Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort Study
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 charac...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.028050 |
| _version_ | 1797905044018823168 |
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| author | Daan C. H. van Dorst Sumeyye Kabadayi Esther Oomen‐de Hoop A.H. Jan Danser Ron H. J. Mathijssen Jorie Versmissen |
| author_facet | Daan C. H. van Dorst Sumeyye Kabadayi Esther Oomen‐de Hoop A.H. Jan Danser Ron H. J. Mathijssen Jorie Versmissen |
| author_sort | Daan C. H. van Dorst |
| collection | DOAJ |
| description | 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 m2 (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. |
| first_indexed | 2024-04-10T09:58:48Z |
| format | Article |
| id | doaj.art-59d3fa5ccc3d4b688b07134a4440606a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T09:58:48Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-59d3fa5ccc3d4b688b07134a4440606a2023-02-16T10:55:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-01-0112110.1161/JAHA.122.028050Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort StudyDaan C. H. van Dorst0Sumeyye Kabadayi1Esther Oomen‐de Hoop2A.H. Jan Danser3Ron H. J. Mathijssen4Jorie Versmissen5Department of Medical Oncology, Erasmus MC Cancer Institute Erasmus MC University Medical Center Rotterdam The NetherlandsDepartment of Hospital Pharmacy Erasmus MC University Medical Center Rotterdam The NetherlandsDepartment of Medical Oncology, Erasmus MC Cancer Institute Erasmus MC University Medical Center Rotterdam The NetherlandsDivision of Vascular Medicine and Pharmacology, Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The NetherlandsDepartment of Medical Oncology, Erasmus MC Cancer Institute Erasmus MC University Medical Center Rotterdam The NetherlandsDivision of Vascular Medicine and Pharmacology, Department of Internal Medicine Erasmus MC University Medical Center Rotterdam The NetherlandsBackground 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 m2 (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.https://www.ahajournals.org/doi/10.1161/JAHA.122.028050antihypertensive agentscardio‐oncologyhypertensionsurvivalvascular endothelial growth factor inhibitor |
| spellingShingle | Daan C. H. van Dorst Sumeyye Kabadayi Esther Oomen‐de Hoop A.H. Jan Danser Ron H. J. Mathijssen Jorie Versmissen Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease antihypertensive agents cardio‐oncology hypertension survival vascular endothelial growth factor inhibitor |
| title | Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort Study |
| title_full | Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort Study |
| title_fullStr | Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort Study |
| title_full_unstemmed | Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort Study |
| title_short | Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor‐Induced Blood Pressure Rise: A Clinical Cohort Study |
| title_sort | treatment and implications of vascular endothelial growth factor inhibitor induced blood pressure rise a clinical cohort study |
| topic | antihypertensive agents cardio‐oncology hypertension survival vascular endothelial growth factor inhibitor |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.028050 |
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