Prevalence And Effects Of Hypertension And Tachycardia After Pediatric Hematopoietic Cell Transplantation

Background Hypertension and tachycardia (H/T) are frequently found after hemopoietic cell transplantation (HCT) and are often underrecognized and undertreated. Maintenance of appropriate hemodynamic parameters after HCT may prevent cardiac dysfunction and other adverse cardiovascular outcomes. We sought to determine trends of H/T after HCT as well as the resolution of H/T after hemodynamic medication (HM) and the association between H/T and significant adverse cardiac events (CE). Methods We performed a retrospective review of all patients undergoing non-autologous HCT from 2015 through 2017 at a pediatric cancer hospital, examining vital sign data before HCT and at specified intervals within 100 days of HCT. H/T were determined by published criteria, and records were queried for the use of HM—ace inhibitor, beta blocker, or calcium channel blocker—and the presence of CE during the study period. Results 140 patients were examined [79 male, median age: 9.33]. Hypertension (HTN) was found in 107 (76.4%) patients. Tachycardia (TAC) was found in 97 (68.8%) patients. Figure 1 demonstrates the trend of H/T in the sample. Of patients who experienced HTN, 68 (70%) also experienced TAC. Hypertensive patients were more likely to be male and were 2.2 years younger than the median age, Tachycardic patients were more likely to be male and were 1.7 years older than the median age. 71% of the sample received HM during the study period. The table examines the effects of H/T in treated and untreated patients, showing the proportion of H/T resolution, the median time to resolution, and the presence of CE within each group. Patients who underwent treatment for TAC were more likely to have resolution than those without treatment (OR=3.68, 95%CI: 1.49-9.07, p=0.005). TAC resolution occurred 29.9 days sooner in the treated vs untreated group (p=0.003). The lower likelihood of HTN resolution in the treated vs. untreated groups and the shorter duration of such did not reach statistical significance. Given low event rates, there were no associations between groups and CEs. Conclusions In this pediatric HCT sample, H/T were common. Patients treated for TAC had higher rates of TAC resolution and resumption of normal vitals in a shorter duration of time. In this highly treated sample, cardiac events were rare. Careful surveillance and treatment of H/T after HCT may allow for prevention of cardiovascular complications.