Renin angiotensin system inhibitors reduce the incidence of arterial thrombotic events in patients with hypertension and
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ORIGINAL ARTICLE
Renin angiotensin system inhibitors reduce the incidence of arterial thrombotic events in patients with hypertension and chronic myeloid leukemia treated with second- or third-generation tyrosine kinase inhibitors Olga Mulas 1 & Giovanni Caocci 1,2 & Fabio Stagno 3 & Massimiliano Bonifacio 4 & Mario Annunziata 5 & Luigiana Luciano 6 & Ester Maria Orlandi 7 & Elisabetta Abruzzese 8 & Nicola Sgherza 9 & Bruno Martino 10 & Francesco Albano 11 & Sara Galimberti 12 & Patrizia Pregno 13 & Monica Bocchia 14 & Fausto Castagnetti 15 & Mario Tiribelli 16 & Gianni Binotto 17 & Antonella Gozzini 18 & Isabella Capodanno 19 & Claudio Fozza 20 & Debora Luzi 21 & Fabio Efficace 22 & Maria Pina Simula 1 & Luigi Scaffidi 4 & Fiorenza De Gregorio 6 & Chiara Elena 7 & Malgorzata Monika Trawinska 8 & Daniele Cattaneo 23 & Imma Attolico 11 & Claudia Baratè 12 & Francesca Pirillo 13 & Anna Sicuranza 14 & Gabriele Gugliotta 15 & Rossella Stella 16 & Emilia Scalzulli 24 & Alessandra Iurlo 23 & Robin Foà 24 & Massimo Breccia 24 & Giorgio La Nasa 1,2 Received: 29 April 2020 / Accepted: 20 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Hypertension is a commonly reported comorbidity in patients diagnosed with chronic myeloid leukemia (CML), and its management represents a challenge in patients treated with 2nd- or 3rd-generation tyrosine kinase inhibitors (TKIs), considering their additional cardiovascular (CV) toxicity. The renin angiotensin system (RAS) contributes to hypertension genesis and plays an important role in atherosclerosis development, proliferation, and differentiation of myeloid hematopoietic cells. We analyzed a cohort of 192 patients with hypertension at CML diagnosis, who were treated with 2nd- or 3rd-generation TKIs, and evaluated the efficacy of RAS inhibitors (angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs)) in the prevention of arterial occlusive events (AOEs), as compared with other drug classes. The 5-year cumulative incidence of AOEs was 32.7 ± 4.2%. Patients with SCORE ≥ 5% (high-very-high) showed a significantly higher incidence of AOEs (33.7 ± 7.6% vs 13.6 ± 4.8%, p = 0.006). The AOE incidence was significantly lower in patients treated with RAS inhibitors (14.8 ± 4.2% vs 44 ± 1%, p < 0.001, HR = 0.283). The difference in the low and intermediate Sokal risk group was confirmed but not in the high-risk group, where a lower RAS expression has been reported. Our data suggest that RAS inhibitors may represent an optimal treatment in patients with hypertension and CML, treated with 2nd or 3rdG TKIs. Keywords Chronic myeloid leukemia . Arterial occlusive events . TKI . Hypertension . Renin angiotensin system inhibitors
Introduction
Olga Mulas and Giovanni Caocci contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04102-6) contains supplementary material, which is available to authorized users. * Giovanni Caocci [email protected] Ext
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