Cancer therapy–related hypertension: a scientific statement from the American Heart Association

Cohen, J. B., Brown, N. J., Brown, S.-A., Dent, S., van Dorst, D. C.H., Herrmann, S. M., Lang, N. N. , Oudit, G. Y. and Touyz, R. M. (2023) Cancer therapy–related hypertension: a scientific statement from the American Heart Association. Hypertension, 80(3), e46-e57. (doi: 10.1161/HYP.0000000000000224) (PMID:36621810)

Abstract

Contemporary anticancer drugs have significantly improved cancer survival at the expense of cardiovascular toxicities, including heart disease, thromboembolic disease, and hypertension. One of the most common side effects of these drugs is hypertension, especially in patients treated with vascular endothelial growth factor inhibitors, as well as tyrosine kinase inhibitors and proteasome inhibitors. Adjunctive therapy, including corticosteroids, calcineurin inhibitors, and nonsteroidal anti-inflammatories, as well as anti-androgen hormone therapy for prostate cancer, may further increase blood pressure in these patients. Cancer therapy–induced hypertension is often dose limiting, increases cardiovascular mortality in cancer survivors, and is usually reversible after interruption or discontinuation of treatment. The exact molecular mechanisms underlying hypertension are unclear, but recent discoveries indicate an important role for reduced nitric oxide generation, oxidative stress, endothelin-1, prostaglandins, endothelial dysfunction, increased sympathetic outflow, and microvascular rarefaction. In addition, genetic polymorphisms in vascular endothelial growth factor receptors are implicated in vascular endothelial growth factor inhibitor–induced hypertension. Diagnosis, management, and follow-up of cancer therapy–induced hypertension follow national hypertension guidelines because evidence-based clinical trials specifically addressing patients who develop hypertension as a result of cancer therapy are currently lacking. Rigorous baseline assessment of patients before therapy is started requires particular emphasis on assessing and treating cardiovascular risk factors. Hypertension management follows guidelines for the general population, although special attention should be given to rebound hypotension after termination of cancer therapy. Management of these complex patients requires collaborative care involving oncologists, cardiologists, hypertension specialists, primary care professionals, and pharmacists to ensure the optimal therapeutic effect from cancer treatment while minimizing competing cardiovascular toxicities.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lang, Professor Ninian and Touyz, Professor Rhian
• Authors: Cohen, J. B., Brown, N. J., Brown, S.-A., Dent, S., van Dorst, D. C.H., Herrmann, S. M., Lang, N. N., Oudit, G. Y., and Touyz, R. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Hypertension
• Publisher: American Heart Association
• ISSN: 0194-911X
• ISSN (Online): 1524-4563
• Published Online: 09 January 2023
• Copyright Holders: Copyright © 2023 American Heart Association, Inc.
• First Published: First published in Hypertension 80(3) e46-e57
• Publisher Policy: Reproduced in accordance with the publisher copyright policy