Hypertension development and treatment in patients with solid and haematological malignancies on anti-cancer therapy: an irish tertiary referral centre experience

Introduction Hypertension represents one of the most common comorbidities encountered in patients with cancer undergoing treatment. Hypertension also represents a frequent adverse effect of a variety of different cancer treatments. Despite its prevalence, hypertension in the cancer patient is frequently underdiagnosed and undertreated, with potential implications for a patient’s cardiovascular outcomes and ability to continue cancer treatment. The European Society of Cardiology have published guidelines on the management of hypertension in patients with cancer. We performed a single centre study to assess the rates of development of hypertension in patients receiving anti-cancer therapy, and to assess how treatment aligned with ESC Hypertension and Cardio-Oncology recommendations. Methods Information was collected from an Irish academic tertiary referral hospital. Data was prospectively collected on patients who were diagnosed with a solid organ or haematological malignancy, who were receiving anticancer treatment either as an inpatient or as an outpatient attending day hospital. Electronic and handwritten records were reviewed for each patient to identify for the presence of hypertension prior to initiating cancer treatment, current blood pressure status and antihypertensive treatment received. Hypertension treatment regimens were compared to recommended regimens from the European Society of Cardiology Hypertension and Cardio-Oncology guidelines to assess for appropriateness. Results 636 patients with a solid or haematological malignancy received cancer treatment as an inpatient or day patient at our centre over the trial period. 57.5% of patients were male. 66% of patients had a haematological malignancy; 34% had a solid organ malignancy. 97.1% of patients had blood pressure data recorded. 59% of patients had hypertension. Of these, 29.1% developed new hypertension after initiating cancer treatment, while 70.9% had pre-existing hypertension. 19.4% of patients with hypertension were not on treatment. 35.5% of patients on antihypertensive treatment remained hypertensive at current treatment doses. 24.5% of patients remained hypertensive at the time of review, with 10.4% having Grade 2 or 3 hypertension. 50% of patients with new hypertension post treatment were not on correct treatment. Conclusions Hypertension is commonly encountered in patients with cancer, both as a pre-morbid condition, and as an adverse effect of treatment. Despite this, it remains underdiagnosed, and when diagnosed, undertreated. Future efforts will need to focus on improved hypertension management to improve long term cardiovascular outcomes in these patients.