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Although arterial hypertension was found to be the most significant modifiable cardiovascular (CV) risk factor in the general population, little\u00a0is known about its role in MPNs as well as a possible role of renin-angiotensin system inhibitors (RASi) in comparison with other anti-hypertensive treatments. We investigated a large cohort of 404 MPN adult patients, 133 diagnosed with PV and 271 with ET. Over half of the patients (53.7%) reported hypertension at MPN diagnosis. The 15-year cumulative incidence of thrombotic-adverse events (TAEs) was significantly higher in patients with hypertension (66.8\u2009\u00b1\u200910.3% vs 38.5\u2009\u00b1\u20098.4%; HR\u2009=\u20091.83; 95%CI 1.08\u20133.1). Multivariate analysis showed that PV diagnosis and hypertension were independently associated with a higher risk of developing TAEs (HR\u2009=\u20093.5; 95%CI 1.928\u20136.451, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and HR\u2009=\u20091.8; 95%CI 0.983\u20133.550, <jats:italic>p<\/jats:italic>\u2009=\u20090.05, respectively). In multivariate analysis, the diagnosis of PV confirmed a significant predictive role in developing TAEs (HR\u2009=\u20094.4; 95%CI 1.92\u201310.09, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), also considering only MPN patients with hypertension. In addition, we found that the use of RASi showed a protective effect from TAEs both in the whole cohort of MPN with hypertension (HR\u2009=\u20090.46; 95%CI 0.21\u20130.98, <jats:italic>p<\/jats:italic>\u2009=\u20090.04) and in the subgroup of thrombotic high-risk score patients (HR\u2009=\u20090.49; 95%CI 0.24\u20131.01, <jats:italic>p<\/jats:italic>\u2009=\u20090.04). In particular, patients with ET and a high risk of thrombosis seem to benefit most from RASi treatment (HR\u2009=\u20090.27; 95%CI 0.07\u20131.01, <jats:italic>p<\/jats:italic>\u2009=\u20090.03). Hypertension in MPN patients represents a significant risk factor for TAEs and should be adequately treated.<\/jats:p>","DOI":"10.1007\/s00277-023-05417-w","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T12:02:18Z","timestamp":1692619338000},"page":"2717-2723","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Renin-angiotensin inhibitors reduce thrombotic complications in Essential Thrombocythemia and Polycythemia Vera patients with arterial hypertension"],"prefix":"10.1007","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7487-3328","authenticated-orcid":false,"given":"Olga","family":"Mulas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brunella","family":"Mola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Pittau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Mantovani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuele","family":"Dess\u00ec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Fronteddu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"La Nasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6585-5187","authenticated-orcid":false,"given":"Giovanni","family":"Caocci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,8,21]]},"reference":[{"key":"5417_CR1","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1182\/blood-2016-03-643544","volume":"127","author":"DA Arber","year":"2016","unstructured":"Arber DA, Orazi A, Hasserjian R et al (2016) The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. 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