Department of Medical Science and Cardio-Renal Medicine, Yokohama City University Graduate School of Medicine, Japan (S.M., S.K., T.I., K.T.).
Chemotherapy Center, Yokohama City University Hospital, Japan (N.H.).
Hypertension. 2022 Nov;79(11):2611-2621. doi: 10.1161/HYPERTENSIONAHA.122.19865. Epub 2022 Sep 12.
Immune checkpoint inhibitors (ICIs) are becoming widely used for novel cancer treatments. Immune-related adverse events, including cardiac toxicity, are frequently observed following immune checkpoint inhibitor (ICI) use. However, little is known regarding the association between ICIs initiation and hypertension in cancer patients.
A systematic literature search was performed using PubMed, EMBASE, Cochrane Library, and Web of Science Core Collection. The risk of hypertension associated with ICI initiation in randomized controlled trials (RCTs) was evaluated. Hypertension was categorized according to the Common Terminology Criteria for Adverse Events. The odds ratios of grades I to V and grades III to V hypertension were calculated using a random-effects meta-analysis.
Thirty-two RCTs (n=19 810 cancer patients) were included. At a median follow-up of 36 months, the median overall survival was 15 months in the ICI group. ICI initiation was not significantly associated with hypertension (grades I-V: odds ratio, 1.12 [95% CI, 0.96-1.30]; grades III-V: odds ratio, 0.95 [95% CI, 0.78-1.16]). Additionally, no significant differences in hypertension risk were evident in ICI combination therapies with various drugs, including anti-VEGF (vascular endothelial growth factor) agents. In a subgroup analysis based on clinical setting (placebo RCT versus nonplacebo RCT), there were discrepancies between the results obtained with different methodologies, with patients in the nonplacebo RCTs having higher grades I-V hypertension (I=88.6%, for heterogeneity=0.003).
ICI initiation was not associated with short-term risk of hypertension in cancer patients, and the association was similar regardless of concomitant treatment with other anticancer drugs.
免疫检查点抑制剂（ICIs）在新型癌症治疗中得到了广泛应用。免疫相关不良反应，包括心脏毒性，在使用免疫检查点抑制剂（ICI）后经常观察到。然而，关于 ICI 启动与癌症患者高血压之间的关联知之甚少。
使用 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 核心合集进行系统文献检索。评估随机对照试验（RCT）中 ICI 启动与高血压相关的风险。根据不良事件通用术语标准对高血压进行分类。使用随机效应荟萃分析计算 I 至 V 级和 III 至 V 级高血压的优势比。
纳入 32 项 RCT（n=19810 例癌症患者）。在 36 个月的中位随访中，ICI 组的中位总生存期为 15 个月。ICI 启动与高血压无显著相关性（I 至 V 级：优势比，1.12 [95% CI，0.96-1.30]；III 至 V 级：优势比，0.95 [95% CI，0.78-1.16]）。此外，ICI 联合各种药物（包括抗血管内皮生长因子 [VEGF] 药物）的治疗方案与高血压风险无显著差异。在基于临床环境（安慰剂 RCT 与非安慰剂 RCT）的亚组分析中，不同方法学得出的结果存在差异，非安慰剂 RCT 中的患者发生 I 至 V 级高血压的比例更高（I=88.6%，异质性检验=0.003）。
ICI 启动与癌症患者短期高血压风险无关，并且无论是否同时使用其他抗癌药物，相关性相似。
