Abstract
Background
One of the long-term complications after hematopoietic stem cell transplantation (HSCT) is hypertension (HT). Previous studies showed that 10–15% of children post-HSCT had office HT, but only a few studies used ambulatory blood pressure monitoring (ABPM). The present study was aimed at exploring the frequency and factors associated with ABPM HT in children post-HSCT.
Methods
Patients aged ≥ 6 years who survived ≥ 2 years after HSCT were enrolled. Clinical and ABPM data were reviewed. ABPM HT was defined according to the 2022 American Heart Association guidelines. Factors associated with HT were analyzed by logistic regression.
Results
Ninety-eight (60 males) patients with a mean age of 15.1 years and a median follow-up time at 4.5 years after HSCT were included. Fifteen patients (15.3%) had ABPM HT (2 ambulatory HT and 13 masked HT). The ABPM HT group had a significantly older age (19 vs. 14 years), a higher proportion of males (87% vs. 57%), a higher office systolic BP index (0.93 vs. 0.85), a higher office diastolic BP index (0.96 vs. 0.82) and a higher proportion of current use of prednisolone and tacrolimus than those in the normal ABPM group. Multivariate analysis revealed that office diastolic BP index was associated with ABPM HT. Left ventricular mass index was significantly correlated with ABPM but not with office BP parameters.
Conclusions
HT in children post-HSCT was not uncommon and most could not be detected with office BP measurement. A diastolic BP index can be used as a screening tool for HT.
Graphical abstract
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Data availability
The datasets used and analyzed during the present study are available from the corresponding author on reasonable request.
References
D’Souza A, Lee S, Zhu X, Pasquini M (2017) Current use and trends in hematopoietic cell transplantation in the United States. Biol Blood Marrow Transplant 23:1417–1421
Bhatia S (2011) Long-term health impacts of hematopoietic stem cell transplantation inform recommendations for follow-up. Expert Rev Hematol 4:437–454
Holmqvist AS, Chen Y, Wu J, Battles K, Bhatia R, Francisco L et al (2018) Assessment of late mortality risk after allogeneic blood or marrow transplantation performed in childhood. JAMA Oncol 4:e182453
Bhatia S, Francisco L, Carter A, Sun CL, Baker KS, Gurney JG et al (2007) Late mortality after allogeneic hematopoietic cell transplantation and functional status of long-term survivors: report from the Bone Marrow Transplant Survivor Study. Blood 110:3784–3792
Gavriilaki E, Gkaliagkousi E, Grigoriadis S, Anyfanti P, Douma S, Anagnostopoulos A (2019) Hypertension in hematologic malignancies and hematopoietic cell transplantation: An emerging issue with the introduction of novel treatments. Blood Rev 35:51–58
Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904
Borchert-Mörlins B, Memaran N, Sauer M, Maecker-Kolhoff B, Sykora KW, Blöte R et al (2018) Cardiovascular risk factors and subclinical organ damage after hematopoietic stem cell transplantation in pediatric age. Bone Marrow Transplant 53:983–992
Gurbanov A, Gülhan B, Kuşkonmaz B, Okur FV, Ozaltin F, Düzova A et al (2023) Predictors of kidney complications and analysis of hypertension in children with allogeneic hematopoietic stem cell transplantation. Pediatr Nephrol 38:461–469
Bhatt GC, Pakhare AP, Gogia P, Jain S, Gupta N, Goel SK et al (2020) Predictive model for ambulatory hypertension based on office blood pressure in obese children. Front Pediatr 8:232
Yip GW, So HK, Li AM, Tomlinson B, Wong SN, Sung RY (2012) Validation of A&D TM-2430 upper-arm blood pressure monitor for ambulatory blood pressure monitoring in children and adolescents, according to the British Hypertension Society protocol. Blood Press Monit 17:76–79
Flynn JT, Urbina EM, Brady TM, Baker-Smith C, Daniels SR, Hayman LL et al (2022) Ambulatory blood pressure monitoring in children and adolescents: 2022 update: a scientific statement from the American Heart Association. Hypertension 79:e114–e124
Díaz A, Zócalo Y, Bia D (2019) Reference intervals and percentile curves of echocardiographic left ventricular mass, relative wall thickness and ejection fraction in healthy children and adolescents. Pediatr Cardiol 40:283–301
de Ferranti SD, Steinberger J, Ameduri R, Baker A, Gooding H, Kelly AS et al (2019) Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association. Circulation 139:e603–e634
Hoffmeister PA, Hingorani SR, Storer BE, Baker KS, Sanders JE (2010) Hypertension in long-term survivors of pediatric hematopoietic cell transplantation. Biol Blood Marrow Transplant 16:515–524
Hierlmeier S, Eyrich M, Wölfl M, Schlegel PG, Wiegering V (2018) Early and late complications following hematopoietic stem cell transplantation in pediatric patients - a retrospective analysis over 11 years. PLoS One 13:e0204914
Pao E, Gove NE, Flynn JT, Hingorani S (2018) Ambulatory blood pressure and endothelial dysfunction in hematopoietic cell transplantation recipients. Biol Blood Marrow Transplant 24:1678–1684
Milone G, Bellofiore C, Leotta S, Milone GA, Cupri A, Duminuco A et al (2022) Endothelial dysfunction after hematopoietic stem cell transplantation: a review based on physiopathology. J Clin Med 11:623
Bruyndonckx L, Hoymans VY, Lemmens K, Ramet J, Vrints CJ (2016) Childhood obesity–related endothelial dysfunction: an update on pathophysiological mechanisms and diagnostic advancements. Pediatr Res 79:831–837
Huang C-C, Leu H-B, Wu T-C, Lin S-J, Chen J-W (2009) Circadian variation of blood pressure is correlated to vascular endothelial function in nondiabetic essential hypertensives. Acta Cardiol Sin 25:131–141
Acknowledgements
The authors would like to thank the Ramathibodi Hospital Research Grant for financial support. We are thankful for the participating patients and families. We also would like to thank Mr. Wirot Phairotsakun, Mrs. Kittirat Phairotsakun, Mr. Khobchai Phairotsakun, Mrs. Nuntawan Chayakul, and Mr. Naratach Chayakul for donating the TM-2430 devices.
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WH, TT, KP, SP, and MS designed the study. WH, TT, KP, MS, WP, and UB performed the study. WH, TT, KP, SP, and MS analyzed the data. WH, TT, KP, SP, and MS drafted the manuscript. WH, TT, KP, SP, MS, WP, and UB have read and approved the final version of the manuscript.
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Homhuan, W., Tosakulsak, T., Pirojsakul, K. et al. Ambulatory blood pressure monitoring in children and adolescents post-hematopoietic stem cell transplantation. Pediatr Nephrol 39, 531–537 (2024). https://doi.org/10.1007/s00467-023-06119-1
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DOI: https://doi.org/10.1007/s00467-023-06119-1