Oncology
HR+ HER2- Breast Cancer
Cancer Therapy–Related Hypertension in Focus
Overview
Advances in breast cancer treatment have contributed to improved survival, but survivors experience significant cardiovascular mortality and morbidity. As such, there is a need to focus on hypertension and other drivers of cardiovascular outcomes in this population.
Expert Commentary
Susan Dent, MD
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“Hypertension likely contributes to the high burden of cardiovascular disease in those with cancer and in survivors. . . . We need more research on how best to manage hypertension in patients with cancer.”
Hypertension is a common comorbidity in patients with cancer, and it is highly prevalent among individuals seeking treatment for breast cancer. A number of factors may be involved, including shared risk factors between cancer and hypertension, as well as anticancer drugs that may cause blood pressure elevation through numerous mechanisms.
Platinum-based agents such as carboplatin, which is used in triple-negative breast cancer, certainly fall in this category. Additionally, alkylating agents, poly (ADP-ribose) polymerase inhibitors, and aromatase inhibitors have been associated with hypertension. Protease inhibitors and tyrosine kinase inhibitors may also be linked to hypertension. Cancer therapy–related hypertension can impact our ability to deliver anticancer therapy.
Both the prevalence of hypertension and the incidence of cancer worldwide are increasing, as noted in the 2023 American Heart Association statement by Cohen et al. The European Society of Cardiology and the International Cardio-Oncology Society have also published statements on hypertension in patients with cancer. Hypertension likely contributes to the high burden of cardiovascular disease in those with cancer and in survivors; however, data on the treatment of hypertension that are specific to patients with cancer have been very limited, and, therefore, many of the current recommendations are based on evidence from noncancer patient populations or expert consensus.
We need more research on how best to manage hypertension in patients with cancer. For instance, we need to determine whether the current approach to antihypertensive therapy in individuals with cancer produces cardiovascular outcomes that are equivalent to those seen in the general population.
Currently, postmenopausal women who are several years out from their breast cancer treatment have a higher risk of dying from cardiovascular disease than from a recurrence of breast cancer. We need to ensure that the gains made in breast cancer survivorship are not offset by premature cardiovascular mortality.
At Duke University, we are currently conducting the randomized ONE TEAM trial, which is evaluating guided interventions for patients and primary care providers vs basic education during cancer treatment. The goal is to determine the optimal intervention that will improve patient outcomes for hypertension, hyperglycemia, and hyperlipidemia. The data from trials such as ONE TEAM will be particularly important for patients who are from vulnerable and underserved communities who may not be receiving appropriate treatment for their hypertension.
References
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Cohen JB, Geara AS, Hogan JJ, Townsend RR. Hypertension in cancer patients and survivors. JACC CardioOncol. 2019;1(2):238-251. doi:10.1016/j.jaccao.2019.11.009
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