Ibrutinib, a tyrosine kinase inhibitor indicated for the treatment of various cancers, is known for its association with atrial fibrillation, but researchers are becoming increasingly concerned about other cardiotoxicities, including an association with hypertension.

A team of researchers conducted a retrospective single-center study of 93 patients with B cell malignancies who were treated with ibrutinib and compared them with 51 patients who were treated with conventional chemoimmunotherapy. Their results were published in Heart.

Baseline hypertension was similar between the 2 treatment groups; however, they found that hypertension developed or worsened in patients treated with ibrutinib. “Both systolic and diastolic blood pressure significantly increased over time with ibrutinib compared with baseline, whereas conventional chemoimmunotherapy was not associated with significant changes in blood pressure.”


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The largest increase in blood pressure occurred during the first month of treatment. Between the baseline and first-month measurement, systolic blood pressure increased by 10 to 19 mm Hg in 18.3% of those who received ibrutinib. Systolic blood pressure increased by 20 mm Hg or more in an additional 18.3% of patients treated with ibrutinib. However, only 7.9% of the patients receiving chemoimmunotherapy experienced an increase in systolic blood pressure of more than 10 mm/Hg during that time period.

Treatment for baseline hypertension was found insufficient for both treatment groups. Among those treated with ibrutinib with new or worsened hypertension, 61.2% did not get changes in their management (increase or addition of antihypertensive medication). Of those whose systolic blood pressure increased by more than 20 mm Hg, only 52.9% had changes to its management. This was similar in those receiving chemoimmunotherapy (39.3% had their hypertension management changed).

The study did have some limitations. As it was a single-center study with a relatively small number of participants, the results may not be generalizable to other institutions. A future prospective observational study may be able to shed more light on the matter, as could a study with a longer follow-up period.

“It is essential to raise awareness on ibrutinib association with hypertension to allow for expeditious initiation of antihypertensives to avoid the adverse acute and chronic cardiovascular consequences associated with uncontrolled hypertension, including myocardial infarction, renal dysfunction and stroke,” the researchers wrote.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Lee DH, Hawk F, Seok K, et al. Association between ibrutinib treatment and hypertension. Heart. Published online July 1, 2021. doi:10.1136/heartjnl-2-21-319110