Impact of Hypertension on Outcomes of Patients with High-Grade Gliomas:  A Propensity-Matched Study from the Global Federated Health Research Network

Purpose : Hypertension (HTN) is known to cause endothelial dysfunction; disrupting the blood-brain barrier and cerebral blood flow. Gliomas also disrupt cerebral vasculature, via tumor-associated vascular abnormalities and healthy tissue displacement. This retrospective analysis aimed to study differences between patients diagnosed with one of three high-grade gliomas and HTN. Methods : We used TriNetX's US Collaborative Network to study the impact of HTN on adult patients with one of three high-grade gliomas: glioblastoma multiforme (GBM), astrocytoma, or oligodendroglioma (ODG) using ICD-10 codes. We tracked these patients for five years to assess outcomes including all-cause mortality, cerebral infarct, seizures, cerebral edema, and emergency endotracheal intubation. Results : The GBM+HTN cohort showed significantly higher risk of all-cause mortality (HR 1.18, 95% CI 1.094 - 1.271, p<0.000), cerebral edema (HR 1.359, 95% CI 1.236 - 1.494, p<0.001), seizures (HR 1.624, 95% CI 1.459 - 1.808, p=0.007), and hemorrhagic stroke (HR 1.255, 95% CI 1.038 – 1.516, p=0.015). The ODG+HTN cohort demonstrated significantly increased risk of all-cause mortality (HR 1.398, 95% CI 1.040 - 1.879, p=0.001), emergency endotracheal intubation (HR 1.381, 95% CI 0.590 - 3.230, p=0.012), and cerebral edema (HR 0.904, 95% CI 0.680 - 1.203, p=0.023). There were no significant differences between HTN and control cohorts in the astrocytoma group. Conclusions : Patients with high-grade gliomas and HTN differ significantly. Patients with HTN appear to be at a higher risk of all-cause mortality, cerebral edema, seizures, and emergency endotracheal intubation; depending on tumor type. Further research is warranted.