Philip Laura J, Findlay Simon G, Gill Jason H
School of Pharmacy, Faculty of Medical Sciences, Newcastle University, UK.
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, UK.
Int J Cardiol Cardiovasc Risk Prev. 2022 Oct 13;15:200153. doi: 10.1016/j.ijcrp.2022.200153. eCollection 2022 Dec.
Anthracyclines, a mainstay of cancer treatment, are associated with significant life-threatening cardiotoxicity. As cancer survivorship improves, there is a growing need to identify patients most at risk and strategies to mitigate anthracycline-associated cardiotoxicity. Elevated baseline blood pressure (bBP) is a possible risk factor for cardiotoxicity. The aim of this systematic review was to summarise the literature and evaluate relationships between bBP and anthracycline-associated cardiotoxicity.
Systematic searches were conducted, limited to English language but without restrictions on study type or country of origin. All studies fulfilled the PRISMA statement and relevant studies reviewed and narratively synthesised. A total of 1330 papers were screened, with 12 included in the qualitative synthesis. Eight papers indicated elevated bBP was associated with significantly higher risk of developing cardiotoxicity. Four papers noted significant relationships between left ventricular ejection fraction (LVEF) decline and elevated bBP. Of the four papers that failed to show an association, one noted increased risk of developing chronic heart failure. A relationship between baseline diastolic and systolic BP and anthracycline-associated cardiotoxicity is also noted.
This study indicates adult patients with elevated bBP have increased vulnerability to anthracycline-associated cardiotoxicity, with those with pre-hypertension or raised systolic versus diastolic pressure potentially an overlooked population. Recommendations for inclusion of bBP, incorporating individual systolic versus diastolic pressures, in cardio-oncology risk prediction models to guide clinical decision-making are thus warranted.
蒽环类药物是癌症治疗的主要药物，与严重的危及生命的心脏毒性有关。随着癌症生存率的提高，越来越需要识别出风险最高的患者以及减轻蒽环类药物相关心脏毒性的策略。基线血压（bBP）升高是心脏毒性的一个可能危险因素。本系统评价的目的是总结文献并评估bBP与蒽环类药物相关心脏毒性之间的关系。
进行了系统检索，限于英文文献，但对研究类型或原产国没有限制。所有研究均符合PRISMA声明，并对相关研究进行了综述和叙述性综合分析。共筛选了1330篇论文，其中12篇纳入定性综合分析。8篇论文表明bBP升高与发生心脏毒性的风险显著更高有关。4篇论文指出左心室射血分数（LVEF）下降与bBP升高之间存在显著关系。在4篇未显示关联的论文中，有1篇指出发生慢性心力衰竭的风险增加。还注意到基线舒张压和收缩压与蒽环类药物相关心脏毒性之间的关系。
本研究表明，bBP升高的成年患者更容易发生蒽环类药物相关心脏毒性，高血压前期患者或收缩压与舒张压升高的患者可能是一个被忽视的人群。因此，有必要在心脏肿瘤学风险预测模型中纳入bBP（包括个体收缩压与舒张压），以指导临床决策。
