Zhu Xiaolei, Wu Shenhong
1Division of Primary Care, State University of New York at Stony Brook, 205 North Belle Mead Road, East Setauket, Stony Brook, NY 11733 USA.
2Division of Hematology and Oncology, Department of Medicine, School of Medicine, State University of New York at Stony Brook, 3 Edmund D. Pellegrino Rd, Stony Brook, NY 11794-9447 USA.
Clin Hypertens. 2019 Jun 1;25:12. doi: 10.1186/s40885-019-0116-x. eCollection 2019.
Hypertension is one of the major side effects associated with abiraterone in the treatment of advanced prostate cancer. The specific contribution of abiraterone to hypertension has not been defined. We performed a systematic review and meta-analysis of randomized clinical trials to determine its overall risk.
Databases including Pubmed (up to July 2018) and Google scholar (up to July 2018) were searched to identify relevant studies. Eligible studies were prospective randomized clinical trials with prostate cancer treated with abiraterone and prednisone. The incidence and relative risk (RR) of hypertension was calculated using random-effects or fixed-effects model depending on the heterogeneity of included studies.
A total of five studies including 5445 patients were selected for analysis. Among patients receiving abiraterone, the overall incidences of all grade and high grade (grade 3 and 4) were 21.9% (95% CI: 13.6-33.2%) and 10.2% % (95% CI: 6.9-11.6%). Abiraterone was associated with a significantly increased risk of hypertension of all grade with a relative risk of 1.80 (95% CI: 1.47-2.19%, < 0.001) and high grade with a relative risk of 2.11 (95%CI: 1.66-2.68%, p < 0.001) in comparison with controls. The risk of hypertension may be affected by concurrent use of prednisone with 5 mg daily is associated with higher incidence than that of prednisone 5 mg twice daily (32.4% vs 16.5%).
There is a significant increase of developing hypertension in prostate cancer patients treated with abiraterone. Appropriate monitoring and management is strongly recommended to reduce the risk of cardiovascular events and treatment interruptions.
高血压是阿比特龙治疗晚期前列腺癌的主要副作用之一。阿比特龙导致高血压的确切作用尚未明确。我们对随机临床试验进行了系统评价和荟萃分析，以确定其总体风险。
检索包括Pubmed（截至2018年7月）和谷歌学术（截至2018年7月）在内的数据库，以识别相关研究。符合条件的研究为使用阿比特龙和泼尼松治疗前列腺癌的前瞻性随机临床试验。根据纳入研究的异质性，使用随机效应或固定效应模型计算高血压的发病率和相对风险（RR）。
共选择5项研究，包括5445例患者进行分析。在接受阿比特龙治疗的患者中，所有级别和高级别（3级和4级）高血压的总体发病率分别为21.9%（95%CI：13.6-33.2%）和10.2%（95%CI：6.9-11.6%）。与对照组相比，阿比特龙与所有级别高血压风险显著增加相关，相对风险为1.80（95%CI：1.47-2.19%，P<0.001），高级别高血压相对风险为2.11（95%CI：1.66-2.68%，P<0.001）。高血压风险可能受泼尼松同时使用的影响，每日5mg泼尼松的发病率高于每日两次5mg泼尼松（32.4%对16.5%）。
接受阿比特龙治疗的前列腺癌患者发生高血压的风险显著增加。强烈建议进行适当监测和管理，以降低心血管事件风险和治疗中断情况。
