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Review
. 2023 Dec 12;9(1):46.
doi: 10.1186/s40959-023-00197-8.

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

Amir Askarinejad  1 , Azin Alizadehasl  2 , Amir Ghaffari Jolfayi  1 , Sara Adimi  3
Affiliations
Review

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

Amir Askarinejad et al. Cardiooncology. .

Abstract

Hypertension is one of the most common comorbidity and the leading cause of cancer-related death in cancer patients. The prevalence of hypertension in cancer patients is much higher than that of the general population. In the older population of cancer patients, specific cancer treatments such as new tyrosine kinase inhibitors and Vascular endothelial growth factor inhibitor drugs give rise to hypertension in cancer patients; The aim of present study is to provide a detailed discussion etiologies of cancer treatment-induced hypertension and explore the most innovative diagnostic and management approaches. This review will address the optimal approach to hypertension treatment, covering treatment initiation thresholds, targets, and the selection of anti-hypertensive agents. The lack of evidence in recent guidelines for managing cardiovascular toxicities in cancer patients can create uncertainty in clinicians' therapeutic and clinical decisions. This review aims to enhance our understanding of hypertension etiology in cancer patients and provide a practical guide to current treatment approaches.

Keywords: Cardio-oncology; Hypertension; Tyrosine kinase inhibitors; Vascular endothelial growth factor inhibitor.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
mechanisms of anti-cancer agents in inducing hypertension. Anti-cancer agents induce hypertension through various mechanisms. A better understanding of these mechanisms can help physicians to choose the proper therapeutic strategies for hypertension treatment in cancer patients. ACTH= Adrenocorticotropic Hormone, CVD=Cardiovascular disease, ET= Endothelin, ET-1 = Endothelin-1, NO=Nitric oxide, RAAS= Renin-angiotensin-aldosterone system VEGFi = Vascular endothelial growth factor inhibitor
Fig. 2
Fig. 2
Thresholds for asymptomatic hypertension treatment in cancer patients. The threshold for initiating the hypertension treatment increases as the patient has a worse prognosis. Starting the hypertension treatment at the proper time is crucial in managing hypertension in cancer patients, especially in patients under treatment of VEGFi, because it has been indicated that the efficacy of these drugs is related to blood pressure increase in these patients
Fig. 3
Fig. 3
Pharmacological management of hypertension in cancer patients. Choosing the proper anti-hypertensive agent for cancer patients is essential in managing hypertension in these patients. ACE or ARB and CCB are the first-line treatment in hypertension treatment. In patients with resistant hypertention, beta-blockers, diuretics, and nitrates can be added to the therapeutic drugs. Beta-blockers are a good choice if cancer patients have high sympathetic tone, tumors with beta-receptor expression (such as angiosarcoma and multiple myeloma), and other cardiovascular comorbidities
Fig. 4
Fig. 4
Etiology, Assessment, Diagnosis, and Management of Hypertension in Cancer patients. Anti-cancer agents induce hypertension by different mechanisms, including vasoconstriction, salt and water retention, RAAS dysfunction, baroreflex failure and other mechanisms illustrated in the figure. Physicians should initiate the treatment at the right time by choosing the proper anti-hypertension drug
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