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Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor-Induced Blood Pressure Rise: A Clinical Cohort Study.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2023 Jan 03; Vol. 12 (1), pp. e028050. Date of Electronic Publication: 2022 Dec 30. - Publication Year :
- 2023
-
Abstract
- Background Anti-cancer vascular endothelial growth factor inhibitors (VEGFI) frequently induce a rise in blood pressure (BP). The most effective treatment of this BP rise is currently unknown, and risk factors and its association with survival remain inconclusive. Methods and Results Baseline characteristics and BP readings were retrospectively collected from oncology patients who received oral VEGFI treatment (sorafenib, sunitinib, pazopanib, regorafenib, lenvatinib, or cabozantinib). Risk factors for a clinically relevant BP rise (increase of ≥20 mm Hg in systolic BP or ≥10 mm Hg in diastolic BP) were investigated via logistic regression (relative), efficacy of antihypertensives via unpaired t-tests, and association of BP rise with survival via Cox regression analysis. In total, 162 (47%) of 343 included patients developed a clinically relevant BP rise ≥7 days after VEGFI treatment initiation. Both calcium channel blockers and renin-angiotensin system inhibitors effectively reduced systolic BP (-24.1 and -18.2 mm Hg, respectively) and diastolic BP (-12.0 and -11.0 mm Hg, respectively). Pazopanib therapy (odds ratio, 2.71 [95% CI, 1.35-5.42; P =0.005], compared with sorafenib) and estimated glomerular filtration rate <60 mL/min per 1.73 m <superscript>2</superscript> (OR, 1.75 [95% CI, 0.99-3.18, P =0.054]) were risk factors for a BP rise, whereas a baseline BP ≥140/90 mm Hg associated with a lower risk (OR, 0.39 [95% CI, 0.25-0.62, P <0.001]). Only for renal cell carcinoma, BP rise was associated with a substantially improved median overall survival compared with no BP rise: 45.4 versus 20.3 months, respectively, P =0.003. Conclusions The type of VEGFI, baseline BP, and baseline estimated glomerular filtration rate determine the VEGFI-induced BP rise. Both calcium channel blockers and renin-angiotensin system inhibitors are effective antihypertensive treatments. Particularly in patients with renal cell carcinoma, a BP rise is associated with improved overall survival.
- Subjects :
- Humans
Blood Pressure
Vascular Endothelial Growth Factor A pharmacology
Calcium Channel Blockers therapeutic use
Cohort Studies
Sorafenib adverse effects
Retrospective Studies
Antihypertensive Agents adverse effects
Angiogenesis Inhibitors adverse effects
Hypertension chemically induced
Hypertension drug therapy
Hypertension metabolism
Carcinoma, Renal Cell drug therapy
Carcinoma, Renal Cell chemically induced
Kidney Neoplasms chemically induced
Kidney Neoplasms drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 12
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 36583425
- Full Text :
- https://doi.org/10.1161/JAHA.122.028050