Classes of Anti-Neoplastic Agents Associated with Increased Risk of Cancer Therapy-Associated Hypertension and Management Strategies

Hypertension (HTN) has been found to be the most common comorbidity in patients with cancer. In addition to increased prevalence of baseline HTN, patients with cancer may be at increased risk of HTN as a short- or long-term adverse event from cancer therapy. Different classes of cancer therapies have been implicated in the development of HTN, including inhibitors of vascular endothelial growth factor (VEGF), Bruton tyrosine kinase inhibitors, proteasome inhibitors, androgen deprivation therapy, and others. While some of these drugs may lead to increases in blood pressure through on-target effects (e.g. with VEGF inhibition), others may be associated with HTN from off-target mechanisms that are not always well-understood. The appropriate management of cancer therapy-associated HTN is also limited by a dearth of studies investigating HTN management specifically in cancer patients, leading to extrapolation of data from the general population. This manuscript aims to review the knowledge on incidence, mechanisms, and sequelae of cancer-therapy related HTN with different classes of anti-neoplastic agents. We further review management strategies as per consensus-based guidelines.