Treatment and Implications of Vascular Endothelial Growth Factor Inhibitor-Induced Blood Pressure Rise: A Clinical Cohort Study

• Published in: Journal of the American Heart Association 2023-01, Vol.12 (1), p.e028050-e028050
• Main Authors: van Dorst, Daan C H, Kabadayi, Sumeyye, Oomen-de Hoop, Esther, Danser, A H Jan, Mathijssen, Ron H J, Versmissen, Jorie
• Format: Article
• Language: English
• Subjects: Angiogenesis Inhibitors - adverse effects; antihypertensive agents; Antihypertensive Agents - adverse effects; Blood Pressure; Calcium Channel Blockers - therapeutic use; Carcinoma, Renal Cell - chemically induced; Carcinoma, Renal Cell - drug therapy; cardio‐oncology; Cohort Studies; Humans; hypertension; Hypertension - chemically induced; Hypertension - drug therapy; Hypertension - metabolism; Kidney Neoplasms - chemically induced; Kidney Neoplasms - drug therapy; Original Research; Retrospective Studies; Sorafenib - adverse effects; survival; Vascular Endothelial Growth Factor A - pharmacology; vascular endothelial growth factor inhibitor
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.122.028050

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; =0.005], compared with sorafenib) and estimated glomerular filtration rate