Dear colleagues:
We all know that anthracyclines have cardiotoxicity in case they are taken for long term or exceeded the lifetime dose limits, what about hypertension? can we consider it as a contraindication for taking anthracyclines? does it matter if the hypertension is controlled or not? any limits or standards for that? Your clinical experience will be really helpful. Thanks
i think it could not be considered a contraindication but use with cautious and strict follow up as hypertension intensifies the effect of anthracyclin on the heart and enhance its cardiotoxicity effect.
and yes it matter the hypertension controlled or not. never start anthracyclin on uncontrolled hypertension . try to control hypertension first to avoid complication on the heart and the kidney.
This wouldn't be a big issue due to Breast CA patients’ young ages. However in that case, I oftenly prescribe ACE to patients who have high risk for CTX because of their cardioprotective effects if there is no contraindication.
yes As long as u evaluate patients for hypertension related LV damage, by strain imaging and echo
Hi Dr. Vijay,
Regarding you recommendations, I was wondering which strain would you use? and what criteria would you use for diagnosis and following up?
Dear Hani,
It's well known that preexisting cardiac disorders including hypertension can increase the risk of anthracycline-associated cardiotoxicity. This was demonstrated in multiple studies, including a very recent study by Vaitiekus et al (2020).
https://pubmed.ncbi.nlm.nih.gov/31782105/
This study is particularly interesting because it demonstrates cardiotoxicity even with antihypertensive treatment; although the sample is very small and contradicts findings in other papers (see Kalay et al, 2006; Cardinale et al, 2006).
Overall there's not enough long-term data to formulate a guideline or to justify forfeiting the highly-effective anthracyclins in this population.
It's generally a good practice to control hypertension and to have a baseline complete assessment of the heart function prior to starting anthracyclines, with frequent monitoring for LV damage during treatment.
Best
MB
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