title: Early detection of hypertension in a patient treated with sunitinib by measuring cardio-ankle vascular index.
abstract: Cardio-ankle vascular index (CAVI) has been established as a marker of arterial stiffness, which is increased in hypertensive patients. CAVI reflects the stiffness of the aorta, femoral artery, and tibial artery. Sunitinib, multi-targeted tyrosine kinase inhibitor with both anti-angiogenic and anti-tumor activities, has been proved effective in patients with gastrointestinal stromal tumors. However, the treatment with sunitinib is often complicated by side effects such as hypertension. We describe an 84-year-old woman with gastrointestinal stromal tumor, who showed changes in arterial stiffness preceding the appearance of hypertension in the early phase after sunitinib initiation. The patient received sunitinib (50 mg given daily) for gastrointestinal stromal tumor. We assessed the influence of sunitinib on arterial stiffness every 7 days by measuring CAVI. The CAVI, which reflects arterial stiffness, was increased from 9.95 at baseline to 11.65 at 7 days after the initiation of sunitinib, whereas the blood pressure remained unchanged (117/72 and 119/76 mmHg). At 14 days after sunitinib initiation, the blood pressure was increased to 159/89 mmHg, indicating the occurrence of hypertension, while the CAVI was 11.90, the similar level detected at 7 days. Subsequently, sunitinib treatment was discontinued, because of the marked decrease in blood platelets. Both blood pressure and CAVI, together with blood platelets, were restored to the baseline values at 12 days after cessation of sunitinib. In conclusion, the increase in the CAVI preceded the appearance of sunitinib-induced hypertension. Arterial stiffness assessed by CAVI may be useful for early detection of sunitinib-induced hypertension.
authors.affiliation: Department of Integrated Medicine, Kagawa University, Kagawa, Japan. masugata@med.kagawa-u.ac.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Masugata
authors.forename: Shoichi
authors.initials: S
authors.lastname: Senda
authors.forename: Takashi
authors.initials: T
authors.lastname: Himoto
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okuyama
authors.forename: Michio
authors.initials: M
authors.lastname: Inukai
authors.forename: Koji
authors.initials: K
authors.lastname: Murao
authors.forename: Naohisa
authors.initials: N
authors.lastname: Hosomi
authors.forename: Kazushi
authors.initials: K
authors.lastname: Yukiiri
authors.forename: Masakazu
authors.initials: M
authors.lastname: Kohno
authors.forename: Ayumu
authors.initials: A
authors.lastname: Yamagami
authors.forename: Takeaki
authors.initials: T
authors.lastname: Kohno
authors.forename: Fuminori
authors.initials: F
authors.lastname: Goda
mesh_terms: D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D003971:Diastole / Q000187:drug effects; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D007211:Indoles / Q000009:adverse effects* / Q000494:pharmacology; D011758:Pyrroles / Q000009:adverse effects* / Q000494:pharmacology; D013318:Stroke Volume / Q000187:drug effects; D000077210:Sunitinib; D014463:Ultrasonography
chemical_list: D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib