Kaneko Hidehiro, Yano Yuichiro, Lee Hokyou, Lee Hyeok-Hee, Okada Akira, Suzuki Yuta, Itoh Hidetaka, Matsuoka Satoshi, Fujiu Katsuhito, Michihata Nobuaki, Jo Taisuke, Takeda Norifumi, Morita Hiroyuki, Nishiyama Akira, Node Koichi, Kim Hyeon Chang, Yasunaga Hideo, Komuro Issei
The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
J Clin Oncol. 2023 Feb 10;41(5):980-990. doi: 10.1200/JCO.22.00083. Epub 2022 Sep 8.
Despite the growing recognition of the importance of hypertension in patients with cancer, little is known about whether high blood pressure (BP) among patients with cancer is associated with incident heart failure (HF) and other cardiovascular disease (CVD) events and what BP levels are linked to these events. We examined the association of BP classification on the basis of the 2017 American College of Cardiology/American Heart Association BP guideline with the risk of HF and CVD events in patients with cancer.
We studied 33,991 patients with a history of breast, colorectal, or stomach cancer (median age, 53 years; 34.1% men). Patients receiving treatment with BP-lowering medications or having a history of CVD including HF were excluded. Using BP measurements at baseline, 33,991 participants were categorized as having normal BP (n = 17,444), elevated BP (n = 4,733), stage 1 hypertension (n = 7,502), or stage 2 hypertension (n = 4,312). The primary outcome was HF.
Over a mean follow-up of 2.6 ± 2.2 years, 779 HF events were recorded. After multivariable adjustment, the hazard ratios (HRs) for HF were 1.15 (95% CI, 0.93 to 1.44) for elevated BP, 1.24 (95% CI, 1.03 to 1.49) for stage 1 hypertension, and 1.99 (95% CI, 1.63 to 2.43) for stage 2 hypertension. A stepwise increase in risk with BP categories was also observed in other CVD events. This association was observed even in patients undergoing active cancer treatment. The relationship between hypertension and the risk of developing HF in patients with cancer was confirmed in the Korean National Health Insurance Service database.
Medication-naïve stage 1 and 2 hypertension was associated with a greater risk of HF and other CVD events in patients with cancer. Our results suggest the importance of multidisciplinary collaboration (eg, oncologists and cardiologists) to establish the optimal management strategy for hypertension in patients with cancer.
尽管人们越来越认识到高血压在癌症患者中的重要性，但对于癌症患者的高血压（BP）是否与新发心力衰竭（HF）和其他心血管疾病（CVD）事件相关，以及何种BP水平与这些事件相关，却知之甚少。我们根据2017年美国心脏病学会/美国心脏协会BP指南，研究了BP分类与癌症患者HF和CVD事件风险之间的关联。
我们研究了33991例有乳腺癌、结直肠癌或胃癌病史的患者（中位年龄53岁；男性占34.1%）。排除正在接受降压药物治疗或有包括HF在内的CVD病史的患者。根据基线时的BP测量值，33991名参与者被分类为血压正常（n = 17444）、血压升高（n = 4733）、1期高血压（n = 7502）或2期高血压（n = 4312）。主要结局是HF。
在平均2.6±2.2年的随访中，记录了779例HF事件。多变量调整后，血压升高组HF的风险比（HRs）为1.15（95%CI，0.93至1.44），1期高血压组为1.24（95%CI，1.03至1.49），2期高血压组为1.99（95%CI，1.63至2.43）。在其他CVD事件中也观察到随着BP分类风险逐步增加。即使在接受积极癌症治疗的患者中也观察到这种关联。韩国国家健康保险服务数据库证实了癌症患者高血压与发生HF风险之间的关系。
未接受药物治疗的1期和2期高血压与癌症患者发生HF和其他CVD事件的风险更高相关。我们的结果表明多学科协作（如肿瘤学家和心脏病学家）对于为癌症患者制定最佳高血压管理策略的重要性。
