(B-002) Association of new-onset hypertension and its treatment with survival in cancer patients: A retrospective cohort study using electronic medical record data.

Background: Evidence for development of new-onset hypertension (HTN) after cancer diagnosis is limited, and the role of cancer treatment and antihypertensive drug use in overall survival (OS) remains unclear.

Objectives: To evaluate the risk of new-onset HTN, and assess the role of cancer treatment and antihypertensive drug use on OS in cancer patients.

Methods: This study utilized electronic health record data from a retrospective cohort of 11,532 adult cancer patients at the Huntsman Cancer Institute, University of Utah from 2016-2023, with no prior diagnosis of HTN or history of antihypertensive drug use. We estimated the cumulative incidence of HTN, with death as a competing event. Cause-specific hazard ratios (HRs) and 95% confidence intervals (CI) were used to identify associations of cancer treatments (surgery, chemotherapy, immunotherapy, radiation, hormonotherapy) with new-onset HTN. Cox proportional hazards regression with left truncation (to account for immortal time bias) was used to estimate HRs and CIs for the association between HTN, anti-hypertensive drug use, and OS.

Results: In our cohort, 50.7% of patients were males, average age of 53.5 ± 14.7 years, and predominantly White (88.5%). Almost half of the patients (42.5%) were overweight or obese. A quarter of patients (24.2%) received surgery as their only treatment. Additionally, patients received surgery plus radiation (6.1%); plus immunotherapy (3.2%); plus chemotherapy (14.3%); or plus hormone therapy (5.8%). The majority (42.4%) received combinations of these treatments. A total of 4,662 (40.4%) patients developed new-onset HTN. Compared to only being treated with surgery, those treated with surgery plus immunotherapy or plus chemotherapy showed a 60% increased risk of new-onset HTN (HRadj (95% CI) = 1.59 (1.35 - 1.87) and 1.55 (1.40 - 1.73), respectively). Patients with new-onset HTN had three times greater risk of death compared to those without HTN (HRadj (95% CI) =3.32 (3.04-3.64)). A total of 86.3% of the patients with HTN received anti-hypertensive treatment; most were prescribed a combination of two or more anti-hypertensive drugs (46.8%). Compared to no HTN treatment, patients on angiotensin converting enzyme inhibitors (ACEi) monotherapy had improved survival (HRadj (95% CI) =0.57 (0.38-0.85) but combination treatments with ACEi did not offer similar protection.

Conclusions: Almost half of the patients with cancer developed new-onset HTN and patients with HTN were at three times increased risk of death. Treatment with immunotherapy or chemotherapy increased the risk of new-onset HTN. Among anti-hypertensive drugs, patients prescribed ACEi monotherapy had improved survival. Future research on dose and timing of anti-hypertensive drug use is warranted.