title: Incidence and risk of hypertension in patients newly treated for multiple myeloma: a retrospective cohort study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, USA. ajai.chari@mountsinai.org.
authors.forename: Ajai
authors.initials: A
authors.lastname: Chari
authors.affiliation: Amgen Inc., One Amgen Center Dr, Thousand Oaks, CA, USA.
authors.forename: Khalid
authors.initials: K
authors.lastname: Mezzi
authors.affiliation: Simulstat, Inc., 4370 La Jolla Village Dr, San Diego, CA, USA.
authors.forename: Shao
authors.initials: S
authors.lastname: Zhu
authors.affiliation: Amgen Inc., 1120 Veterans Blvd, South San Francisco, CA, USA.
authors.forename: Winifred
authors.initials: W
authors.lastname: Werther
authors.affiliation: Onyx Pharmaceuticals, Inc., an Amgen subsidiary, 1641 Kansas St, Redwood City, CA, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Felici
authors.affiliation: NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, SW3 6NP, London, UK.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Lyon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications* / Q000628:therapy; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents
keywords: Cardiovascular comorbidity; Hypertension; Incidence; Multiple myeloma; Newly-treated; Risk factor