Hypertension is a significant comorbidity in cancer patients, with some cases directly related to cancer therapy drugs. Among these, vascular endothelial growth factor (VEGF) inhibitors are most strongly associated with hypertension, with the incidence of new-onset hypertension or exacerbation of pre-existing hypertension reaching 11% to 45%. The mechanisms underlying VEGF inhibitor-induced hypertension include reduced endothelial nitric oxide (NO) secretion, vasoconstriction, a decrease in peripheral microvascular density, reduced vascular elasticity, and endothelial dysfunction.
Blood pressure monitoring and management are necessary throughout the entire course of cancer treatment. The target for blood pressure control is <140/90 mmHg, and if the patient tolerates it well, <130/80 mmHg is recommended. In cases of cancer therapy-related hypertension:
If blood pressure is <160/100 mmHg, angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are preferred as initial therapy. If blood pressure remains uncontrolled, dihydropyridine calcium channel blockers can be added.
If blood pressure is ≥160/100 mmHg, combination therapy with ACEIs/ARBs and dihydropyridine calcium channel blockers is recommended.
For patients with coexisting coronary artery disease or heart failure, beta-blockers should be considered.
For resistant hypertension, additional agents such as aldosterone receptor antagonists (e.g., spironolactone), alpha-blockers, nitrates, or hydralazine may be used.
If blood pressure remains inadequately controlled, discontinuation of the cancer therapy drug should be considered.