In the absence of high-quality evidence, individualized monitoring and treatment of hypertension in cancer patients and survivors may be paramount, according to a state-of-the-art review published Dec. 17 in JACC: CardioOncology.

Jordana B. Cohen, MD, MSCE, et al., provide a call for action for improved hypertension identification, treatment and control among cancer patients to reduce cardiovascular risk. They note that treatment with chemotherapy is an independent risk factor for hypertension due to direct effects of many agents on endothelial function, sympathetic activity and renin-angiotensin system activity, as well as nephrotoxicity.

The authors explain that diagnosis and management of hypertension in cancer patients requires accurate blood pressure measurement and consideration of potential confounding factors – like adjuvant treatments and acute pain – that can temporarily elevate blood pressure readings.

Furthermore, the authors note that home blood pressure monitoring can be a useful tool to facilitate longitudinal blood pressure monitoring for titration of antihypertensive medications. They add that the selection of antihypertensive agents in cancer patients should account for treatment specific morbidities and target organ damage.

"There is a paucity of data on the benefit of blood pressure treatment in cancer patients with regard to cardiovascular risk reduction," the authors conclude. "Future studies are needed to identify optimal treatment targets and therapies for the management of hypertension in this patient population."

In an accompanying editorial comment, Françoise A. Marvel, MD, et al., write that "it is critical to individualize hypertension management for cancer patients by accurately estimating their cardiovascular risk, type of cancer, oncological therapies, adjuvant medications and pain level when initiating lifestyle modification and antihypertensive medications." They add, "In the future, cardio-oncology-focused cardiac rehabilitation and mobile health tools may be a new approach to improving cardiovascular risk management."

Don't miss Advancing the Cardiovascular Care of the Oncology Patient, held Feb. 14-16, 2020, at the Ritz-Carlton, Washington, DC. Led by Course Directors Ana Barac, MD, PhD, FACC, and Bonnie Ky, MD, MSCE, FACC, the overall goal of the course is to provide clinically relevant, state-of-the-art, best practice strategies for the interprofessional team in the assessment, diagnosis and management of cardiovascular concerns for patients with cancer and/or those requiring survivorship care. Register today.

Keywords: Antihypertensive Agents, Blood Pressure Monitoring, Ambulatory, Blood Pressure Determination, Hypertension, Adjuvants, Pharmaceutic, Telemedicine, Neoplasms

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