The panel recommended that a patient should be thoroughly screened before treatment with angiogenesis inhibitors. A risk assessment should be performed, similar to the cardiovascular assessment given patients before major surgery, Maitland said. Before treatment begins, blood pressure in high-risk patients should be reduced and maintained at less than140/90 mmHg, or even lower in patients with diabetes or chronic kidney disease.
A variety of antihypertensive drug classes can be used to lower a patient's blood pressure before or during treatment with angiogenesis inhibitors, but physicians should be aware of potential adverse interactions between the two drugs. Oncologists faced with complex cases of blood pressure management should consult colleagues more experienced in cardiology and hypertension, the panel advised.
"The recommendations put all of us on the same page," said George Bakris, MD, director of the Hypertensive Diseases Unit at the Medical Center and another author on the JNCI commentary. "It really is a seminal effort to provide some kind of general guidance and understanding of how these drugs work, what to do about their consequences, and how to successfully manage patients to make sure the outcome is ideal across the board."
Improved monitoring and treatment of hypertension during angiogenesis inhibitor treatment may open up the treatment to patients considered to be at high-risk for the side effect due to a history of cardiovascular disease or predisposition toward high blood pressure.
"We're not trying to keep anybody from getting these drugs, but there should be different levels of intensity and attention to the potential side effects based on what we know about hypertension and cardiovascular disease," Maitland said.
Further research is also underway to determine the mechanism of how angiogenesis inhibitors promote hypertension, studies that could further improve
|Contact: Robert Mitchum|
University of Chicago Medical Center