Pazopanib-induced hypertensive crisis in a patient with metastatic renal cell carcinoma: A case report

Pazopanib, a vascular endothelial growth factor receptor tyrosine kinase inhibitor, is widely used as first-line therapy for metastatic renal cell carcinoma (mRCC) and is frequently associated with hypertension. We report the case of a 65-year-old woman with mRCC who had undergone left radical nephrectomy and was initiated on pazopanib 400 mg once daily with normal baseline blood pressure. Following good tolerance, the dose was escalated to 400 mg twice daily. The patient later presented with palpitations, seizures, and transient loss of consciousness and was diagnosed with a hypertensive crisis, with blood pressure recorded at 220/130 mmHg. Neuroimaging and laboratory evaluations revealed no abnormalities. Pazopanib-induced hypertension was suspected, and the dose was reduced to 400 mg once daily along with initiation of antihypertensive therapy using amlodipine and metoprolol, resulting in rapid clinical improvement. Blood pressure remained well controlled during follow-up. Causality assessment using the World Health Organization-Uppsala Monitoring Centre system categorized the adverse drug reaction as “possible.” This case underscores the importance of regular blood pressure monitoring and early cardiovascular risk management in patients receiving pazopanib.