Table 1.
Main results of the studies regarding the epidemiology of HTN in MPNs.
| Author and Year | Study Location | MPN Subtype | Number of Patients | Main Results |
|---|---|---|---|---|
| Mitra et al. (2013) [20] | USA | PMF, SMF | 180 |
↑ BP in 52% of PMF/SMF patients with splenomegaly, 50% in those without HTN = most common comorbidity in PMF/SMF |
| Parasuraman et al. (2018) [21] | USA | PV | 7718 | HTN = most prevalent comorbidity (~72%) (n = 5531) of PV patients enrolled in the United States Veterans Health Administration database |
| Grunwald et al. (2018) [22] | USA | PV | 2510 | HTN = most prevalent comorbidity (~71%) (n = 1772) of PV subjects enrolled in The Prospective Observational Study of Patients With Polycythemia Vera in US Clinical Practices (REVEAL) |
| Paranagama et al. (2018) [23] | USA | PV | 2856 | HTN in ~57 (n = 1630) of PV cases ↑ BP more prevalent in high-risk vs. low-risk PV (~65% vs. ~43%, p < 0.001) |
| Accurso et al. (2020) [24] | Italy | PV, ET, PMF, SMF | 603 |
↑BP = #1 CVRF in MPNs ↑ BP in ~63% of PV, ~64% of ET, ~15% of pre-fibrotic PMF, ~63% of PMF/SMF |
| Yacoub et al. (2021) [25] | USA | ET | 1207 | ↑ BP in 56% of the 1207 ET Myelofibrosis and Essential Thrombocythemia Observational STudy (MOST), HTN #1 comorbidity in ET |
| Jain et al. (2021) [26] | India | PV | 52 | HTN #1 comorbidity in PV (n = 24/52 patients, 46%) |
| Yap et al. (2018) [27] | Malaysia | PV, ET, PMF | 1010 | association of HTN with JAK2V617F (OR = 1.688; 95% CI = 1.234–2.310; p = 0.001) and with the diagnosis of PV and ET HTN #1 comorbidity in MPN subjects, i.e., PV > ET > PMF > MPN unclassifiable > hypereosinophilic syndrome (~58% vs. ~42% vs. ~41% vs. ~36% vs. ~33%, p < 0.001) |
| Shah et al. (2021) [28] | Pakistan | PV | 51 | ~90% of PV cases display HTN HTN associated with patients’ age (p = 0.033) |
| Mancuso et al. (2020) [29] | Italy | ET | 233 | HTN #1 CVRF in ET ~40% of ET cases display 1 CVRF, whereas ~35% have multiple CVRFs IPSET-thrombosis score calculation reclassifies several ET cases from low-risk of thrombotic events to intermediate or high-risk thrombotic complications occur mainly in ET with associated CVRFs |
| Fattizzo et al. (2020) [30] | Italy | NS | 16 | HTN #1 comorbidity (56%) in myeloid cancers (50% of which were MPNs or MPN/MDS) who developed COVID-19 HTN had no impact on survival in this setting |
| Morrissey et al. (2020) [31] | UK | NS | NS | HTN #1 comorbidity (41%) in COVID-19 patients with malignant (including MPNs) and benign blood disorders of whom 55% died HTN not linked with adverse outcomes |
| Delluc et al. (2018) [32] | France | PV, ET | 192 | HTN #1 comorbidity in MPNs (57.3%) HTN more likely in PV and ET cases on statin treatment (~85% vs. ~51%, p < 0.001) |
| Palandri et al. (2009) [33] | Italy | ET | 386 | HTN occurred in 48% of ET cases HTN independently predicted poor survival in ET |
| Wojcicki et al. (2016) [10] Lewandowski et al. (2017) [11] |
Poland | PV | 20 12 |
↑ BP in ¾ of PV subjects when examined in the investigator’s offices or on ambulatory BP measurements less notable ↓ in BP during the night ↓ heart rate values per 24 h (heart rate during the day was particularly ↓ in PV) ↓ microneurography-evaluated muscle sympathetic nervous activity (muscle activity per minute particularly ↓ in PV and positively associated with the heart rate during the night, r = 0.617, p < 0.05) ↓ serum free epinephrine, ↓ aldosterone concentrations (p = 0.048) in HTN + PV versus HTN non-PV patients no differences regarding the morphology of the retina between the two groups ↓ decreased retinal microperfusion (p = 0.032) in PV negatively associated with number of erythrocytes in PV (r = −0.44, p = 0.012) ↑ resistive index of the kidney arteries in PV versus non-PV HTN (p = 0.033) |
| Maruyama et al. (2019) [34] | Japan | PMF | 1 | HTN may aggravate MPN-related glomerulopathy via nephrosclerosis with development of polar vasculosis and exudative lesions |
| Patino-Alonso et al. (2021) [35] | Spain | PV, ET, PMF | 57 | similar values for SBP and DBP between MPNs (n = 57) and controls ↑ risk of carotid artery injury in MPNs (OR = 2.382, 1.066–5.323, p = 0.034) ↑ albumin-to-creatinine ratio in MPNs |
| Rana et al. (2021) [36] | Australia | NS | 1 | MPN and HTN association can contribute to the occlusion of the central artery of the retina and present as sudden loss of vision |
| Gecht et al. (2021) [37] | Germany | PV, ET, PMF, SMF | 1420 | 49%o of 1420 MPN cases had HTN ↑ BP more common in PV vs. ET or vs. PMF/SMF (~63% vs. ~46% and ~63% vs. ~39%, respectively, p < 0.0001) MPN subjects have eGFR = 60–89 mL/min/1.73 m2 (~57%), followed by eGFR < 60 mL/min/1.73 m2 (~22%) and eGFR ≥ 90 mL/min/1.73 m2 (~21%) more PMF/SMF subjects had eGFR < 60 mL/min/1.73 m2 vs. PV or vs. ET (~28% vs. ~20%, p = 0.005 for both) HTN = risk factor (OR = 2.419, 95% CI 1.879–3.114, p < 0.0001) for kidney dysfunction, particularly in subjects with eGFR < 60 mL/min/1.73 m2 vs. eGFR ≥ 90 mL/min/1.73 m2 (OR = 6.220, 95% CI 1.501–25.779, p = 0.01) and vs. eGFR = 60–89 mL/min/1.73 m2 (OR = 3.429, 95% CI 1.207–9.739, p = 0.02) in the univariate regression analysis HTN = risk factor for kidney dysfunction (OR = 2.004, 95% CI 1.440–2.789, p < 0.0001) following multiple regression analysis HTN = risk factor for thrombotic (OR = 1.838, 95% CI 1.398–2.418, p < 0.0001 in the univariate and OR = 1.800, 95% CI 1.349–2.401, p = 0.01 in the multivariate regression) but not for bleeding complications (OR = 1.302, 95% CI 0.678–2.499, p > 0.05) HTN = predictor for thrombotic events in ET (OR = 1.913, 95% CI 1.099–3.330, p = 0.02) and PMF/SMF (OR = 1.960, 95% CI 1.067–3.601, p = 0.03) |
| Kwiatkowski et al. (2021) [13] | Poland | ET | 310 | ET subjects display a degree of kidney dysfunction even before initiation of risk-adapted treatment (hydroxyurea or anagrelide) the decision to prescribe these drugs is associated with ↑ in creatinine levels ET with concomitant HTN cases had ↑ creatinine concentrations before the commencement of treatment (p < 0.001) and experienced ↑ in creatinine levels after cytoreduction with hydroxyurea or anagrelide (0.91 mg/dL pre-treatment versus 0.96 mg/dL post-treatment, p < 0.001) ET patients on antihypertensive agents (OR = 2.20, 95% CI: 1.26–3.85, p = 0.006) and anagrelide (OR = 13.01, 95% CI: 6.27–27.01, p < 0.001), as well as harboring CALR mutations (OR = 1.95, 95% CI: 1.10–3.45, p = 0.02), were more likely to experience kidney dysfunction |
| Person et al. (2021) [37] | Switzerland | PV, ET, PMF | 57 | post-mortem evaluation of kidneys in MPNs did not delineate proof of HTN or T2DM-related nephropathy in subjects who exhibited diffuse glomerulosclerosis |
| Lucijanic et al. (2022) [38] | Croatia | PMF, SMF | 173 | PMF/SMF with high vs. low uric acid levels at diagnosis more likely to suffer from HTN (PMF: ~71% vs. ~52%, p = 0.03; SMF: ~65% vs. ~30%, p = 0.01) |
| Akdi et al. (2020) [39] | Turkey | PV | 50 | PV cases likely to be non-dippers (~64% vs. ~37%, p = 0.007) and display lower nocturnal fall in SBP, DBP and MBP (−6.91 ± 8.92 mmHg vs. −11.65 ± 7.68 mmHg, p = 0.005; −11.31 ± 12.18 mmHg vs. −16.28 ± 12.03 mmHg, p = 0.042; −9.31 ± 10.41 mmHg vs. −14.06 ± 9.41 mmHg, p = 0.018) vs. hypertensive non-PV counterparts average-24 h and daytime SBP and DBP similar between the two groups nighttime SBP and DBP elevated in PV (125.32 ± 17.24 mmHg vs. 118.93 ± 12.20 mmHg, p = 0.034; 73.74 ± 12.16 mmHg vs. 69.49 ± 8.52 mmHg, p = 0.044, respectively) nocturnal falls in SBP (r = 0.305, p = 0.002 and r = 0.354, p < 0.001), DBP (r = 0.197, p = 0.048 and r = 0.236, p = 0.017) and MBP (r = 0.246, p = 0.013 and r = 0.293, p = 0.003) positively associated with hemoglobin and hematocrit levels |
| Dobrowolski et al. (2017) [5] | Poland | PV | 23 | no significant differences in office or 24 h SBP, DBP, heart rate or use of antihypertensive agents in PV vs. healthy counterparts signs of systolic and diastolic dysfunction of the heart by the assessment of several echocardiographic parameters, i.e., septal and lateral systolic velocities (8.7 ± 1.3 vs. 7.2 ± 2.4, p = 0.04 and 9.3 ± 1.2 vs. 7.7 ± 2.4, p = 0.04, respectively) and global longitudinal, circumferential and radial strains (−20.1 ± 4.3% vs. −18.1 ± 3.1%, p = 0.01; −19.7 ± 1.1% vs. −16.7 ± 2.7%, p = 0.001; 37.5 ± 8.7% vs. 29.6 ± 12.8%, p = 0.05, respectively) elevated in controls, whereas the isovolumic relaxation time was increased in PV (110.9 ± 24.9 ms vs. 83.5 ± 12.9 ms, p = 0.0001) hemoglobin levels were negatively associated with the global longitudinal and circumferential strains (β = −0.488, p = 0.0001; β = −0.537, p = 0.005) in PV hematocrit value was positively linked only with the global longitudinal strain (β = 0.408, p = 0.001) in PV red blood cell count was negatively correlated with the isovolumic relaxation time (β = −0.463, p = 0.05) in PV |
| Jóźwik-Plebanek et al. (2020) [40] | Poland | PV | 20 | HTN affected 75% of PV cases who displayed lower 24 h SBP and 24 h DBP (p = 0.003 and p = 0.01, respectively) versus comparators All other office or ambulatory BP measurements similar in PV and controls ↓ metanephrine and aldosterone in the plasma (p < 0.001 and p = 0.008, respectively), ↑ potassium levels (p < 0.001), ↓ free normetanephrine, metanephrine and norepinephrine in the urine (p = 0.03, p = 0.007 and p = 0.03, respectively) in PV number of erythrocytes (p < 0.001), leukocytes (p = 0.001), platelets (p < 0.001), hemoglobin (p < 0.001) and hematocrit (p = 0.02) ↑ in PV ↓ mean corpuscular volume, mean corpuscular hemoglobin concentration and mean corpuscular hemoglobin were lower (p < 0.001 for all) PV exhibited reduced capillary blood flow in the retina (p = 0.08) which was inversely associated with hemoglobin levels and erythrocyte numbers in PV (r = −0.57; p = 0.001 and r = −0.40, p = 0.02, respectively aldosterone concentrations negatively correlated with the aforementioned red cell parameters (r = −0.33, p = 0.04 for both) although HR baroreflex control was not different in PV and healthy counterparts, daytime, nighttime and 24 h ABPM, in addition to muscle adrenergic nerve activity (p = 0.007 for bursts/min and p = 0.04 for bursts/100 heartbeats) were ↓ in PV |
| Rusak et al. (2013) [41] | Poland | PV | 73 | PV subjects exhibited higher blood viscosity (p < 0.01), SBP (p < 0.05), DBP (p < 0.05), MAP (p < 0.05), cell-free hemoglobin (p < 0.01) and nitrite/nitrate (p < 0.01) versus healthy comparators especially when PV and HTN co-occur cell-free hemoglobin values were positively associated with MAP (r = +0.49, p < 0.05), nitrite/nitrate (r = +0.46, p < 0.05), hematocrit (r = +0.47, p < 0.05) and blood viscosity (r = +0.39, p < 0.05) isovolemic erythrocytapheresis decreased several biochemical parameters; however, it barely influenced the cell-free hemoglobin—hematocrit, cell-free hemoglobin—blood viscosity associations which continued to display a positive trend line and remained statistically significant (p < 0.05) |
Legend: NS, not specified. ↑, increase(d). ↓, decrease(d). For abbreviations, see List of abbreviations.