title: Use of Antihypertensive Drugs in Neoplastic Patients.
abstract: The introduction of Vascular Endothelial Growth Factor (VEGF) signaling pathway inhibitor treatment has highlighted the role of the baseline activity of the VEFG system for blood pressure regulation. VEGF signaling pathway is associated with hypertension and proteinuria. Activation of the endothelin system, endothelial dysfunction and capillary rarefaction are among the underlying mechanisms possibly explaining the rise in blood pressure and, to some extent, also the renal injury. The hypertension induced by VEGF signaling pathway inhibition is, usually, responsive to treatment. Recommendations about the management of cardiovascular toxicity in patients receiving VEGF signaling pathway inhibitors include a formal cardiovascular risk assessment before initiation of VEGF signaling pathway inhibitor treatment, active monitoring of blood pressure and cardiac toxicity throughout treatment, with more frequent monitoring during the first cycles of therapy, given that marked and unpredictable blood pressure rises can occur early after treatment with a VEGF signaling pathway inhibitor, and aggressive management of blood pressure elevations and early symptoms and signs of cardiac toxicity to prevent clinically limiting complications. In patients with preexisting hypertension, the blood pressure target for initiating VEGF signaling pathway inhibitor treatment should be <140/90 mmHg. Blockers of the renin-angiotensin system and calcium channel antagonists are among the drugs to be preferably used in these clinical conditions.
authors.affiliation: Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy. damiano.rizzoni@unibs.it.|Division of Medicine, Istituto Clinico Città di Brescia, Brescia, Italy. damiano.rizzoni@unibs.it.
authors.forename: Damiano
authors.identifier: http://orcid.org/0000-0002-1253-0186
authors.initials: D
authors.lastname: Rizzoni
authors.affiliation: Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: De Ciuceis
authors.affiliation: Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Porteri
authors.affiliation: Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Agabiti-Rosei
authors.affiliation: Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Agabiti-Rosei
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D009369:Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D009389:Neovascularization, Pathologic; D012307:Risk Factors; D015398:Signal Transduction / Q000187:drug effects; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors* / Q000378:metabolism
chemical_list: D020533:Angiogenesis Inhibitors; D000959:Antihypertensive Agents; D042461:Vascular Endothelial Growth Factor A
keywords: Angiogenesis; Antiangiogenic treatment; Blood pressure; Hypertension; Microvasculature