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Incidence and risk of hypertension in patients newly treated for multiple myeloma: a retrospective cohort study

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hypertension is commonly reported in multiple myeloma (MM) patients and may be associated with older age, disease-related complications and consequences of MM treatments. This study evaluated the incidence rates of and risk factors for hypertension and malignant hypertension in newly-treated MM patients in the United States.

Methods: Newly-treated adult MM patients were identified from Truven MarketScan claims database from 1/1/05 to 3/31/14. Inclusion criteria were new diagnosis of MM with start of MM treatment, ≥12 months continuous enrollment prior to diagnosis, ≥30 days of continuous enrollment following initial diagnosis, and prescription drug coverage. Non-MM patients were matched for age (within +/− 5 years), sex and distribution of index dates to MM patients. Baseline cardiovascular (CV) comorbidities, incidence rate of hypertension and malignant hypertension in the follow-up period, and risk of hypertension and malignant hypertension based on existing baseline CV comorbidities were evaluated.

Results: A total of 7895 MM patients (38% with hypertension history) and 23,685 non-MM patients (24% with hypertension history) were included in the study. Twenty-two percent of MM patients versus 3% of non-MM patients had baseline renal failure. A higher percentage of MM versus non-MM patients had baseline hypertension in combination with renal failure, congestive heart failure or both. The incidence rate of hypertension in MM and non-MM patients was 260 and 178 per 1000 person-years, respectively. There was a 30% increase in the risk of hypertension for MM versus non-MM patients: hazard ratio (HR) 1.30 (95% confidence interval [CI] 1.22, 1.37). In MM patients with a history of hypertension, the risk of malignant hypertension was significantly increased with the following comorbid conditions: cardiomyopathy, HR 2.79 (95% CI 1.20, 6.48); renal failure, HR 2.13 (95% CI 1.36, 3.34); and diabetes mellitus, HR 1.59 (95% CI 1.05, 2.39).

Conclusions: This study confirms that the incidence of hypertension and malignant hypertension is significantly higher in newly-treated MM versus non-MM patients. Hypertension is a risk factor for MM patients developing malignant hypertension. Management of CV comorbidities in MM patients is important based on the increased risk of hypertension and malignant hypertension among patients with these comorbidities.

Electronic supplementary material: The online version of this article (doi:10.1186/s12885-016-2955-0) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Addition of anti-hypertensive medications during the follow-up period for MM and non-MM patients. Classes of anti-hypertensive medications added included diuretics, ACE-I, angiotensin II blockers, calcium channel blockers and other (alpha blockers, alpha-2 receptor agonists, beta-blockers, central agonists, combined alpha and beta blockers, peripheral adrenergic inhibitors, renin inhibitors and vasodilators). ACE-I, angiotension-converting enzyme inhibitor; MM, multiple myeloma
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Fig4: Addition of anti-hypertensive medications during the follow-up period for MM and non-MM patients. Classes of anti-hypertensive medications added included diuretics, ACE-I, angiotensin II blockers, calcium channel blockers and other (alpha blockers, alpha-2 receptor agonists, beta-blockers, central agonists, combined alpha and beta blockers, peripheral adrenergic inhibitors, renin inhibitors and vasodilators). ACE-I, angiotension-converting enzyme inhibitor; MM, multiple myeloma

Mentions: The numbers of MM and non-MM patients taking anti-hypertensive medications at baseline are shown in Table 3. The proportion of patients receiving at least one class of anti-hypertensive medication at baseline was the same for MM and non-MM patients (71%). The number of classes of anti-hypertensive medication at baseline between the two groups was similar (Fig. 3). Among patients who were treated for hypertension, the most common medications at baseline for both groups were diuretics, ACE-I, calcium channel blockers and angiotensin II receptor blockers (ARBs) (Table 3). For patients with incident hypertension, 1425 of 1865 (76.4%) MM patients and 4548 of 5861 (77.6%) non-MM patients received at least one class of anti-hypertensive medication during follow-up. A total of 16.0% of MM patients and 10.4% of non-MM patients received one new class of anti-hypertensive medication during the follow-up period; 9.9% of MM patients and 11.2% of non-MM patients received two additional classes of anti-hypertensive medications during the follow-up period (Fig. 4).Table 3


Incidence and risk of hypertension in patients newly treated for multiple myeloma: a retrospective cohort study
Addition of anti-hypertensive medications during the follow-up period for MM and non-MM patients. Classes of anti-hypertensive medications added included diuretics, ACE-I, angiotensin II blockers, calcium channel blockers and other (alpha blockers, alpha-2 receptor agonists, beta-blockers, central agonists, combined alpha and beta blockers, peripheral adrenergic inhibitors, renin inhibitors and vasodilators). ACE-I, angiotension-converting enzyme inhibitor; MM, multiple myeloma
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120425&req=5

Fig4: Addition of anti-hypertensive medications during the follow-up period for MM and non-MM patients. Classes of anti-hypertensive medications added included diuretics, ACE-I, angiotensin II blockers, calcium channel blockers and other (alpha blockers, alpha-2 receptor agonists, beta-blockers, central agonists, combined alpha and beta blockers, peripheral adrenergic inhibitors, renin inhibitors and vasodilators). ACE-I, angiotension-converting enzyme inhibitor; MM, multiple myeloma
Mentions: The numbers of MM and non-MM patients taking anti-hypertensive medications at baseline are shown in Table 3. The proportion of patients receiving at least one class of anti-hypertensive medication at baseline was the same for MM and non-MM patients (71%). The number of classes of anti-hypertensive medication at baseline between the two groups was similar (Fig. 3). Among patients who were treated for hypertension, the most common medications at baseline for both groups were diuretics, ACE-I, calcium channel blockers and angiotensin II receptor blockers (ARBs) (Table 3). For patients with incident hypertension, 1425 of 1865 (76.4%) MM patients and 4548 of 5861 (77.6%) non-MM patients received at least one class of anti-hypertensive medication during follow-up. A total of 16.0% of MM patients and 10.4% of non-MM patients received one new class of anti-hypertensive medication during the follow-up period; 9.9% of MM patients and 11.2% of non-MM patients received two additional classes of anti-hypertensive medications during the follow-up period (Fig. 4).Table 3

View Article: PubMed Central - PubMed

ABSTRACT

Background: Hypertension is commonly reported in multiple myeloma (MM) patients and may be associated with older age, disease-related complications and consequences of MM treatments. This study evaluated the incidence rates of and risk factors for hypertension and malignant hypertension in newly-treated MM patients in the United States.

Methods: Newly-treated adult MM patients were identified from Truven MarketScan claims database from 1/1/05 to 3/31/14. Inclusion criteria were new diagnosis of MM with start of MM treatment, ≥12 months continuous enrollment prior to diagnosis, ≥30 days of continuous enrollment following initial diagnosis, and prescription drug coverage. Non-MM patients were matched for age (within +/− 5 years), sex and distribution of index dates to MM patients. Baseline cardiovascular (CV) comorbidities, incidence rate of hypertension and malignant hypertension in the follow-up period, and risk of hypertension and malignant hypertension based on existing baseline CV comorbidities were evaluated.

Results: A total of 7895 MM patients (38% with hypertension history) and 23,685 non-MM patients (24% with hypertension history) were included in the study. Twenty-two percent of MM patients versus 3% of non-MM patients had baseline renal failure. A higher percentage of MM versus non-MM patients had baseline hypertension in combination with renal failure, congestive heart failure or both. The incidence rate of hypertension in MM and non-MM patients was 260 and 178 per 1000 person-years, respectively. There was a 30% increase in the risk of hypertension for MM versus non-MM patients: hazard ratio (HR) 1.30 (95% confidence interval [CI] 1.22, 1.37). In MM patients with a history of hypertension, the risk of malignant hypertension was significantly increased with the following comorbid conditions: cardiomyopathy, HR 2.79 (95% CI 1.20, 6.48); renal failure, HR 2.13 (95% CI 1.36, 3.34); and diabetes mellitus, HR 1.59 (95% CI 1.05, 2.39).

Conclusions: This study confirms that the incidence of hypertension and malignant hypertension is significantly higher in newly-treated MM versus non-MM patients. Hypertension is a risk factor for MM patients developing malignant hypertension. Management of CV comorbidities in MM patients is important based on the increased risk of hypertension and malignant hypertension among patients with these comorbidities.

Electronic supplementary material: The online version of this article (doi:10.1186/s12885-016-2955-0) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus