Top Things to Know: Cancer Therapy-Related HTN

Published: January 09, 2023
  1. Cancer and cardiovascular disease (CVD) are both major causes of morbidity and mortality globally. Hypertension (HTN) is a main factor in the development of CVD (ischemic heart disease, heart failure, stroke, and kidney disease). The prevalence of HTN worldwide is increasing, reaching 1.3 billion in adults in 2019.
  2. Even with the availability of antihypertensive drugs, blood pressure is controlled at only about 50% of those with known HTN.
  3. The current definitions for HTN discussed in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults are defined in general as normal BP, elevated BP and hypertension.
  4. A bidirectional relationship between cancer and HTN has been proposed. This has been seen in renal cell carcinoma in patients with HTN. The prevalence of HTN is higher in patients with cancer and cancer survivors than in the general population.
  5. The frequent occurrence of cancer and HTN and an increased CVD risk in patients with cancer may be explained by the presence of common risk factors and pathophysiological mechanisms including smoking, diabetes, chronic kidney disease, physical inactivity, obesity, oxidative stress and inflammation.
  6. This scientific statement calls attention to the many anti-cancer drugs that have cardiovascular toxicities including cancer therapy induced HTN.
  7. Many anti-cancer drugs may worsen BP control in patients that have existing HTN.
  8. HTN control is always important prior to, during and following completion of cancer treatment.
  9. Suggestions for BP monitoring during while on anti-cancer drugs and then upon discontinuing these drugs, knowing the risk of BP lability, where careful consideration of dosing of antihypertensive drugs may be needed.
  10. This paper discusses the gaps in knowledge and the need for more research addressing the need to understand the mechanisms of how anti-cancer drugs cause HTN. Some gaps that need addressing include the timing and frequency of BP monitoring and CV risk assessment with cancer during and after therapy.
  11. Clinicians should be keenly aware of the potential for development of HTN during anti-cancer drug treatment. Management of cancer patients with HTN is complex and requires a team approach including the oncologist, cardiologist, hypertension specialists, primary care providers and pharmacists in all stages of treatment including the follow-up period post anti-cancer drug phase. Detection is critical for prevention of comorbid condition. In addition to managing HTN levels with antihypertensive agents, lifestyle changes should also be addressed if appropriate.

View the summary for Cancer Therapy–Related Hypertension

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Citation

Cohen JB, Brown NJ, Brown S-A, Dent S, van Dorst DCH, Herrmann SM, Lang NN, Oudit GY, Touyz RM; on behalf of the American Heart Association Council on Hypertension; Council on Arteriosclerosis, Thrombosis and Vascular Biology; and Council on the Kidney in Cardiovascular Disease. Cancer therapy–related hypertension: a scientific statement from the American Heart Association [published online ahead of print January 9, 2023]. Hypertension. doi: 10.1161/HYP.0000000000000224

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