HANI GUDA Staff asked 3 years ago
We all know that anthracyclines have cardiotoxicity in case they are taken for the long term or exceed the lifetime dose limits, what about hypertension? can we consider it as a contraindication for taking anthracyclines? does it matter if hypertension is controlled or not?
HANI GUDA Staff answered 3 years ago
Answer 1:
I think it could not be considered a contraindication but use with cautious and strict follow up as hypertension intensifies the effect of anthracyclin on the heart and enhance its cardiotoxicity effect.
and yes it matters hypertension is controlled or not. never start anthracyclin on uncontrolled hypertension. try to control hypertension first to avoid complications on the heart and the kidney.
HANI GUDA Staff answered 3 years ago
Answer 2:
It’s well known that preexisting cardiac disorders including hypertension can increase the risk of anthracycline-associated cardiotoxicity. This was demonstrated in multiple studies, including a very recent study by Vaitiekus et al (2020).
https://pubmed.ncbi.nlm.nih.gov/31782105/
This study is particularly interesting because it demonstrates cardiotoxicity even with antihypertensive treatment; although the sample is very small and contradicts findings in other papers (see Kalay et al, 2006; Cardinale et al, 2006).
Overall there’s not enough long-term data to formulate a guideline or to justify forfeiting the highly-effective anthracyclins in this population.
It’s generally a good practice to control hypertension and to have a baseline complete assessment of the heart function prior to starting anthracyclines, with frequent monitoring for LV damage during treatment.