Uncontrolled arterial hypertension in patients with breast cancer and the risk of developing cardiotoxicity with anthracycline-containing chemotherapy

Aim. To study of the role of the effectiveness of blood pressure control according to the daily monitoring of blood pressure in patients with triple negative breast cancer with arterial hypertension at risk of developing cardiotoxicity with anthracycline-containing chemotherapy. Materials and methods. The study included 99 breast cancer patients (mean age 48 years [36; 63]) who received chemotherapy including anthracyclines, taxanes and platinum -based agent. Before chemotherapy, patients underwent 24-hour blood pressure monitoring, which revealed masked uncontrolled hypertension. Before and after chemotherapy, echocardiography was performed, including speckle tracking echocardiography in a two-dimensional mode, and the concentration of biomarkers (highly sensitive troponin T and NT-proBNP) was also determined. Patients with breast cancer with masked uncontrolled hypertension (n=12) were the main group of the study, and patients with controlled hypertension (n=17) and patients with normotension (n=70) were the comparison group. Results. After chemotherapy in patients with uncontrolled hypertension, a large degree of decrease in global longitudinal strain (GLS) was recorded, a high incidence of subclinical cardiotoxicity, assessed by the diagnostic criterion of GLS; a larger increase in the volume of the drug and a higher degree of increase in highly sensitive troponin T. In patients with uncontrolled hypertension who received a higher total dose of doxorubicin, the degree of decrease in GLS was statistically significantly greater than in patients with controlled hypertension. Conclusion. Uncontrolled hypertension in patients with breast cancer is unfavorable in terms of the risk of developing subclinical and clinical cardiotoxicity, especially when using high doses of anthracycline. The method of daily monitoring of blood pressure should be used in patients with breast cancer both to detect masked hypertension and to assess the achievement of the target level of blood pressure before anthracycline-containing chemotherapy.

cardio-oncology, arterial hypertension, cardiotoxicity, masked arterial hypertension, chemotherapy, breast cancer

1. Unitt C, Montazeri K, Tolaney S, Moslehi J. Cardiology patient page: breast cancer chemotherapy and your heart. Circulation 2014; 129 (25): e680-e682. DOI: 10.1161/CIRCULATIONAHA.113.007181

2. Sitia S, Tomasoni L, Turiel M. Speckle tracking echocardiography: A new approach to myocardial function. World J Cardiol 2010; 2 (1): 1-5.

3. Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced Cardiotoxicity. Maedica 2013; 8 (1): 59-67.

4. Gillespie H.S, McGann C.J, Wilson B.D. Noninvasive diagnosis of chemotherapy related cardiotoxicity. Curr Cardiol Rev 2011; 7: 234-44.

5. Чазова И.Е., Ощепкова Е.В., Кириллова М.Ю., Шарипова Г.Х. Сердечно-сосудистые и онкологические заболевания: поиск решений новых проблем. Системные гипертензии. 2015; 12 (2): 6-7.

6. Sadurska E. Current Views on Anthracycline Cardiotoxicity in Childhood Cancer Survivors. Pediatr Cardiol 2015; 36:1112-9.

7. https://www.who.int/ru

8. Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и др. Распространенность факторов риска сердечно-сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014; 10: 4-12.

9. Zamorano J.L, Lancellotti P, Munoz DR et al. 2016 ESC Position Paper on cancer treatment and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J 2016.

10. Hahn V.S, Lenihan D.J, Ky B. Cancer therapy-induced cardiotoxicity: basic mechanisms and potential cardioprotective therapies [serial online]. J Am Heart Assoc 2014; 3: e000665

11. Curigliano G, Cardinale D, Dent S et al. Cardiotoxicity of Anticancer Treatments: Epidemiology, Detection, and Management. CA Cancer J Clin 2016; 66: 309-25.

12. Di Lisi D, Madonna R, Zito C et al. Anticancer therapy-induced vascular toxicity: VEGF inhibition and beyond. Int J Cardiol 2017; 227: 11-7.

13. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019; 16 (1): 6-31. DOI: 10.26442/2075082X.2019.1.190179

14. Рогоза А.Н., Ощепкова Е.В., Посохов И.Н. Суточное мониторирование артериального давления. Национальное руководство. Функциональная диагностика. М.: ГЭОТАР-Медиа; с. 446-7.

15. Avila M.S, Ayub-Ferreira S.M, de Barros Wanderley M.R Jr et al. Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity: The CECCY Trial. J Am Coll Cardiol 2018; 71 (20): 2281-90. DOI: 10.1016/j.jacc.2018.02.049

16. Авалян А.А., Ощепкова Е.В., Саидова М.А. и др. Оценка субклинической кардиотоксичности антрациклинсодержащей химиотерапии рака молочной железы в зависимости от кумулятивной дозы доксорубицина и исходного уровня артериального давления. Системные гипертензии. 2018; 15 (4): 59-64. DOI: 10.26442/2075082X.2018.4.000021

17. Rakha E.A, Reis Filho J.S et al. Basal Like Breast Cancer: A Critical Review. J Clin Oncol 2008; 26: 2568-81.

18. Стенина М.Б., Фролова М.А. Рак молочной железы: наиболее важные научные события и выводы последних лет. Практическая онкология 2011; 12 (1): 6-11.

19. Ranpura V, Pulipati B, Chu D et al. Increase risk of high-grade hypertension with bevacizumab in cancer patients: a meta-analysis. Am J Hypertens 2010; 23 (5): 460-8.

20. Li-Ling Tan, Alexander R. Lyon. Role of Biomarkers in Prediction of Cardiotoxicity During Cancer Treatment. Curr Treat Options Cardio Med 2018.

21. Kuriakose R.K, Kukreja R.C, Potential L.Xi. Therapeutic Strategies for Hypertension-Exacerbated Cardiotoxicity of Anticancer Drugs. Oxid Med Cell Longev 2016; 8139861; 9.

22. Moazeni S et al. Anthracycline induced cardiotoxicity: biomarkers and “Omics” technology in the era of patient specific care. Clin Trans Med 2017; 6: 17. DOI: 10.1186/s40169-017-0148-3

23. Ponikowski P, Voors A.A, Anker S.D et al. Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37 (27): 2129-200.

24. Mancia G et al. Long-Term Risk of Sustained Hypertension in White-Coat or Masked Hypertension. Hypertension 2009; 54 (2): 226-32.

25. Чазова И.Е., Виценя М.В., Агеев Ф.Т. Сердечно-сосудистые осложнения противоопухолевой терапии. М.: Гранат, 2019; с. 25-31.