AHA Statement Addresses Anticancer Therapy-Induced Hypertension
In January, the American Heart Association (AHA) released a statement regarding anticancer therapy-induced hypertension, which is a common cardiovascular-related side effect for treatment.
In their statement, the AHA called for a multidisciplinary collaboration among several specialists including oncologists, cardiologists, and pharmacists to improve outcomes for patients with anticancer therapy-induced hypertension.
Consultant360 spoke with Jordana B. Cohen, MD, MSCE, assistant professor of medicine and epidemiology at the University of Pennsylvania School of Medicine as well as a nephrologist and research scientist at the University of Pennsylvania. Dr Cohen provided insight on the AHA’s statement and spoke about how the statement impacted specialists in this area of care.
Consultant360: What was the impetus for this statement. Why now?
Jordana Cohen, MD, MSCE: The statement was driven by growing knowledge about the drivers of hypertension among patients with cancer and the need to mitigate adverse cardiovascular outcomes among these patients, who are now living longer to experience the long-term effects of hypertension due to increasingly effective cancer treatments.
C360: This AHA statement covers a lot of ground regarding anticancer therapy-induced hypertension. What are the main takeaways?
Dr Cohen: There are several takeaways to consider: (1) Patients undergoing treatment for cancer and cancer survivors have an elevated risk of hypertension compared to the general population, resulting in an elevated risk of adverse cardiovascular outcomes; (2) specific cancer therapies, particularly vascular endothelial growth factor inhibitors and tyrosine kinase inhibitors, are associated with a markedly elevated risk of hypertension or worsening blood pressure control, which often needs to be monitored and addressed quickly and aggressively, and which often requires quick de-escalation in therapy upon stopping these treatments; and (3) patients undergoing cancer treatment should be monitored closely for the development of or worsening hypertension, using appropriate in-office blood pressure measurement along with home blood pressure monitoring with a validated device and correct technique. These patients should also be more closely monitored than the general population for development of target organ damage due to hypertension (including electrocardiogram, cardiac imaging, creatinine/cystatin C, and urinalysis).
Consultant360: What are the clinical implications of this AHA statement for oncologists and cardiologists? What other specialists, in your view, are impacted by this statement?
Dr Cohen: Oncologists and cardiologists should be increasingly taking a multidisciplinary team-based approach to the management of these patients, working closely with other related specialists such as nephrology, where appropriate.
C360: Can you briefly explain why nephrologists would find this statement clinically relevant?
Dr Cohen: Nephrologists, like myself, are often involved in the management of complex hypertension—many of us are hypertension specialists, and even if not, we’re trained specifically in managing difficult to control hypertension. The kidney is also a target organ of hypertension and of many cancer therapies—the statement notes that several cancer therapies (such as platinum-based therapies) likely cause hypertension via damage to the kidney. These considerations are why the statement recommends screening patients’ creatinine/cystatin C and urinalysis more closely following cancer treatment.
Cohen JB, Brown NJ, Brown SA, et al. Cancer therapy-related hypertension: a scientific statement from the American Heart Association. Hypertension. Published online January 3, 2023. doi:10.1161/HYP.0000000000000224