Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors - PubMed (original) (raw)

. 2010 May 5;102(9):596-604.

doi: 10.1093/jnci/djq091. Epub 2010 Mar 29.

George L Bakris, Henry R Black, Helen X Chen, Jean-Bernard Durand, William J Elliott, S Percy Ivy, Carl V Leier, Joann Lindenfeld, Glenn Liu, Scot C Remick, Richard Steingart, W H Wilson Tang; Cardiovascular Toxicities Panel, Convened by the Angiogenesis Task Force of the National Cancer Institute Investigational Drug Steering Committee

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Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors

Michael L Maitland et al. J Natl Cancer Inst. 2010.

Abstract

Hypertension is a mechanism-based toxic effect of drugs that inhibit the vascular endothelial growth factor signaling pathway (VSP). Substantial evidence exists for managing hypertension as a chronic condition, but there are few prospectively collected data on managing acute hypertension caused by VSP inhibitors. The Investigational Drug Steering Committee of the National Cancer Institute convened an interdisciplinary cardiovascular toxicities expert panel to evaluate this problem, to make recommendations to the Cancer Therapy Evaluation Program on further study, and to structure an approach for safe management by treating physicians. The panel reviewed: the published literature on blood pressure (BP), hypertension, and specific VSP inhibitors; abstracts from major meetings; shared experience with the development of VSP inhibitors; and established principles of hypertension care. The panel generated a consensus report including the recommendations on clinical concerns summarized here. To support the greatest possible number of patients to receive VSP inhibitors safely and effectively, the panel had four recommendations: 1) conduct and document a formal risk assessment for potential cardiovascular complications, 2) recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy, 3) actively monitor BP throughout treatment with more frequent assessments during the first cycle of treatment, and 4) manage BP with a goal of less than 140/90 mmHg for most patients (and to lower, prespecified goals in patients with specific preexisting cardiovascular risk factors). Proper agent selection, dosing, and scheduling of follow-up should enable maintaining VSP inhibition while avoiding the complications associated with excessive or prolonged elevation in BP.

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Figures

Figure 1

Figure 1

Stratification of cardiovascular risk and its relationship to blood pressure in adults. Reprinted with permission from Mancia et al. (33). OD = subclinical organ damage; SBP = systolic blood pressure; DBP = diastolic blood pressure, HT = hypertension; MS = metabolic syndrome; CV = cardiovascular. As per the European Societies of Cardiology and Hypertension guidelines low, moderate, high, and very high added risk refer to 10-year risk of a CV fatal or nonfatal event relative to the average population risk. These categories are associated with population and occupation-based cohorts and empiric methods of quantitative risk determination. Risk factors are boldfaced in Table 2. The dashed line indicates that the categorization of hypertension might be variable and dependent on total CV risk. For example, a patient with established CV or renal disease might have normal blood pressure limits of 129/84 mmHg, whereas someone with no other risk factors could have 150/95 mmHg as a normal blood pressure limit to achieve the same degree of cardiovascular risk reduction.

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