Journal
JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION
Volume 12, Issue 6, Pages 409-425Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jash.2018.03.008
Keywords
Angiogenesis inhibitors; cardiovascular events; chemotherapy; hypertension
Categories
Funding
- British Heart Foundation [CH/12/4/29762]
- National Institute of Health [HL116952-04]
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [K08HL116952] Funding Source: NIH RePORTER
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The vascular endothelial growth factor (VEGF) signaling pathway (VSP) fulfills a cardinal role in endothelial cells and its inhibition has profound cardiovascular impact. This is true not only for the normal vasculature but also for the tumor vasculature when VSP inhibitors are used as anti-angiogenic therapies. Generalized endothelial dysfunction predisposes to vasoconstriction, atherosclerosis, platelet activation, and thrombosis (arterial more than venous). All of these have been reported with VSP inhibitors and collectively give rise to vascular toxicities, the most concerning of which are arterial thromboembolic events (ATE). VSP inhibitors include antibodies, acting extracelluarly on VEGF, such as bevacizumab and tyrosine kinases inhibitors, acting intracellularly on the kinase domain of VEGF receptors, such as sunintib and sorafenib. The addition of bevacizumab and VSP tyrosine kinase inhibitor therapy to the cancer treatment regimen is associated with a 1.5-2.5-fold and 2.3-4.6-fold increase risk of ATEs, respectively. Risk factors for ATEs while on VSP inhibitor therapy include age older than 65 years, previous thromboembolic events, history of atherosclerotic disease, and duration of VSP inhibitor therapy. In clinical practice, hypertension remains the most commonly noted vascular manifestation of VSP inhibition. Optimal blood pressure goals and preferred therapeutic strategies toward reaching these goals are not defined at present. This review summarizes current data on this topic and proposes a more intensive management approach to patients undergoing VSP inhibitor therapy including Systolic Blood PRessure Intervention Trial (SPRINT) blood pressure goals, pleiotropic vasoprotective agents such as angiotensin converting enzyme inhibitors, amlodipine, and carvedilol, high-dose statin therapy, and aspirin. J Am Soc Hypertens 2018;12(6):409-425. (C) 2018 The Authors. Published by Elsevier Inc. on behalf of American Society of Hypertension.
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