Ibrutinib tied to worsening blood pressure, hypertension

Reuters Health - 09/07/2021 - Ibrutinib is associated with rising blood pressure and increased risk of developing hypertension in patients with B cell malignancies, a new study suggests.

Researchers examined data on 144 patients diagnosed with B cell malignancies, including 93 individuals treated with ibrutinib and 51 treated with conventional chemotherapy. At baseline, a majority of patients on ibrutinib (63.4%) and on chemotherapy (66.7%) had hypertension, defined as blood pressure of at least 130/80 mmHg or use of antihypertensive medication.

One month after treatment initiation, the proportion of patients with hypertension climbed to 72% in the ibrutinib group and decreased to 54.9% in the chemotherapy group. In addition, significantly more patients on ibrutinib (36.6%) than on chemotherapy (7.9%) experienced an increase in systolic blood pressure of more than 10 mmHg at one month compared to baseline, according to the results published in Heart.

"It is essential for cardiologists and oncologists to be aware of this side effect since uncontrolled hypertension can lead to various life threatening consequences including heart attack or stroke," said senior study author Dr. Michael Fradley, medical director of the Penn Cardio-Oncology Program at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

"Vigilant monitoring and treatment of ibrutinib associated hypertension is essential to allow patients to continue taking a potentially life-saving medication while preventing the long-term harm that can be associated with blood pressure elevations," Dr. Fradley said by email.

The study results suggest that there is room for improvement in monitoring and treating hypertension among patients on ibrutinib.

Among patients on ibrutinib with hypertension, only 38.8% either initiated treatment with antihypertensive medication or had medication changes in response to increasing blood pressure. But the majority (61.2%) of people on ibrutinib who had hypertension didn't start antihypertensive medication or change their treatment in response to worsening blood pressure.

Just 52.9% of patients on ibrutinib who experienced at least a 20 mmHg increase in systolic blood pressure initiated or changed antihypertensive medication as a result.

One limitation of the single-center study is that results may not be generalizable to outcomes elsewhere, the authors point out. The study also wasn't designed to assess the effectiveness of different antihypertensive medications or examine adverse cardiac events.

While the study didn't examine possible mechanisms for the potential cardiotoxicity of ibrutinib, it's possible that off-target downregulation of the VEGF pathway plays a role, the authors note.

"Ibrutinib appears to act on a broad number of receptors which have been linked with high blood pressure," said Dr. Daniel Addison, co-director of the cardio-oncology program at the Ohio State University Comprehensive Cancer Center in Columbus.

"We have seen similar findings with high rates of new and significant hypertension with Ibrutinib, and other BTK inhibitors," Dr. Addison, who wasn't involved in the study, said by email.

Results from the current study underscore that clinicians should be vigilant for increased blood pressure in patients treated with ibrutinib, particularly in the first month after treatment initiation, Dr. Addison said.

"Undertreating blood pressure may impact the risk of other cardiotoxic events with ibrutinib," Dr. Addison said.

SOURCE: https://bit.ly/2TLVDib Heart, online July 1, 2021.



Posted on 9 July 202120 July 2021