Leslie L.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 26, No. 12, 01.12.2017, p. 1705-1713.

Research output: Contribution to journalArticle

Gibson, TM, Li, Z, Green, DM, Armstrong, G, Mulrooney, DA, Srivastava, DK, Bhakta, N, Ness, KK, Hudson, MM & Robison, LL 2017, 'Blood pressure status in adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort Study', Cancer Epidemiology Biomarkers and Prevention, vol. 26, no. 12, pp. 1705-1713. https://doi.org/10.1158/1055-9965.EPI-17-0510
Gibson, Todd M. ; Li, Zhenghong ; Green, Daniel M. ; Armstrong, Gregory ; Mulrooney, Daniel A. ; Srivastava, Deo Kumar ; Bhakta, Nickhill ; Ness, Kirsten K. ; Hudson, Melissa M. ; Robison, Leslie L. / Blood pressure status in adult survivors of childhood cancer : A report from the St. Jude Lifetime Cohort Study. In: Cancer Epidemiology Biomarkers and Prevention. 2017 ; Vol. 26, No. 12. pp. 1705-1713.
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abstract = "Background: Hypertension potentiates cardiovascular risk in survivors of childhood cancer previously exposed to cardiotoxic therapies, so it is important to determine the prevalence and risk factors for hypertensive blood pressure in this high-risk group. Methods: Participants included 3,016 adult 10-year survivors of childhood cancer who had resting blood pressure measurements performed at St. Jude Children's Research Hospital (Memphis, TN). We characterized the blood pressure status of participants, calculated standardized prevalence ratios based on U.S. population rates, and examined demographic and treatment factors associated with hypertensive blood pressure using logistic regression. Results: The age-specific cumulative prevalence of hypertension in survivors increased sharply with age, exceeding 70{\%} by age 50, and was substantially higher in all diagnosis groups than expected on the basis of age-, sex-, race/ethnicity-, and BMI-specific population rates. Specific cancer treatments were not significantly associated with hypertension, with the exception of nephrectomy (OR, 1.68; 95{\%} confidence interval, 1.11–2.53). Previously undiagnosed hypertensive blood pressure was identified in 8{\%} of survivors, and uncontrolled hypertension in 22{\%} of those with a previous hypertension diagnosis. In a subset (n = 1,185) with longitudinal blood pressure measurements (mean interval, 3.6 years), 5{\%} and 21{\%} of participants with previously normal blood pressure developed hypertensive and prehypertensive blood pressure, respectively. Conclusions: Survivors of childhood cancer have a higher prevalence of hypertension compared with the general population, and many have uncontrolled hypertension that may exacerbate treatment-related cardiovascular risks. Impact: Our results suggest enhanced clinical attention to blood pressure status is warranted in all survivors, regardless of diagnosis or cancer treatment.",
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T2 - A report from the St. Jude Lifetime Cohort Study

AU - Gibson, Todd M.

AU - Li, Zhenghong

AU - Green, Daniel M.

AU - Armstrong, Gregory

AU - Mulrooney, Daniel A.

AU - Srivastava, Deo Kumar

AU - Bhakta, Nickhill

AU - Ness, Kirsten K.

AU - Hudson, Melissa M.

AU - Robison, Leslie L.

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Y1 - 2017/12/1

N2 - Background: Hypertension potentiates cardiovascular risk in survivors of childhood cancer previously exposed to cardiotoxic therapies, so it is important to determine the prevalence and risk factors for hypertensive blood pressure in this high-risk group. Methods: Participants included 3,016 adult 10-year survivors of childhood cancer who had resting blood pressure measurements performed at St. Jude Children's Research Hospital (Memphis, TN). We characterized the blood pressure status of participants, calculated standardized prevalence ratios based on U.S. population rates, and examined demographic and treatment factors associated with hypertensive blood pressure using logistic regression. Results: The age-specific cumulative prevalence of hypertension in survivors increased sharply with age, exceeding 70% by age 50, and was substantially higher in all diagnosis groups than expected on the basis of age-, sex-, race/ethnicity-, and BMI-specific population rates. Specific cancer treatments were not significantly associated with hypertension, with the exception of nephrectomy (OR, 1.68; 95% confidence interval, 1.11–2.53). Previously undiagnosed hypertensive blood pressure was identified in 8% of survivors, and uncontrolled hypertension in 22% of those with a previous hypertension diagnosis. In a subset (n = 1,185) with longitudinal blood pressure measurements (mean interval, 3.6 years), 5% and 21% of participants with previously normal blood pressure developed hypertensive and prehypertensive blood pressure, respectively. Conclusions: Survivors of childhood cancer have a higher prevalence of hypertension compared with the general population, and many have uncontrolled hypertension that may exacerbate treatment-related cardiovascular risks. Impact: Our results suggest enhanced clinical attention to blood pressure status is warranted in all survivors, regardless of diagnosis or cancer treatment.

AB - Background: Hypertension potentiates cardiovascular risk in survivors of childhood cancer previously exposed to cardiotoxic therapies, so it is important to determine the prevalence and risk factors for hypertensive blood pressure in this high-risk group. Methods: Participants included 3,016 adult 10-year survivors of childhood cancer who had resting blood pressure measurements performed at St. Jude Children's Research Hospital (Memphis, TN). We characterized the blood pressure status of participants, calculated standardized prevalence ratios based on U.S. population rates, and examined demographic and treatment factors associated with hypertensive blood pressure using logistic regression. Results: The age-specific cumulative prevalence of hypertension in survivors increased sharply with age, exceeding 70% by age 50, and was substantially higher in all diagnosis groups than expected on the basis of age-, sex-, race/ethnicity-, and BMI-specific population rates. Specific cancer treatments were not significantly associated with hypertension, with the exception of nephrectomy (OR, 1.68; 95% confidence interval, 1.11–2.53). Previously undiagnosed hypertensive blood pressure was identified in 8% of survivors, and uncontrolled hypertension in 22% of those with a previous hypertension diagnosis. In a subset (n = 1,185) with longitudinal blood pressure measurements (mean interval, 3.6 years), 5% and 21% of participants with previously normal blood pressure developed hypertensive and prehypertensive blood pressure, respectively. Conclusions: Survivors of childhood cancer have a higher prevalence of hypertension compared with the general population, and many have uncontrolled hypertension that may exacerbate treatment-related cardiovascular risks. Impact: Our results suggest enhanced clinical attention to blood pressure status is warranted in all survivors, regardless of diagnosis or cancer treatment.

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