Abstract P541: Ambulatory Blood Pressure and Endothelial Dysfunction an Hematopoietic Cell Transplant Patients

Abstract

Hematopoietic cell transplantation (HCT) is a common treatment for malignancies, metabolic, and genetic disorders. Albuminuria post-HCT, which may represent systemic endothelial injury or inflammation from graft vs host disease, increases the risk of kidney disease and non-relapse mortality at 1 year post-HCT. HCT patients are also known to have abnormal blood pressure (BP) and increased rates of cardiovascular complications. We sought to determine the relationships between albuminuria, endothelial dysfunction and ambulatory BP in HCT patients. Patients ≥ 12 years of age who had their first allogeneic HCT between 2012-2015 and survived through day 80 were eligible. Peripheral endothelial function was assessed using the EndoPAT2000 device at day 80 post HCT along with a 24 hour ambulatory blood pressure monitor (ABPM) study. Clinical and lab data were collected and a urine sample for an albumin to creatinine ratio (ACR). Both logistic and linear regression analyses were used to identify associations between EndoPAT score and clinical variables including eGFR, 24 hour ABPM study, albuminuria, and serum lipids. Sixty patients completed the study. The median age was 48 years (range, 14-69). The median EndoPAT score (RHI normal ≥ 1.69) was 2.05 (range, 1.02- 4.45) and 28% (17/60) of the patients had abnormal endothelial function. Forty-two patients (72%) had hypertension based on the 24-hr ABPM results and 63% of the patients (38/60) had abnormal nocturnal dipping. Hypertension on ABPM (p = 0.04), abnormal nocturnal dipping (p=0.04), and elevated serum triglyceride levels (p=0.03) were associated with a lower EndoPAT score. Albuminuria was not associated with EndoPAT score or hypertension based on ABPM. Abnormal nocturnal dipping was associated with lower eGFR (p=0.03). There was a lack of agreement between office BP and use of medications and results on a 24 hour ABPM study (p < 0.001). We did not find a correlation with lower EndoPAT scores and albuminuria; we did find associations between abnormal nocturnal dip, elevated triglyceride levels and hypertension diagnosed by 24 hour ABPM. Casual office BP readings do not accurately reflect the HCT patient’s true BP suggesting that 24 hour ABPM studies are needed to diagnose and treat hypertension appropriately.