Hypertension associated with systemic therapy for hepatocellular carcinoma and management strategies

Antiangiogenic therapy and immune checkpoint inhibitors represent two cornerstone approaches in the current systemic treatment of patients with hepatocellular carcinoma (HCC). Since the advent of the immunotherapy era, the survival of patients with HCC, particularly those with unresectable disease, has improved significantly. However, both drug classes carry the potential for vascular injury, with hypertension being a notable adverse event. Antiangiogenic agents, such as lenvatinib and bevacizumab, frequently induce hypertension. Given that the main systemic regimens for HCC often combine multiple agents prone to cause hypertension, effective management of blood pressure is crucial for long-term adherence to cancer treatment and survival. However, patients with HCC often present with underlying conditions such as cirrhosis, portal hypertension, and ascites. These conditions themselves or their treatments, such as diuretics and non-selective beta-blockers, may lower blood pressure, which is often accompanied by hypoperfusion of vital abdominal organs, particularly the kidneys, posing greater harm than hypertension alone. Consequently, blood pressure management in patients undergoing systemic HCC therapy is highly complex, necessitating the involvement of a ultidisciplinary team collaboration in future practice.