Etiology and management of hypertension in patients with cancer

Abstract

The pathophysiology of hypertension and cancer are intertwined. Hypertension has been associated with an increased likelihood of developing certain cancers and with higher cancer-related mortality. Moreover, various anticancer therapies have been reported to cause new elevated blood pressure or worsening of previously well-controlled hypertension. Hypertension is a well-established risk factor for the development of cardiovascular disease, which is rapidly emerging as one of the leading causes of death and disability in patients with cancer. In this review, we discuss the relationship between hypertension and cancer and the role that hypertension plays in exacerbating the risk for anthracycline- and trastuzumab-induced cardiomyopathy. We then review the common cancer therapies that have been associated with the development of hypertension, including VEGF inhibitors, small molecule tyrosine kinase inhibitors, proteasome inhibitors, alkylating agents, glucocorticoids, and immunosuppressive agents. When available, we present strategies for blood pressure management for each drug class. Finally, we discuss blood pressure goals for patients with cancer and strategies for assessment and management. It is of utmost importance to maintain optimal blood pressure control in the oncologic patient to reduce the risk of chemotherapy-induced cardiotoxicity and to decrease the risk of long-term cardiovascular disease.

Keywords: Cardio-oncology; Cardiotoxicity; Hypertension; Tyrosine kinase inhibitors; VEGF inhibitors.

Fig. 1

Algorithm for blood pressure assessment and management in patients newly diagnosed with cancer. BP, blood pressure; HBPM, home blood pressure monitoring; VSP, VEGF signaling pathway; PI, proteasome inhibitor; CCB, calcium channel blockers; DHP, dihydropyridine; ACEI, angiotensin converting enzyme inhibitors; ARB, angiotensin II receptor blocker; CKD, chronic kidney disease; IHD, ischemic heart disease; NSAID, non-steroidal anti-inflammatory drug; EPO, erythropoietin; DBP, diastolic blood pressure