Pauley Heart Center, Virginia Commonwealth University, Richmond, VA.
J Cardiovasc Pharmacol. 2022 Oct 1;80(4):522-530. doi: 10.1097/FJC.0000000000001342.
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Hypertension, which is common among cancer survivors with a prevalence of greater than 70% by age 50, potentiates the risk for CVD in a more than additive fashion. For example, childhood cancer survivors who develop hypertension may have up to a 12 times higher risk for heart failure than survivors who remain normotensive. Studies have shown that mild valvular disease (28% incidence), cardiomyopathy (7.4%), arrhythmias (4.6%), and coronary artery disease (3.8%) are among the most common CVDs in childhood cancer survivors. Among adolescent and young adult cancer survivors, the most common reasons for cardiovascular-related hospital admission are venous/lymphatic disease (absolute excess risk 19%), cardiomyopathy and arrhythmia (15%), hypertension (13%), and ischemic heart disease (12%). In addition, cancer therapies can increase the risk for hypertension and CVD. Therefore, early detection and treatment of hypertension is essential to reducing cardiovascular morbidity and mortality among survivors.
We present a literature review, which identified over 20 clinical trials, systemic reviews, and meta-analyses (13 clinical trials, 8 systemic reviews or meta-analyses) by searching PubMed, Google Scholar, and the Cochrane Library for relevant articles addressing hypertension in cancer survivors.
Although our understanding of the complex relationship between cancer therapies and CVD has grown significantly over the past 2 decades, there remain several gaps in knowledge when specifically addressing CVD in the survivor population. This review provides an up-to-date survivor-centered approach to the screening and treatment of hypertension, which considers survivor-specific cardiovascular risk, applies guideline directed therapies when appropriate, screens for survivor-specific factors that may influence antihypertensive medication selection, and finally considers the prohypertensive mechanisms of antineoplastic agents as a potential target for antihypertensive medications.
Screening for and treating hypertension among survivors can promote cardiovascular health in this vulnerable population.
心血管疾病（CVD）是癌症幸存者发病率和死亡率的主要原因。高血压在 50 岁前的癌症幸存者中较为常见，患病率超过 70%，以一种超过相加的方式增加 CVD 的风险。例如，患有高血压的儿童癌症幸存者患心力衰竭的风险可能比保持正常血压的幸存者高 12 倍。研究表明，轻度瓣膜病（28%的发病率）、心肌病（7.4%）、心律失常（4.6%）和冠状动脉疾病（3.8%）是儿童癌症幸存者中最常见的 CVD 之一。在青少年和年轻成年癌症幸存者中，心血管相关住院的最常见原因是静脉/淋巴疾病（绝对超额风险 19%）、心肌病和心律失常（15%）、高血压（13%）和缺血性心脏病（12%）。此外，癌症治疗会增加高血压和 CVD 的风险。因此，早期发现和治疗高血压对于降低幸存者的心血管发病率和死亡率至关重要。
我们进行了文献综述，通过在 PubMed、Google Scholar 和 Cochrane 图书馆中搜索有关癌症幸存者高血压的相关文章，确定了 20 多项临床试验、系统评价和荟萃分析（13 项临床试验、8 项系统评价或荟萃分析）。
尽管在过去的 20 年中，我们对癌症治疗与 CVD 之间复杂关系的理解有了显著的提高，但在具体针对幸存者人群中的 CVD 时，仍存在一些知识空白。本综述提供了一种以幸存者为中心的方法，用于筛查和治疗高血压，该方法考虑了幸存者特有的心血管风险，在适当的情况下应用指南指导的治疗方法，筛查可能影响降压药物选择的幸存者特有的因素，最后考虑了抗肿瘤药物的促高血压机制，作为降压药物的潜在靶点。
在幸存者中筛查和治疗高血压可以促进这一脆弱人群的心血管健康。
