Using the New Threshold
Prior to the new guidelines, The Investigational Drug Steering Committee of the National Cancer Institute established recommendations in the management of hypertension in cancer patents. The group recommended following the guidelines of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure with the goal of aggressive blood pressure management to minimize end-organ damage.2
The new guidelines classify hypertension into 4 categories: normal, <120/80 mm Hg; elevated, 120-129/<80 mm Hg; stage I hypertension, 130-139/80-89 mm Hg; and stage II hypertension, ≥140/≥90 mm hg.1
Differences from previous guidelines include the recommendation for home or ambulatory blood pressure monitoring in the diagnosis of hypertension. Furthermore, the guidelines included encouraging nonpharmacologic interventions for blood pressure control such as weight loss, sodium reduction, increased physical activity, decreased alcohol consumption, and improvements in diet for heart health.1
Pharmacologic therapy initiation is determined by calculating the patient’s 10-year ASCVD risk score. Patients with a 10-year risk score for the development of myocardial infarction, cardiovascular accident, or coronary heart disease death of 10% or higher would meet criteria for treatment of hypertension at blood pressures greater than 130/80 mm Hg with a goal of less than 130/80 mm Hg. Whereas patients without or at low risk for ASCVD would meet criteria for hypertension treatment at blood pressures greater than 140/90 mm Hg.1
“New or worsening hypertension is commonly encountered in cancer patients,” Dr Mouhayar’s paper highlighted. “The aim is to minimize the risk of end-organ damage and to enable the continuation of needed cancer therapy. A team approach involving collaborative efforts between oncologists and other specialists (internists, cardiologists, and nephrologists) is encouraged for optimal management of this comorbidity.”2
1. Cifu AS, Davis AM. Prevention, detection, evaluation, and management of high blood pressure in adults. JAMA. 2017;318(21):2132-2134.
2. Mouhayar E, Salahudeen A. Hypertension in cancer patients. Tex Heart Inst J. 2011;38(3):263-265.
3. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published online November 13, 2017]. Hypertension. doi: 10.1161/HYP.0000000000000065
4. Souza VB, Silva EN, Ribeiro ML, Martins Wde A. Hypertension in patients with cancer. Arq Bras Cardiol. 2015;104(3):246-252.
5. Abi aad S, Pierce M, Barmaimon G, Farhat FS, Benjo A, Mouhayar E. Hypertension induced by chemotherapeutic and immunosuppressive agents: a new challenge. Crit Rev Oncol Hematol. 2015;93(1):28-35.