Resistance to antihypertensive drugs targeting Renin-Angiotensin-Aldosterone-System in cancer patients: a case series
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Resistance to antihypertensive drugs targeting Renin-Angiotensin-AldosteroneSystem in cancer patients: a case series Mishita Goel1* , Rajiv Sunil Varandani2 and Tochukwu M. Okwuosa3
Abstract Hypertension impacts overall prognosis in cancer patients. There are no specific recommendations for its management in these patients. We report a case series of 5 cancer patients with suboptimal BP lowering and even worsening BP with ACEi or ARBs that improved to normal upon discontinuation of these drugs. Keywords: Hypertension, Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Chemotherapeutic agents
Learning points Hypertension is one of the most common
comorbidities significantly impacting prognosis in cancer patients but still there are no specific recommendations for its management in these patients. Antihypertensive drugs targeting the Renin Angiotensin Aldosterone System (RAAS) are commonly used for management of hypertension in cancer patients. Preclinical studies in rats have demonstrated suboptimal blood pressure lowering effects of these agents in severe hypertension, however clinical experience with use of these agents for management of hypertension in cancer patients has never been reported. Our study involved 5 cancer patients with uncontrolled hypertension managed with Angiotensin-converting enzyme inhibitors (ACEi) and Angiotensin Receptor Blockers (ARBs) that later
* Correspondence: [email protected] 1 Department of Internal Medicine, WSU/Ascension Providence Rochester Hospital, 1101 W University Drive, Rochester Drive, Rochester, MI 48307, USA Full list of author information is available at the end of the article
improved to normal upon discontinuation of these drugs. There are very few current studies that have reported beneficial outcomes in patients on antiangiogenic based cancer therapy with specific antihypertensive medication classes. Clinical experience with the use of specific anti-hypertensive medication classes in patients with cancer needs to be reported in a disciplined fashion.
Introduction Hypertension is one of the most common comorbidities reported in cancer patients. Chemotherapeutic agents, especially VEGF signaling pathway (VSP) inhibitors can not only worsen but cause de novo hypertension [1]. There are no specific recommendations for management of hypertension in cancer patients despite its significant impact on prognosis compared to any of the other cardiovascular risk factors in these patients [2]. Angiotensin-converting enzyme inhibitors (ACEi) are most commonly used to manage hypertension. Dirix et al. [3] reported continued increase in blood pressure (BP) despite addition of an ACEi in a 51-year old male with renal cell carcinoma until treated successfully with a long acting nitrate. Thus their efficacy in reducing BP in cancer patients needs further exploration.
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, shari
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