ASPO Abstracts
Hypertension: Incidence and Associated Risk Factors Among Black and White Breast Cancer Survivors Treated with Anthracycline Chemotherapy or Trastuzumab
Category: Cancer Health Disparities
Conference Year: 2023
Abstract Body:
Purpose: Studies indicate racial differences in the presence of hypertension upon a breast cancer diagnosis; however, the rates and risk factors associated with hypertension following breast cancer diagnosis and treatment are lacking. Methods: This retrospective cohort analysis studied Black and white women diagnosed with stages I-III breast cancer and treated with anthracycline chemotherapies or trastuzumab from 2009-2019 at Virginia Commonwealth University Massey Cancer Center. Women had no prior indication of a hypertension diagnosis or receipt of antihypertensive medications at the time of their breast cancer diagnosis. All data (e.g., race, treatments) were abstracted from the electronic health record. A hypertension diagnosis was identified using International Classification of Diseases, versions nine and 10 codes. Analyses included descriptive statistics and Cox proportional hazard models. Results: Of 627 women, 66.2% were white, 33.8% were Black, and 45.0% developed hypertension before censuring. In bivariate analysis, baseline characteristics associated with hypertension were age at breast cancer diagnosis, race, insurance status, geographic location, and body mass index. Among Black women, the rate of hypertension was 65.1% compared with 34.7% for white women (p<0.001). After adjusting for other risk factors, Cox regression analysis indicated that white women were less likely to develop hypertension than Black women (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.35-0.61). Additional baseline characteristics significantly associated with hypertension included: > 50 years of age (HR, 1.35; 95% CI, 1.04-1.74); residing in non-metropolitan areas (HR, 0.55; 95% CI, 0.41-0.76); public insurance (HR, 1.61; 95% CI, 1.19-2.18), obesity (HR, 1.65; 95% CI, 1.17-2.34); and diabetes (HR, 2.29; 95% CI, 1.45-3.61). Trastuzumab or anthracycline use did not confer an elevated risk of hypertension in this sample. Conclusions: Among women who receive cardiotoxic treatment, sociodemographic characteristics and comorbid conditions were the most salient predictors of hypertension risk. These findings warrant further investigation of the roles of social determinants of health and cancer care delivery factors on hypertension risk.
Keywords: Breast Cancer, Hypertension, Cardiovascular Toxicities, Disparities