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Samples L, Voutsinas J, Fakhri B, Khajavian S, Spurgeon S, Stephens D, Skarbnik A, Mato A, Broome C, Gopal A, Smith S, Lynch R, Rainey M, Kim MS, Barrett-Campbell O, Hemond E, Tsang M, Ermann D, Malakhov N, Rao D, Shakib-Azar M, Morrigan B, Chauhan A, Plate T, Gooley T, Ryan K, Lansigan F, Hill B, Pongas G, Parikh SA, Roeker L, Allan JN, Cheng R, Ujjani C, Shadman M. Hypertension treatment for patients receiving ibrutinib: a multicenter retrospective study. Blood Adv 2024; 8:2085-2093. [PMID: 38315043 PMCID: PMC11063398 DOI: 10.1182/bloodadvances.2023011569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 02/07/2024] Open
Abstract
ABSTRACT Although Bruton tyrosine kinase inhibitors (BTKis) are generally well tolerated and less toxic than chemotherapy alternatives used to treat lymphoid malignancies, BTKis like ibrutinib have the potential to cause new or worsening hypertension (HTN). Little is known about the optimal treatment of BTKi-associated HTN. Randomly selected patients with lymphoid malignancies on a BTKi and antihypertensive drug(s) and with at least 3 months of follow-up data were sorted into 2 groups: those diagnosed with HTN before BTKi initiation (prior-HTN), and those diagnosed with HTN after BTKi initiation (de novo HTN). Generalized estimating equations assessed associations between time varying mean arterial pressures (MAPs) and individual anti-HTN drug categories. Of 196 patients included in the study, 118 had prior-HTN, and 78 developed de novo HTN. Statistically significant mean MAP reductions were observed in patients with prior-HTN who took β blockers (BBs) with hydrochlorothiazide (HCTZ), (-5.05 mmHg; 95% confidence interval [CI], 10.0 to -0.0596; P = .047), and patients diagnosed with de novo HTN who took either an angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) with HCTZ (-5.47 mmHg; 95% CI, 10.9 to -0.001; P = .05). These regimens also correlated with the greatest percentages of normotensive MAPs. Treatment of HTN in patients taking a BTKi is challenging and may require multiple antihypertensives. Patients with prior-HTN appear to benefit from combination regimens with BBs and HCTZ, whereas patients with de novo HTN appear to benefit from ACEi/ARBs with HCTZ. These results should be confirmed in prospective studies.
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Affiliation(s)
- Laura Samples
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Jenna Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Bita Fakhri
- Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Sirin Khajavian
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Stephen Spurgeon
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | - Deborah Stephens
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | | | - Anthony Mato
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Catherine Broome
- Division of Hematology and Oncology, Georgetown University, Washington, DC
| | - Ajay Gopal
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Stephen Smith
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Ryan Lynch
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Magdalena Rainey
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Myung Sun Kim
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | | | - Emily Hemond
- Hematology/Oncology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mazie Tsang
- Division of Hematology and Oncology, University of California, San Francisco, CA
| | - Daniel Ermann
- Division of Hematology and Hematologic Malignancies, The University of Utah, Salt Lake City, UT
| | - Nikita Malakhov
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Danielle Rao
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Beth Morrigan
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Ayushi Chauhan
- Division of Hematology and Oncology, Georgia Cancer Center, Augusta University, Augusta, GA
| | - Thomas Plate
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Frederick Lansigan
- Hematology/Oncology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Brian Hill
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
| | - Georgios Pongas
- Division of Hematology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | - Lindsey Roeker
- Division of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - John N. Allan
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Richard Cheng
- Division of Cardiology, University of Washington, Seattle, WA
| | - Chaitra Ujjani
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
| | - Mazyar Shadman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology and Oncology, University of Washington, Seattle, WA
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Aljaibeji H, Heydarpour M, Stanton AM, Williams JS, Pojoga LH, Romero JR, Williams GH. Role of Raptor Gene Variants in Hypertension: Influence on Blood Pressure Independent of Salt Intake in White Population. Hypertension 2024; 81:1167-1177. [PMID: 38497230 PMCID: PMC11023780 DOI: 10.1161/hypertensionaha.123.22273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND The mTOR (mechanistic target of rapamycin) is an essential regulator of fundamental biological processes. mTOR forms 2 distinct complexes, mTORC1 (mTOR complex 1) when it binds with RAPTOR (Regulatory-associated Protein of mTOR) and mTORC2 (mTOR complex 2) when it associates with RICTOR (Rapamycin-insesitive companion of mTOR). Due to the previous link between the mTOR pathway, aldosterone, and blood pressure (BP), we anticipated that variants in the mTOR complex might be associated with salt-sensitive BP. METHODS BP and other parameters were assessed after a one-week liberal Na+ (200 mmol/d) and a one-week restricted Na+ (10 mmol/d) diet in 608 White subjects from the Hypertensive Pathotype cohort, single-nucleotide variants in MTOR, RPTOR, and RICTOR genes were obtained for candidate genes analyses. RESULTS The analysis revealed a significant association between a single nucleotide variants within the RPTOR gene and BP. Individuals carrying the RPTOR rs9901846 homozygous risk allele (AA) and heterozygous risk allele (GA) exhibited a 5 mm Hg increase in systolic BP on a liberal diet compared with nonrisk allele individuals (GG), but only in women. This single nucleotide variants effect was more pronounced on the restricted diet and present in both sexes, with AA carriers having a 9 mm Hg increase and GA carriers having a 5 mm Hg increase in systolic BP compared with GG. Interestingly, there were no significant associations between MTOR or RICTOR gene variants and BP. CONCLUSIONS The RPTOR gene variation is associated with elevated BP in White participants, regardless of salt intake, specifically in females.
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Affiliation(s)
- Hayat Aljaibeji
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (H.A., M.H., A.M.S., J.S.W., L.H.P., J.R.R., G.H.W.)
| | - Mahyar Heydarpour
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (H.A., M.H., A.M.S., J.S.W., L.H.P., J.R.R., G.H.W.)
| | - Ana Maria Stanton
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (H.A., M.H., A.M.S., J.S.W., L.H.P., J.R.R., G.H.W.)
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (H.A., M.H., A.M.S., J.S.W., L.H.P., J.R.R., G.H.W.)
| | - Luminita H Pojoga
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (H.A., M.H., A.M.S., J.S.W., L.H.P., J.R.R., G.H.W.)
| | - Jose R Romero
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (H.A., M.H., A.M.S., J.S.W., L.H.P., J.R.R., G.H.W.)
| | - Gordon H Williams
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (H.A., M.H., A.M.S., J.S.W., L.H.P., J.R.R., G.H.W.)
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Prousi GS, Joshi AM, Atti V, Addison D, Brown SA, Guha A, Patel B. Vascular Inflammation, Cancer, and Cardiovascular Diseases. Curr Oncol Rep 2023; 25:955-963. [PMID: 37261651 DOI: 10.1007/s11912-023-01426-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE OF REVIEW Cancer and cardiovascular disease are among the leading causes of morbidity and mortality in the USA. Cancer and cardiovascular disease have inflammatory underpinnings that have been associated with both the development and progression of these disease states. RECENT FINDINGS Inflammatory signaling has been found to be a critical event in both cardiovascular disease and cancer formation and progression. Further, many chemotherapeutic agents potentiate inflammation exacerbating existing cardiovascular disease or leading to its presence. The exact mechanisms of these interactions remain poorly understood. The proinflammatory milieu observed in both cancer and cardiovascular disease likely plays an important role in the development and potentiation of both conditions. Further evaluation of this relationship will be critical in the development of new diagnostic and therapeutic modalities.
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Affiliation(s)
| | - Amogh M Joshi
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Varun Atti
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26505, USA
| | - Daniel Addison
- Department of Cardiology, Ohio State University, Columbus, OH, USA
| | - Sherry-Ann Brown
- Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Avirup Guha
- Department of Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Brijesh Patel
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Dr, Morgantown, WV, 26505, USA.
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The use of renin angiotensin aldosterone system inhibitors may be associated with decreased mortality after cancer surgery. Sci Rep 2022; 12:6838. [PMID: 35477724 PMCID: PMC9046295 DOI: 10.1038/s41598-022-10759-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
Renin–angiotensin–aldosterone system (RAAS) inhibitors are antihypertensive agents with conflicting results on protective effects against some types of cancer. In light of these controversies, we aimed to study the effects of RAAS inhibitors in patients undergoing cancer surgery. From March 2010 to December 2019, consecutive adult patients with antihypertensive drug prescription at discharge after cancer surgery were enrolled and divided into two groups according to RAAS inhibitors prescription. The primary outcome was 5-year mortality after surgery. Secondary outcomes included mortalities during 3-year and 1-year follow-ups and cancer-specific mortality and recurrence rates during 5-, 3-, and 1-year follow-ups. A total of 19,765 patients were divided into two groups according to RAAS inhibitor prescription at discharge: 8,374 (42.4%) patients in the no RAAS inhibitor group and 11,391 (57.6%) patients in the RAAS inhibitor group. In 5022 pairs of propensity-score matched population, 5-year mortality was significantly lower in the RAAS inhibitor group (11.4% vs. 7.4%, hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.64–0.83, P < 0.001), and 5-year recurrence rate was also lower for the RAAS inhibitor group (5.3% vs. 3.7%, HR 0.82, 95% CI 0.68–0.99, P = 0.04). In our analysis, RAAS inhibitor was associated with decreased 5-year mortality in hypertensive patients who underwent cancer surgery. Prescription of RAAS inhibitor in accordance with current guidelines may be associated with improved mortality after cancer surgery.
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Wang Y, Wang Y, Han X, Sun J, Li C, Adhikari BK, Zhang J, Miao X, Chen Z. Cardio-Oncology: A Myriad of Relationships Between Cardiovascular Disease and Cancer. Front Cardiovasc Med 2022; 9:727487. [PMID: 35369296 PMCID: PMC8968416 DOI: 10.3389/fcvm.2022.727487] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/21/2022] [Indexed: 12/21/2022] Open
Abstract
Cardiovascular disease (CVD) and cancer are the leading causes of death worldwide. With an increasing number of the elderly population, and early cancer screening and treatment, the number of cancers cases are rising, while the mortality rate is decreasing. However, the number of cancer survivors is increasing yearly. With the prolonged life span of cancer patients, the adverse effects of anti-tumor therapy, especially CVD, have gained enormous attention. The incidence of cardiovascular events such as cardiac injury or cardiovascular toxicity is higher than malignant tumors' recurrence rate. Numerous clinical studies have also shifted their focus from the study of a single disease to the interdisciplinary study of oncology and cardiology. Previous studies have confirmed that anti-tumor therapy can cause CVD. Additionally, the treatment of CVD is also related to the tumors incidence. It is well established that the increased incidence of CVD in cancer patients is probably due to an unmodified unhealthy lifestyle among cancer survivors or cardiotoxicity caused by anti-cancer therapy. Nevertheless, some patients with CVD have a relatively increased cancer risk because CVD and malignant tumors are highly overlapping risk factors, including gender, age, hypertension, diabetes, hyperlipidemia, inflammation, and obesity. With advancements in the diagnosis and treatment, many patients simultaneously suffer from CVD and cancer, and most of them have a poor prognosis. Therefore, clinicians should understand the relationship between CVD and tumors, effectively identify the primary and secondary prevention for these diseases, and follow proper treatment methods.
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Affiliation(s)
- Yinghui Wang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, China
| | - Yonggang Wang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, China
| | - Xiaorong Han
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, China
| | - Jian Sun
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, China
| | - Cheng Li
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, China
| | | | - Jin Zhang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, China
| | - Xiao Miao
- The Second Hospital of Jilin University, Changchun, China
- *Correspondence: Xiao Miao
| | - Zhaoyang Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China
- Zhaoyang Chen
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Bruton's tyrosine kinase Inhibitors and Cardiotoxicity: More Than Just Atrial Fibrillation. Curr Oncol Rep 2021; 23:113. [PMID: 34342738 PMCID: PMC8330192 DOI: 10.1007/s11912-021-01102-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
Purpose of Review The purpose of this review is to summarize the epidemiology, mechanisms, and management of cardiovascular complications of Bruton’s Tyrosine Kinase inhibitors (BTKIs). Recent Findings Ibrutinib increases the risk of atrial fibrillation, bleeding, and hypertension compared with non-BTKI therapies. The evidence to support an association between ibrutinib and other cardiovascular complications including ventricular tachyarrhythmias or cardiomyopathy is limited. Ibrutinib metabolism can be inhibited by some medications used to treat cardiovascular complications. The cardiovascular effects of more selective BTKIs, such as acalabrutinib, remain to be determined. Summary Future research should address the mechanisms underlying the cardiovascular complications of BTKIs and how best to manage them. The risks and benefits of more selective BTKIs as compared with ibrutinib require further evaluation.
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Effect of concomitant use of antihypertensives and immune check point inhibitors on cancer outcomes. J Hypertens 2021; 39:1274-1281. [PMID: 34074965 DOI: 10.1097/hjh.0000000000002799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Antihypertensives and cancer have a complex relationship. Among the antihypertensives, renin--angiotensin system inhibitors have strong immune modulatory activities that may affect immune check point inhibitors-related outcomes in cancer patients. We evaluated the association between concomitant use of renin--angiotensin system inhibitors and other antihypertensive agents with survival/toxicity outcomes from atezolizumab. METHODS A post hoc analysis of individual patient data from seven clinical trials of lung, renal or urothelial cancers was performed. Users and nonusers of antihypertensive classes were compared for overall survival, progression-free survival and immune adverse events. Cox proportional hazards were calculated between the groups and reported as hazards ratio and 95% confidence interval (95% CI). RESULTS Of the 3695 patients, 2539 were treated with atezolizumab and the rest with chemotherapy. Twenty-four percent of patients were on a renin--angiotensin system inhibitor at trial commencement. No statistically significant difference in overall survival (hazard ratio 0.92, 95% CI 0.79-1.07, P = 0.29), progression-free survival (hazard ratio 0.95, 95% CI 0.84-1.08, P = 0.42) or immune adverse events (odds ratio 0.94, 95% CI 0.76-1.15, P = 0.55) between renin--angiotensin system inhibitor users and nonusers were identified in the atezolizumab-treated cohort. Other classes of antihypertensives were also not associated with survival. CONCLUSION Concomitant use of antihypertensives including RASi was not associated with survival and immune-related safety outcomes during atezolizumab therapy for solid cancers. Future studies should evaluate the association between antihypertensives and other ICI as well as ICI combination interventions in clinical trials and real-world settings.
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Hypertension management in cardio-oncology. J Hum Hypertens 2020; 34:673-681. [PMID: 32747676 PMCID: PMC7398285 DOI: 10.1038/s41371-020-0391-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 12/13/2022]
Abstract
Cancer is one of the leading causes of death worldwide. During the last few decades prognosis has improved dramatically and patients are living longer and suffering long-term cardiovascular consequences of chemotherapeutic agents. Cardiovascular disease is a leading cause of morbidity and mortality in cancer survivors second only to recurrent cancer. In some types of cancer, cardiovascular disease is a more common cause of death than the cancer itself. This has led to a new sub-specialty of cardiology coined cardio-oncology to manage this specific population. Hypertension is one of the most common cardiovascular disease seen in this cohort. The aetiology of hypertension in cardio-oncology is complex and multifactorial based on the type of chemotherapy, type of malignancy and intrinsic patient factors such as age and pre-existing comorbidities. A variety of different oncological treatments have been implicated in causing hypertension. The effect can be transient whilst undergoing treatment or can be delayed occurring decades after treatment. A tailored management plan is recommended given the plethora of agents and their differing underlying mechanisms and speed of this mechanism in causing hypertension. Management by a multidisciplinary team consisting of oncology, general practice and cardiology is advised. There are currently no trials comparing antihypertensives in this specific cohort of patients. In the absence of evidence demonstrating otherwise, hypertension in cardio-oncology should be managed utilising the same treatment guidelines for the general population.
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Abstract
BACKGROUND Cardio-oncology aims to mitigate adverse cardiovascular manifestations in cancer survivors, but treatment-induced hypertension or aggravated hypertension has received less attention in these high cardiovascular risk patients. METHODS In this systematic review, we searched literature for contemporary data on the prevalence, pathophysiologic mechanisms, treatment implications and preventive strategies of hypertension in patients under antineoplastic therapy. RESULTS Several classes of antineoplastic drugs, including mainly vascular endothelial growth factor inhibitors, proteasome inhibitors, cisplatin derivatives, corticosteroids or radiation therapy were consistently associated with increased odds for new-onset hypertension or labile hypertensive status in previous controlled patients. Moreover, hypertension constitutes a major risk factor for chemotherapy-induced cardiotoxicity, which is the most serious cardiovascular adverse effect of antineoplastic therapy. Despite the heterogeneity of pooled studies, the pro-hypertensive profile of examined drug classes could be attributed to common structural and functional disorders. Importantly, certain antihypertensive drugs are considered to be more effective in the management of hypertension in this population and may partially attenuate indirect complications of cancer treatment, such as progressive development of cardiomyopathy and/or cardiovascular death. Nonpharmacological approaches to alleviate hypertension in cancer patients are also described, albeit adjudicated as less effective in general. CONCLUSION A growing body of evidence suggests that multiple antineoplastic agents increase the rate of progression of hypertension. Physicians need to balance the life-saving cancer treatment and the inflated risk of adverse cardiovascular events due to suboptimal management of hypertension in order to achieve improved clinical outcomes and sustained survival for their patients.
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Hypertension and incident cardiovascular events following ibrutinib initiation. Blood 2020; 134:1919-1928. [PMID: 31582362 DOI: 10.1182/blood.2019000840] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/26/2019] [Indexed: 12/12/2022] Open
Abstract
Ibrutinib is associated with dramatic efficacy against B-cell malignancies. Yet, it has been linked with potentially limiting cardiotoxicity, including emerging reports of profound hypertension (HTN). The long-term incidence, severity, and impact of HTN development with ibrutinib are unknown. Therefore, in 562 consecutive patients treated with ibrutinib for B-cell malignancies from 2009 through 2016, we assessed the new/incident or worsened HTN (systolic blood pressure [BP] cutoff, 130 mm Hg). Observed incident HTN rates were compared with Framingham-heart-predicted incident HTN rates. We also evaluated the relationship of HTN to the development of other major adverse cardiovascular events (MACEs), including arrhythmia, myocardial infarction, stroke, heart failure, and cardiovascular death. Further, we assessed the effects of different antihypertensive classes on ibrutinib-related HTN. Overall, 78.3% of ibrutinib users developed new or worsened HTN over a median of 30 months. New HTN developed in 71.6% of ibrutinib users, with a time to 50% cumulative incidence of 4.2 months. Among those without preceding HTN, 17.7% developed high-grade HTN (BP >160/100 mm Hg). In multivariate regression, new or worsened HTN was associated with increased MACEs (hazard ratio [HR], 2.17; 95% confidence interval [CI], 1.08-4.38). No single antihypertensive class was associated with prevention or control of ibrutinib-related HTN. However, antihypertensive initiation was associated with a lower risk of a MACE (HR, 0.40; 95% CI, 0.24-0.66). Collectively, these data suggest that ibrutinib is associated with a substantial increase in the incidence and severity of HTN, and that HTN development carries a higher risk of subsequent cardiotoxic events.
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Ketterl TG, Latham GJ. Perioperative Cardiothoracic and Vascular Risk in Childhood Cancer and its Survivors. J Cardiothorac Vasc Anesth 2020; 35:162-175. [PMID: 32360009 DOI: 10.1053/j.jvca.2020.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/11/2020] [Accepted: 02/28/2020] [Indexed: 11/11/2022]
Abstract
CHILDREN with cancer and survivors of childhood cancer have an increased risk of cardiovascular disease, and this risk in the perioperative period must be understood. During diagnosis and treatment of pediatric cancer, multiple acute cardiovascular morbidities are possible, including anterior mediastinal mass, tamponade, hypertension, cardiomyopathy,and heart failure. Childhood cancer survivors reaching late childhood and adulthood experience substantially increased rates of cardiomyopathy, heart failure, valvular disease, pericardiac disease, ischemia, and arrhythmias. Despite considerable advances in the understanding and therapeutic options of pediatric malignancies, cardiac disease remains the most common treatment-related, noncancer cause of death in childhood cancer survivors. Increasingly, molecularly targeted agents, including small molecule inhibitors, are being incorporated into pediatric oncology. The acute and chronic risks associated with these newer therapeutic options in children are not yet well-described, which poses challenges for clinicians caring for these patients. In the present review, the unique risks factors, prevention strategies, and treatment of cardiovascular toxicities of the child with cancer and the childhood cancer survivor are examined, with an emphasis on the perioperative period.
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Affiliation(s)
- Tyler G Ketterl
- Department of Pediatric Hematology and Oncology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Gregory J Latham
- Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
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12
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Intriguing relationship between antihypertensive therapy and cancer. Pharmacol Res 2019; 141:501-511. [DOI: 10.1016/j.phrs.2019.01.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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Kozłowska K, Kozłowski L, Małyszko J. Hypertension prevalence in early breast cancer patients undergoing primary surgery. Adv Med Sci 2019; 64:32-36. [PMID: 30419489 DOI: 10.1016/j.advms.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/14/2018] [Accepted: 10/11/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE Treatment with chemotherapy and targeted drugs may results in elevated risk of cardiac and renal toxicity as well as hypertension. However, data on prevalence of chronic kidney disease and hypertension in subjects with early breast cancer undergoing primary surgery are very limited. PATIENTS AND METHODS The study aimed to assess the prevalence of chronic kidney disease and hypertension (evaluated as a preoperative assessment and defined according to ESC/ESH guidelines) in a cohort of 100 consecutive female patients with early breast cancer treated with primary surgery with curative intent. RESULTS Patients with breast cancer were 53 ± 14 years of age, with serum creatinine of 0.68 ± 0.14 mg/dl and estimated glomerular filtration rate by chronic kidney disease-epidemiological collaboration formula of 99 ± 18 mL/min/1.72 m2. Hypertension was present in 37%, but in the elderly patients (over 65 years) the prevalence was 74%. Hypertensive females had worse kidney function as reflected by higher serum creatinine and lower estimated glomerular filtration rate, higher body mass index and fibrinogen, which reflects general inflammatory state. When we divided the patients according to age (≤ vs >65 years) and the presence of hypertension, the elderly hypertensive females had significantly worse kidney function, higher fibrinogen and fasting glucose. CONCLUSIONS The prevalence of hypertension in patients with breast cancer raises with age, and presence of comorbidities, including chronic kidney disease. Hypertension should be treated promptly to prevent cardiovascular complications during oncological therapy.
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Ray A. Cancer and comorbidity: The role of leptin in breast cancer and associated pathologies. World J Clin Cases 2018; 6:483-492. [PMID: 30397604 PMCID: PMC6212611 DOI: 10.12998/wjcc.v6.i12.483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 02/05/2023] Open
Abstract
Obesity is an important risk factor for postmenopausal breast cancer and also a poor prognostic factor among cancer patients. Moreover, obesity is associated with a number of health disorders such as insulin resistance/type-2 diabetes mellitus, hypertension, and other cardiovascular diseases. Frequently, these health disorders exhibit as components/complications of the metabolic syndrome. Nevertheless, obesity-related diseases may coexist with postmenopausal breast cancer; and these comorbid conditions could be substantial. Therefore, it may be assumed that different diseases including breast cancer could originate from a common pathological background in excessive adipose tissue. Adipocyte-released hormone-like cytokine (or adipokine) leptin behaves differently in a normal healthy state and obesity. A growing body of evidence suggests an important role of leptin in our major obesity-related health issues such as insulin resistance, hypertension, and neoplasia. In this context, this review describes the relationships of the abovementioned pathologies with leptin.
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Affiliation(s)
- Amitabha Ray
- Lake Erie College of Osteopathic Medicine, Seton Hill University, Greensburg, PA 15601, United State
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