Hypertension Impacts Survival and Treatment in Chronic Lymphocytic Leukemia

Hypertension is the most common comorbidity in patients with chronic lymphocytic leukemia (CLL), but its impact on the CLL disease course remains poorly understood. In this nationwide cohort study of Danish patients with incident CLL (2008-2022), we examined the association between hypertension and survival from CLL diagnosis and treatment and compare to the general population. Cox proportional hazard regression was applied for survival analyses, and the Aalen-Johansen estimator for cumulated incidence. At CLL diagnosis the hypertension prevalence was 46% in the CLL cohort and 45% in the general population. Hypertension was associated with shorter overall survival (OS), following CLL diagnosis (HR=1.10, 95%CI [1.00-1.20]) and first-line treatment (HR=1.48, 95%CI [1.18-1.86]), primarily driven by infections and cardiocerebrovascular causes of death. The difference was seen for patients younger than 75 years both following diagnosis (HR 1.43, 95%CI [1.25-1.64]) and first-line treatment (HR 1.89, 95%CI [1.34-2.66]). For patients treated with BTK-inhibitors, we observed a trend towards poorer OS in patients with hypertension (HR 1.97, 95%CI [0.90-4.34]). No interaction between CLL in general and hypertension was observed (HR 0.89, 95%CI [0.79-1.02]), meaning that hypertension did not confer a higher additional risk in patients with CLL compared with individuals without CLL. This study identifies an important subgroup of patients with CLL younger than 75 years with coexisting hypertension, who have a poorer prognosis. Our findings support encouraging patients to maintain regular contact with primary care and adhere to preventative health measures, as hypertension and related comorbidities remain important for survival even after CLL diagnosis.