Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Oncology Department, Radiotherapy Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Am J Hypertens. 2018 Jan 12;31(2):235-239. doi: 10.1093/ajh/hpx158.
Radiotherapy (RT) plays a key role in the management of head and neck cancer (HNC), especially in locally advanced disease. Patients undergoing head and neck RT, especially elderly ones, are suffering from low and labile blood pressure (BP) during the treatment. They complain of weakness and fatigue and are prone to recurrent falls. The aim of this study was to characterize BP changes during RT period.
Patients with HNC, receiving radiation to the neck, were recruited from Sheba medical center RT unit. Office BP, orthostatic measurements, 24-hour ambulatory BP monitoring, body weight, and metabolic parameters were measured at baseline after 30 days and after 90 days from beginning of therapy.
Nineteen patients (17 males), 64 ± 12 years old were recruited. Nine hypertensive patients continued their antihypertensive treatment during the study. Office systolic BP and diastolic BP decreased significantly after 30 days (128 ± 4/80 ± 3 to 122 ± 3/74 ± 3 mm Hg; P < 0.05). Average 24-hour BP values after 30 days of RT decreased from 130 ± 3/76 ± 2 to 123 ± 3/71 ± 2 mm Hg; P < 0.05. A similar trend was observed for day and night BP levels. Decrease in office and ambulatory BP was sustained for several months after RT completion. No orthostasis was observed during the study period. Patient lost weight significantly during the study period. However, BP changes were independent of weight loss.
There is a significant and sustained BP reduction after head and neck RT, without orthostatic changes. Clinicians should be aware of this phenomenon and consider treatment adaption accordingly.
放射治疗（RT）在头颈部癌症（HNC）的治疗中起着关键作用，特别是在局部晚期疾病中。接受头颈部 RT 的患者，尤其是老年患者，在治疗过程中会出现低血压和不稳定的血压（BP）。他们会感到虚弱和疲劳，并且容易反复跌倒。本研究旨在描述 RT 期间 BP 变化的特征。
从 Sheba 医疗中心 RT 部门招募了接受颈部放疗的 HNC 患者。在治疗开始后 30 天和 90 天时，测量了诊室血压、直立位测量、24 小时动态血压监测、体重和代谢参数。
共招募了 19 名患者（17 名男性），年龄为 64 ± 12 岁。9 名高血压患者在研究期间继续接受降压治疗。30 天后，诊室收缩压和舒张压显著下降（128 ± 4/80 ± 3 至 122 ± 3/74 ± 3mmHg；P<0.05）。RT 后 30 天的平均 24 小时 BP 值从 130 ± 3/76 ± 2 降至 123 ± 3/71 ± 2mmHg；P<0.05。日间和夜间 BP 水平也呈现出类似的趋势。RT 完成后几个月，诊室和动态血压的下降仍持续存在。研究期间未观察到直立性变化。患者在研究期间体重明显下降。然而，BP 变化与体重减轻无关。
头颈部 RT 后会出现显著且持续的 BP 降低，而无直立性变化。临床医生应意识到这一现象，并相应地调整治疗方案。
