Use of Antihypertensive Drugs in Neoplastic Patients
- PDF / 877,285 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 70 Downloads / 191 Views
REVIEW ARTICLE
Use of Antihypertensive Drugs in Neoplastic Patients Damiano Rizzoni1,2 • Carolina De Ciuceis1 • Enzo Porteri1 • Claudia Agabiti-Rosei1 Enrico Agabiti-Rosei1
•
Received: 13 February 2017 / Accepted: 27 March 2017 Ó Springer International Publishing Switzerland 2017
Abstract The introduction of Vascular Endothelial Growth Factor (VEGF) signaling pathway inhibitor treatment has highlighted the role of the baseline activity of the VEFG system for blood pressure regulation. VEGF signaling pathway is associated with hypertension and proteinuria. Activation of the endothelin system, endothelial dysfunction and capillary rarefaction are among the underlying mechanisms possibly explaining the rise in blood pressure and, to some extent, also the renal injury. The hypertension induced by VEGF signaling pathway inhibition is, usually, responsive to treatment. Recommendations about the management of cardiovascular toxicity in patients receiving VEGF signaling pathway inhibitors include a formal cardiovascular risk assessment before initiation of VEGF signaling pathway inhibitor treatment, active monitoring of blood pressure and cardiac toxicity throughout treatment, with more frequent monitoring during the first cycles of therapy, given that marked and unpredictable blood pressure rises can occur early after treatment with a VEGF signaling pathway inhibitor, and aggressive management of blood pressure elevations and early symptoms and signs of cardiac toxicity to prevent clinically limiting complications. In patients with preexisting hypertension, the blood pressure target for initiating VEGF signaling pathway inhibitor treatment should be \140/90 mmHg. Blockers of the renin-angiotensin system
& Damiano Rizzoni [email protected] 1
Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100 Brescia, Italy
2
Division of Medicine, Istituto Clinico Citta` di Brescia, Brescia, Italy
and calcium channel antagonists are among the drugs to be preferably used in these clinical conditions. Keywords Hypertension Blood pressure Microvasculature Angiogenesis Antiangiogenic treatment
1 Introduction The population of cancer survivors has gradually increased in recent decades. A study of the relative prevalence of cancer survival in the United States shows that in 2014, nearly 14.5 million Americans with a history of cancer were alive [1]. The number of cancer survivors is projected to increase by 31% to almost 19 million in the next 10 years [1]. The increasing number of cancer survivors is a reflection of an enhanced survival of cancer, as a result of improvements in cancer detection, treatment advances, more adjuvant treatments, and also of an increasing number of new cancer diagnoses due to a growing and aging population as cancer incidence increases with age [1]. However, the cancer survivors are at risk for conditions related to the disease and its treatment, which are of increasing importance as
Data Loading...
