Hypertension in malignancy–an underappreciated problem

// Jolanta Malyszko 1, 2 , Maciej Malyszko 1 , Leszek Kozlowski 3 , Klaudia Kozlowska 1 and Jacek Malyszko 4 1 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University in Bialystok, Bialystok, Poland 2 Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland 3 Department of Oncological Surgery, Regional Cancer Center, Bialystok, Poland 4 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University in Bialystok, Bialystok, Poland Correspondence to: Jolanta Malyszko, email: jolmal@poczta.onet.pl Keywords: malignancy; hypertension Received: October 09, 2017      Accepted: March 19, 2018      Published: April 17, 2018 ABSTRACT Hypertension is one of the most common comorbidities in cancer patients with malignancy, in particular, in the elderly. On the other hand, hypertension is a long-term consequence of antineoplastic treatment, including both chemotherapy and targeted agents. Several chemotherapeutics and targeted drugs may be responsible for development or worsening of the hypertension. The most common side effect of anti-VEGF (vascular endothelial growth factor) treatment is hypertension. However, pathogenesis of hypertension in patients receiving this therapy appears to be associated with multiple pathways and is not yet fully understood. Development of hypertension was associated with improved antitumor efficacy in patients treated with anti-antiangiogenic drugs in some but not in all studies. Drugs used commonly as adjuvants such as steroids, erythropoietin stimulating agents etc, may also cause rise in blood pressure or exacerbate preexisiting hypertension. Hypotensive therapy is crucial to manage hypertension during certain antineoplastic treatment. The choice and dose of antihypertensive drugs depend upon the presence of organ dysfunction, comorbidities, and/or adverse effects. In addition, severity of the hypertension and the urgency of blood pressure control should also be taken into consideration. As there are no specific guidelines on the hypertension treatment in cancer patients we should follow the available guidelines to obtain the best possible outcomes and pay the attention to the individualization of the therapy according to the actual situation.