How to manage hypertension in patients undergoing radiation therapy?

From the Guidelines

Managing hypertension in patients undergoing radiation therapy should prioritize the use of ACE inhibitors, ARBs, beta-blockers, and dihydropyridine calcium channel blockers as first-line antihypertensive treatments, according to the current clinical practice guidelines. When considering the management of hypertension in patients undergoing radiation therapy, it is crucial to monitor blood pressure before initiating cancer treatment and periodically during treatment, depending on the patient’s characteristics and adequate blood pressure control 1. The preferred antihypertensive drugs for these patients include ACE inhibitors, ARBs, beta-blockers, and dihydropyridine calcium channel blockers, while non-dihydropyridine calcium channel blockers should be avoided due to potential drug interactions 1. Some key points to consider in the management of hypertension in these patients include:

• Early and aggressive treatment of hypertension to prevent cardiovascular complications
• Monitoring of blood pressure before and during cancer treatment
• Use of conventional antihypertensive treatment, with consideration of dose reduction or reinforcement as needed
• Potential discontinuation of VEGF inhibitors if blood pressure is not controlled, with the option to restart once blood pressure control is achieved 1. In terms of specific management strategies, patients should be encouraged to maintain adequate hydration, follow a low-sodium diet, and continue regular physical activity as tolerated, with medication adjustments made as necessary to account for any radiation-related side effects that may impact medication absorption. Overall, a multidisciplinary approach to managing hypertension in patients undergoing radiation therapy is essential, with close communication between oncology and cardiology teams to ensure optimal blood pressure control and minimize the risk of cardiovascular complications.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Managing Hypertension in Patients Undergoing Radiation Therapy

• Radiation therapy can cause blood pressure elevation, as seen in patients undergoing prostate radiation therapy, where 36 patients developed radiation-associated hypertension (RAH) 2.
• The management of hypertension in these patients is crucial, and the treatment goals should be to lower systolic blood pressure below 140 mmHg in all hypertensive patients, and below 130 mmHg in patients with diabetes and high/very-high-risk patients 3.
• The choice of antihypertensive agents is important, and diuretics, beta-blockers, and ACE inhibitors are effective in reducing overall morbidity and mortality 4.
• ACE inhibitors and angiotensin II receptor antagonists are also effective in the treatment and mitigation of radiation nephropathy, a potential complication of radiation therapy 5.
• Compliance and persistence with antihypertensive therapy are crucial, and angiotensin II antagonists have been shown to be well tolerated and associated with high persistence rates 6.

Treatment Options

• Diuretics and beta-blockers can be considered as initial therapy for hypertension in patients undergoing radiation therapy 4.
• ACE inhibitors and angiotensin II receptor antagonists can be used to treat radiation nephropathy and hypertension in these patients 5.
• The use of combination therapy, including a diuretic, may be necessary to achieve blood pressure control in high-risk patients 4.

Monitoring and Follow-up

• Regular blood pressure monitoring is essential in patients undergoing radiation therapy to detect any changes in blood pressure 2.
• Follow-up appointments should be scheduled to assess the effectiveness of antihypertensive therapy and to make any necessary adjustments to the treatment plan 2.