CLL-517 Hypertension as an Adverse Event of Ibrutinib: Does Age Matter?

CONTEXT: Ibrutinib and other Bruton-tyrosine kinase inhibitors (BTKi) have transformed treatment of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) and improved overall survival. However, cardiovascular and other non-CLL progression related events remain a significant cause of morbidity and mortality for patients with CLL. Therefore, it is important to more fully understand and optimize management of cardiometabolic risk factors such as hypertension. OBJECTIVE: Determine the prevalence of new-onset or uncontrolled hypertension following initiation of ibrutinib and determine whether age is associated is associated with this outcome. DESIGN: Retrospective chart review Setting: Single academic institution Patients: Consecutive CLL/SLL patients (n=219) treated with ibrutinib at Duke University Medical Center from April 18, 2011 through October 31, 2019. MAIN OUTCOME MEASURES: New-onset or uncontrolled hypertension. RESULTS: Prior to initiation of ibrutinib, 130/219 (59.4%) patients had preexisting hypertension (80% controlled, 13.8% uncontrolled, 6.2% indeterminate). Following ibrutinib, 100/130 (76.9%) became uncontrolled. When compared to younger patients, the risk of developing uncontrolled hypertension was lower in those ages 65-74yo (p=.03). The median number of days from ibrutinib initiation to development of uncontrolled hypertension (N=67) was not associated with age (p=0.49). Of the 89 patients without hypertension prior to ibrutinib, 47.2% developed new-onset hypertension. There was no significant difference in incidence of new-onset hypertension by age (42.9%, 57.1%, 42.1% of those <65, 65-74, and 75+ years old, respectively). The median time between ibrutinib initiation and development of new-onset hypertension was not associated with age (p=.34). CONCLUSIONS: Over two-thirds (65%) of CLL/SLL patients developed new-onset or uncontrolled hypertension after starting ibrutinib. Age did not appear to be associated with these changes. The increase in prevalence of hypertension highlights the importance of blood pressure monitoring, irrespective of age, after initiation of ibrutinib.

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