Morgantown, WV—With improved prognosis and survival rates of cancer patients, cardiovascular disease (CVD) has become the leading cause of late morbidity and mortality in malignancy survivors.

That is according to a new study reporting that hypertension (HTN) is one of the most frequently reported medical issues in cancer patients and is considered a significant risk factor for the development of CVD.

The study published in The Internal Journal of Cardiology: Cardiovascular Risk & Prevention sought to better understand the trend of different antihypertensive (AHT) medications used in cancer patients.

The West Virginia University Heart and Vascular Institute–led researchers used the Medical Expenditure Panel Survey database from 2002 to 2019 to identify adult cancer patients with HTN based on the ICD-9 and ICD-10 codes.

Approximately 46 million adult hypertensive cancer patients with an increasing trend from 2002 to 2019 (3.3 m-6.7 m) were identified. The results revealed that the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) in hypertensive cancer patients increased steadily, while the use of diuretics and combined drugs decreased.

The researchers also reported that calcium channel blocker (CCB) use has increased since 2014–15, while beta-blocker (BB) use in cancer patients with heart failure (HF) also increased. Diuretic use peaked in 2014-2015 and declined, however, according to the article.

“The use of ACEi/ARB in cancer patients with diabetes (DM) has increased, whereas BB, CCB, and diuretic use remained stable,” according to the authors. “Hypertensive cancer patients with atherosclerotic cardiovascular disease (ASCVD) had increased ACEI/ARB use. Combination AHT use has decreased broadly.”

The researchers also noted that “total expenditure and out-of-pocket expenditure have a decreasing trend for all AHT medications.”

Background information in the article cites a recent study saying that more than 22 million cancer survivors are expected in the United States by this year. Another retrospective study identified as much as a 3.5-fold increase in the risk for the development of new-onset HTN after the initiation of chemotherapy.

“Cancer patients have a greater chance of developing these comorbidities, so selecting the ideal AHT medication should be considered carefully,” the authors recommended. They point out that the many advantages of ACEI/ARBs could explain its increase in usage, adding, “ACEI/ARB slows the progression of diabetic nephropathy and improves mortality in HF patients. In addition, ACEI, such as enalapril, has some protective effects in patients receiving high-dose chemotherapy. Although there is little evidence of which AHT to select in this population, currently, ACEI/ARBs seem to have the best risk-to-reward ratio.”

While BBs are not recommended as first-line treatment for HTN, they have mortality benefits and are often used for heart failure, coronary artery disease, or both, the study stated, adding “The trend in CCB use increased over the study period. The medication is one of the recommended first-line therapies for HTN according to the ACC’s recent guidelines and additionally was found to be one of the most frequently prescribed medications in the United States.”

The researchers attributed the decreased diuretic use in cancer patients to frequent electrolyte and acid-base disturbances that complicate the management of cancer patients. They also suggested that the introduction of sodium-glucose transporter-2 inhibitors could have also contributed to decreased diuretics usage.

“Combination AHT medications are reported to be more effective than monotherapy agents in the early course of treatment; however, randomized clinical trials found that patients started on monotherapy eventually achieved blood pressure control as patients did with combination therapy,” according to the study authors. “We found decreased combined AHT use in cancer patients at a higher risk of autonomic dysfunction and orthostatic hypotension.”

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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