Arterial hypertension and cancer

Abstract

Arterial hypertension and cancer are two of the most important causes of mortality in the world; correlations between these two clinical entities are complex and various. Cancer therapy using old (e.g., mitotic spindle poisons) as well as new (e.g., monoclonal antibody) drugs may cause arterial hypertension through different mechanisms; sometimes the increase of blood pressure levels may be responsible for chemotherapy withdrawal. Among newer cancer therapies, drugs interacting with the VEGF (vascular endothelial growth factors) pathways are the most frequently involved in hypertension development. However, many retrospective studies have suggested a relationship between antihypertensive treatment and risk of cancer, raising vast public concern. The purposes of this brief review have then been to analyse the role of chemotherapy in the pathogenesis of hypertension, to summarize the general rules of arterial hypertension management in this field and finally to evaluate the effects of antihypertensive therapy on cancer disease.

Chronic arterial hypertension impedes glioma growth: a multiparametric MRI study in the rat

“…Complete prospective studies are needed to analyze the impact of antihypertensive drugs in cancer evolution and prognosis. 61 In such studies, it appears important to know if antihypertensive drugs would obtund or not the hypertensionrelated beneficial prognosis observed and if all hypertensive drugs would have the same effect on this hypertension-related prognosis in glioma patients. In addition, the vessels potentially present a higher altered functionality within the tumor of hypertensive animals.…”

Prevention, monitoring and treatment of cardiovascular adverse events in myeloma patients receiving carfilzomib A consensus paper by the European Myeloma Network and the Italian Society of Arterial Hypertension

“…No clear recommendation for an antihypertensive agent can be made in this context, due to the lack of controlled studies. The most commonly prescribed antihypertensive agents are ACEi and ARBs, dihydropyridine calcium channel blockers, ß‐blockers and diuretics . In patients with clinical signs or symptoms suggestive for grade ≥2 cardiac dysfunction, CFZ should be temporarily discontinued until recovery and the following strategy is recommended: –ECG and echocardiogram with echocardiography‐derived strain for diagnostic workup; –Cardiac magnetic resonance (preferred) or MUGA if echocardiogram is not available or technically feasible (e.g. poor image quality). –Serum cardiac biomarkers (cardiac troponin, brain natriuretic peptides). –Cardiologist's referral depending on findings. …”

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

“…w raku nerki [160]. Stosowanie inhibitorów VEGF wiąże się z dużym ryzykiem (11-45%) wywołania nowego nadciśnienia lub destabilizacji uprzednio dobrze kontrolowanego nadciśnienia, w tym wystąpienia ciężkiego nadciśnienia w 2-20% przypadków [161,162]. Częstość występowania i stopień ciężkości nadciśnienia zależą od wieku pacjenta, wcześniejszych wywiadów nadciśnienia i CVD, rodzaju nowotworu (rak nerki lub inny), rodzaju i dawki leku, schematu dawkowania, a także innego stosowanego leczenia onkologicznego.…”