Risks and management of hypertension in cancer patients undergoing targeted therapy: a review

Abstract

Background Rapid progress over the last decade has added numerous agents targeting specific cellular signaling pathways to the treatment armamentarium for advanced cancer. However, many of these agents can cause hypertension resulting in major adverse cardiovascular event. Methods and results A systematic literature search was performed on the databases PubMed and Google Scholar for papers published in English until December 2020. This review summarizes the risk, mechanism, diagnosis, and management of hypertension in cancer patients undergoing targeted therapy. The risk and pathogenesis of hypertension vary widely with different classes of targeted agents. Currently there is a paucity of data investigating optimal management of hypertension with targeted therapy. A practical approach is discussed with a focus on the goal of blood pressure control as well as drug selection based on the mechanism of hypertension in the context of advanced cancer, treatment toxicity, comorbidity, and drug-drug interactions. This review also discusses many studies that have explored hypertension as a biomarker for cancer treatment efficacy and as a pharmacodynamic biomarker to titrate drug dose. Conclusions The diversity of targeted agents has provided important insights into the pathogenesis of hypertension in cancer patients. The underlying mechanism may provide a guidance to the management of hypertension. Further studies are needed to investigate optimal treatment and hypertension as a biomarker for cancer treatment.

Analysis of competing risks of cardiovascular death in patients with hepatocellular carcinoma: A population-based study

“…This finding could potentially be attributed to the use of HCC-related drugs such as bevacizumab, ramucirumab, sorafenib, and sunitinib, [ 51 ] all of which have been associated with an elevated risk of hypertension in patients with HCC. [ 52 ] Cumulative incidence from CVD increased with age at diagnosis, with multifactorial competing risk analysis showing that older patients were more likely to develop CVD (HR: 3.223 [95% CI: 2.817–3.689]). Interestingly, patients aged 0 to 54 years had the highest SMR for CVD (54.72 [95% CI: 53.51–55.95]), which was similar to the results of Soohwan Kim et al [ 53 ] Younger patients often receive more intense cancer treatments such as radiotherapy, chemotherapy, and surgery, which may cause damage to the cardiovascular system and increase the risk of cardiovascular events.…”

Repurposing of Chronically Used Drugs in Cancer Therapy: A Chance to Grasp

“…Nevertheless, the involvement of renin-angiotensin and β-adrenergic signaling in blood pressure elevation, cell proliferation, angiogenesis, and tissue invasion highlights the potential importance of inhibiting these pathways for cancer prevention or treatment [ 67 ]. In addition, preclinical studies have demonstrated that some anti-hypertensive drugs have a co-adjuvant effect against chemo-resistant cell lines, inhibit cell growth, and increase chemosensitivity in different cancers [ 63 ].…”

Hypertension in Cardio-Oncology Clinic: an update on etiology, assessment, and management

“…One may significantly improve their health by following a diet that is low in salt and abundant in fruits, vegetables, and whole grains. Adhering to a consistent schedule of physical activity, limiting alcohol consumption, and cessasion of smoking also have a considerable impact on the prevention of hypertensive disorders [ 131 ]. Various classes of medications used for the treatment of cancer have been associated with the development of new-onset hypertension or exacerbation of previously well-controlled hypertension.…”

“…In this regard, patients should be informed about the causes of hypertension in cancer patients, including various anti-cancer therapies, and the potential side effects of anti-hypertensive drugs. The caregiver must educate them on which anti-cancer therapies have potential risks for developing malignant hypertension [ 7 , 63 , 131 , 133 , 144 ]. Patients should be educated about lifestyle modifications that can help lower blood pressure, such as weight loss, regular exercise, a healthy diet, and stress reduction.…”

“…Patients should be informed about the potential side effects of anti-hypertensive drugs and how to manage them [ 7 , 144 ]. Also, they have to be educated to report any symptoms of uncontrolled hypertension to their healthcare providers, such as headache, chest pain, shortness of breath, or vision changes, immediately [ 131 ] . They need to be reminded to attend regular follow-up appointments with their physicians to monitor their blood pressure and adjust their treatment if necessary [ 7 , 63 , 131 , 133 , 144 ].…”