Hypertension affects 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 disease course of CLL 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 with the general population. Cox proportional hazard regression was applied for survival analyses, and the Aalen-Johansen estimator for cumulated incidence. At diagnosis of CLL, 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 (hazard ratio [HR], 1.10; 95% confidence interval [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 aged <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 Bruton tyrosine kinase inhibitors, we observed a trend toward 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 than in individuals without CLL. This study identifies an important subgroup of patients with CLL aged <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.