ESPN 53rd Annual Meeting

ESPN 2021


 
HYPERTENSION IN CHILDHOOD CANCER SURVIVORS AFTER TREATMENT WITH POTENTIALLY NEPHROTOXIC THERAPY AND THE ADDED VALUE OF AMBULATORY BLOOD PRESSURE MONITORING; DCCSS-LATER 2: RENA.
ESMEE C.M. KOOIJMANS 1 HELENA J.H. VAN DER PAL 2 SASKIA PLUIJM 2 DORINE BRESTERS 2 ELINE VAN DULMEN-DEN BROEDER 1 MARGRIET VAN DER HEIDEN-VAN DER LOO 2 MARRY M. VAN DEN HEUVEL-EIBRINK 2 LEONTIEN C.M. KREMER 2 JACQUELINE LOONEN 3 MARLOES LOUWERENS 4 MAXIME PILON 1 CECILE M. RONCKERS 2 WIM J.E. TISSING 2 ANDRICA C.H. DE VRIES 5 GERTJAN J.L. KASPERS 2 AREND BOKENKAMP 6 MARGREET A. VEENING 2 ON BEHALF OF THE DUTCH LATER STUDY GROUP 2

1- EMMA CHILDREN’S HOSPITAL, AMSTERDAM UMC, VRIJE UNIVERSITEIT AMSTERDAM, PEDIATRIC ONCOLOGY, AMSTERDAM, THE NETHERLANDS
2- PRINCESS MAXIMA CENTER FOR PEDIATRIC ONCOLOGY, UTRECHT, THE NETHERLANDS
3- DEPARTMENT OF HEMATOLOGY, RADBOUD UNIVERSITY MEDICAL CENTER, NIJMEGEN, THE NETHERLANDS
4- DEPARTMENT OF INTERNAL MEDICINE, LEIDEN UNIVERSITY MEDICAL CENTER, LEIDEN, THE NETHERLANDS
5- DEPARTMENT OF PEDIATRIC ONCOLOGY, SOPHIA CHILDREN’S HOSPITAL/ERASMUS MEDICAL CENTER, ROTTERDAM, THE NETHERLANDS
6- EMMA CHILDREN’S HOSPITAL, AMSTERDAM UMC, VRIJE UNIVERSITEIT AMSTERDAM, PEDIATRIC NEPHROLOGY, AMSTERDAM, THE NETHERLANDS
 
Introduction:

We evaluated the prevalence of and risk factors for hypertension in childhood cancer survivors (CCS) compared to controls. Furthermore, a pilot study using 24-hour ambulatory blood pressure monitoring (ABPM) was performed.

Material and methods:

In the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort (1963-2001) part2; clinical visit & questionnaire study; RENA project, 1,024 CCS participated; ≥5 years after diagnosis, aged ≥18 years at study participation, treated between 1963-2001 with nephrectomy, abdominal radiotherapy (RT), total body irradiation (TBI), cisplatin, carboplatin, ifosfamide, high-dose cyclophosphamide (≥1g/m2 per course or ≥10g/m2 total) or bone marrow transplantation. We used 500 age- and sex matched controls from Lifelines. Hypertension was defined as blood pressure (BP) (mmHg) systolic ≥140 and/or diastolic ≥90 or receiving antihypertensive medication for previously diagnosed hypertension. Multivariable regression analyses were used. The ABPM-pilot study was performed in 77 CCS. Hypertension was defined as BP daytime: systolic ≥135 and/or diastolic ≥85, nighttime: systolic ≥120 and/or diastolic ≥70, 24-hour: systolic ≥130 and/or diastolic ≥80. Outcomes were masked hypertension (MH), white coat hypertension (WCH) and abnormal nocturnal dipping (aND).

Results:

Median age at diagnosis was 4.7 years (IQR 2.4-9.2), at study 32.5 years (IQR 27.7-38.0), and follow-up time 25.5 years (IQR 21.4-30.3). The prevalence of hypertension was comparable in CCS (16.3%) and controls (18.2%). A decrease in glomerular filtration rate (GFR) per 10ml/min/1.73m2 was associated with hypertension in CCS (OR 1.2, 95%CI 1.1-13), but not in controls. Treatment risk factors were abdominal RT (OR 2.2, 95%CI 1.3-4.0) and TBI (OR 3.0, 95%CI 1.6-5.8). The ABPM-pilot study showed 7.8% MH, 2.6% WCH, and 20.8% aND.

Conclusions:

Prevalence of hypertension was comparable in CCS and controls, but an association with decreased GFR was only found in CCS. Treatment risk factors were abdominal RT and TBI. ABPM has added value by identifying masked hypertension and abnormal nocturnal dipping.