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    VEGFI-induced Hypertension: How to Manage This New Syndrome?

    Malignant tumors require a generous blood supply to remain viable. A novel and effective class of chemotherapy agents interfere with a tumor’s ability to attract a blood supply for nutrition and growth. The he drugs are referred to as “VEGFIs” or vascular endothelial growth factor inhibitors (bevacizumab is the one most widely used). The drugs’ mechanism of action is mediated through tyrosine kinase and their interference inhibits tumor vasodilatation, cell proliferation, and differentiation into blood vessels.1

    Although the VEGFIs have become successful adjuncts in the treatment of cancer, up to 80% of individuals who are treated with drugs in this class develop elevated blood pressures and even hypertensive crises.1  Hypertension has been noticed in every trial in which VEGFIs have been used.1

    Currently, the mechanism underlying VEGFI-induced hypertension is unknown. Nitric oxide down-regulation at the endothelial level may be the culprit, but all the answers are not in. Nonetheless, non-oncology physicians will be seeing patients with hypertension as a consequence of VEGFIs utilized as treatment for various cancers and should be informed regarding specifics of diagnosis and treatment options.

    See what you do and/or don’t know about this side effect.

    1. Which of the following statements is/are correct:

    A. Hypertension as a consequence of VEGFI therapy occurs after repeated, long-term administration.

    B. VEGFI-induced hypertension does not resolve after treatment is completed.

    C. Only dihydropyridine calcium channel blockers are effective in lowering blood pressures in patients being treated with a VEGFI.

    D. VEGFIs have a greater effect on diastolic than on systolic blood pressures.

    Please click here for answer and discussion. 

    Gregory W. Rutecki, MD
    Dr Rutecki is with the Cleveland Clinic National Consultation Service.

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