Residents and Fellows Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction:
Numerous antineoplastics (ANs) have been associated with hypertension (HTN). While the 2022 European Society of Cardiology Cardio-oncology Guideline recommends treating HTN if BP >160/100 mmHg and holding ANs if BP >180/110mmHg, clinical practice varies.
Research Question or Hypothesis:
The purpose of this study was to assess incidence, severity, and management of AN-induced HTN.
Study Design:
This was a retrospective, single-center study.
Methods:
From April 2014 to May 2020, demographic and clinical characteristics, including blood pressure (BP) were collected at baseline and every 4 weeks (+ 2 weeks) over 24 weeks following initiation of vascular endothelial growth factor inhibitors (VEGFIs), Bruton tyrosine kinase inhibitors (BTKIs) and antiandrogen agents. Uncontrolled BP was defined as >130/80 mmHg. Change in BP was calculated using the difference between baseline BP and the highest BP measurement between week 4 and 24.
Results:
Of 472 patients, median age was 64 years (19-92), 73% male, 66% White, 25% Black. Patients with prior medical history of HTN (62%) had greater likelihood of an uncontrolled BP measurement during the 24-week period (96% vs 88%, p=0.0029). Patients with BP < 130/80 mmHg at baseline (36%) had a greater median change in both SBP (30 mmHg vs 15 mmHg, p<0.0001) and DBP (14 mmHg vs 9 mmHg, p<0.0001). Across AN agents, there was a significant difference in change in SBP (p=0.02) and DBP (p=0.0002) with largest changes observed with BTKIs and VEGFIs. Despite BP >160/100 mmHg (270/2204, 12%), anti-hypertensive intensification was limited (64/2240, 2.4%). Regardless of BP > 180/110 mmHg (52/2204 visits, 2.4%), holding ANs due to HTN (8/2204, 0.7%) was rare.
Conclusion:
Following initiation of select ANs, uncontrolled BP was common regardless of history of HTN and change in BP varies across AN agents. Anti-hypertensive intensification and AN de-escalation was infrequent and the appropriateness of such requires further investigation.
Presenting Author
Kaitlyn Paxton PharmD, MBAUNC Eshelman School of Pharmacy
Authors
Sarah Kaspari PharmD
UNC Eshelman School of Pharmacy
Dominic Moore MS
UNC Chapel Hill
Katherine Morgan PharmD, BCOP, CPP
UNC Health
Benyam Muluneh PharmD, BCOP, CPP
UNC Eshelman School of Pharmacy
Kristina Paramore PharmD, MPH
UNC Eshelman School of Pharmacy
Kevin Chen PharmD, PhD
Alexis Wardell MS
UNC Chapel Hill
Jo E. Rodgers PharmD, FCCP, BCPS-AQ Cardiology
Eshelman School of Pharmacy, University of North Carolina