From: Etiology and management of hypertension in patients with cancer
Cancer Drug Class | Mechanism of Hypertension | Incidence of Hypertension | Recommended Treatment |
---|---|---|---|
VEGF inhibitors | endothelial dysfunction, decrease in nitric oxide and prostacyclin I, increase in endothelin, vascular remodeling, capillary rarefaction, decreased renal excretion of sodium | All Grade: 17–80% Grade 3–4: 6–9% | CCB (e.g., amlodipine) ACEI (e.g., lisinopril) |
TKI | decrease in NOS activity, activation of RAAS | All Grade: 17–47% Grade 3–4: 4–6% | ACEI CCB |
Proteasome inhibitors | angiotensin-induced hypertension, aortic vascular remodeling | All Grade: 3–15% | ACEI or ARB (e.g., losartan) |
Alkylating agents | oxidative damage to endothelial cells, increased intimal thickness, abnormal vascular remodeling, sodium retention | All Grade: 36–50% | ACEI or ARB |
Steroids | promoting sodium and water retention, intrinsic vasoconstricting properties, enhanced sensitivity to endogenous vasopressors | All Grade: up to 13%a | Diuretics (e.g., hydrochlorothiazide) Mineralocorticoid antagonists (e.g., spironolactone) |
Calcineurin inhibitors and other immunosuppressive agents | sympathetic overactivity, increased renal sodium reabsorption (distal tubule ENaC activation), decrease in NO production, RAAS activation, altered renal PG synthesis | All Grade: 30–80% | CCB Thiazide diuretics (especially for Tacrolimus) |
Taxanes | endothelial dysfunction, enhanced toxicity of bevacizumab and anthracyclines | NA | ACEI or ARB CCB |
Abiraterone | increase in steroid precursors with mineralocorticoid properties (sodium and fluid retention) | NA | Mineralocorticoid antagonists Diuretics |
Recombinant human erythropoietin | increased blood viscosity, direct vasoconstricting properties, increased sensitivity to endogenous vasopressors | All Grade: 30–35% | CCB |