Treatment of Hypertension in Patients Receiving Cancer Therapy
Hypertension is a common cardiovascular disease associated with high morbidity and mortality when left untreated. As the incidence of hypertension increases in the general population, its prevalence among oncology patients continues to rise. Some of this
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Treatment of Hypertension in Patients Receiving Cancer Therapy Aaron P. Kithcart, Giuseppe Curigliano, and Joshua A. Beckman
Introduction Hypertension affects one in three adults in the United States. Epidemiological studies estimate that high blood pressure contributes to one out of every seven deaths and nearly half of all cardiovascular disease-related deaths in the United States [1]. Not surprisingly, hypertension is diagnosed commonly in the oncology population with important implications for both antineoplastic therapy and longterm prognosis. The presence of hypertension may be a negative predictor of morbidity and mortality [2]. High blood pressure is the most common comorbidity in patients with malignancy [3]. While the prevalence of hypertension in cancer patients is similar at the time of initial diagnosis, the prevalence increases to 37 % over the course of cancer therapy, especially those who have received chemotherapy [4, 5]. The increased prevalence stems from the effect of many antineoplastic agents on blood pressure, in part, due to their mechanisms of cancer treatment [6–8]. Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-31943096-6_5) contains supplementary material, which is available to authorized users. A.P. Kithcart (*) Cardiology, Brigham and Women’s Hospital, Boston, MA, USA e-mail: [email protected] G. Curigliano Division of Early Drug Development for Innovative Therapies, Istituto Europeo di Oncologia, Milano, Italy e-mail: [email protected] J.A. Beckman Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 G.G. Kimmick et al. (eds.), Cardio-Oncology, DOI 10.1007/978-3-319-43096-6_5
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The clinician caring for the oncologic patient has a constantly expanding requirement to be acquainted with the management of hypertension, the associated risks of antineoplastic therapy, and the impact of cancer therapy on cardiovascular disease to provide high-quality care. This chapter will define hypertension and describe a basic approach for management, provide an overview of the association between cancer and hypertension, review common chemotherapeutic agents that contribute to hypertension, and discuss the mechanisms by which these agents increase blood pressure thereby providing insight into the specific treatment of hypertension.
Hypertension Hypertension is the most common cardiovascular comorbidity in the United States, found in nearly one third of all adults [1]. The prevalence among adults is 30.9 %, but among those greater than 65, the prevalence approaches 70 % [1]. Rates remain highest among African-Americans, with Mexican-Americans having the lowest rates of documented hypertension. Contemporary studies suggest there is no clear difference across socioeconomic status or education level, although it is worth noting that the highest rates of hypertension are found in tho
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