Table 1 Hypertension induced anticancer drugs; mechanism of action and side effects
From: Hypertension in Cardio-Oncology Clinic: an update on etiology, assessment, and management
Medication Group | Mechanism of action leading to hypertension | Drugs | Side effects |
|---|---|---|---|
Vascular endothelial growth factor inhibitors | • ET-1and vasoconstriction [26, 27]. • through inactivation of ETB receptors, endothelial dysfunction, vasoconstrictor prostanoids • reducing NO bioavailability [30]. • inactivating endothelial eNOS • increasing salt sensitivity [20] • ENaC | Axitinib [31] sorafenib [31] | dose-dependent hypertension [20]. |
Immune therapeutic agents | Immune checkpoint inhibitors [39, 40, 99] • dysregulated NO hemostasis and vasoconstriction | Bortezomib [38] Carfilzomib [38] Everolimus [35] | Myocarditis [100] arrhythmias, conduction abnormalities [100] pericardial diseases [100] interstitial nephritis Acute kidney injury [101] cardiotoxicity |
|  | mTOR inhibitors • increased oxidative stress [34] sympathetic activation [34] | Rapamycin | Hyperglycemia [105], hypercholesterolemia [105], hypertriglyceridemia [105] |
| Â | CAR-T therapy | Â | fever, flu-like symptoms, low blood pressure, and organ damage [106] |
• blocking the β proteolytic subunits of the 20s proteasome | bortezomib and carfilzomib | muscle weakness and tingling [107] | |
Traditional chemotherapeutic agents | Alkylating agents • creating cross-linkage in DNA strands and cell death [43] • disturbance in renin-angiotensin system [48]. | Cyclophosphamide [46, 47] ifosfamide [48] Anthracycline [49] Cisplatin [51]. | Nephrotoxicity endothelial injury |
BCR-ABL tyrosine-kinase inhibitors (TKIs) | • inhibiting the development and maturation of monocytes [108] | Nilotinib [109], dasatinib [110], bosutinib [111] and ponatinib [112] | itching and rash, nausea, diarrhea, and tiredness [113] |
RAF and MEK inhibitors | Â | vemurafenib and cobimetinib, dabrafenib and trametinib, and encorafenib and binimetinib | rash, diarrhea, peripheral edema, fatigue, and dermatitis acneiform [114] |
Vinca alkaloids | • Mitosis-mediated inhibition of endothelial cell proliferation [44]. • Endothelial cell caspase-mediated apoptosis [44]. • Cardiovascular Autonomic neuropathy [115] | Vinblastine [116] Vincristine [117] | Hypertension Hypotension |
Endocrine therapy | Anti-androgens • Blocking the cytochrome P450 17A1 • Decrease in androgen synthesis Increase in ACTH • Increase mineralocorticoid production | Cyproterone acetate, Flutamide, Bicalutamide, Enzalutamide [69] Abiraterone, Enzalutamide [70] | Cardiotoxicity [70]. |
Radiotherapy | Â | hypertensive encephalopathy renal injury [97] Renal artery stenosis resulting from abdominal radiation [98] | |
Adjuvant therapies | |||
Corticosteroids | Mineralocorticoid Salt and water retention | Hydrocortisone, methylprednisolone, prednisone | induce dose-dependent hypertension |
Calcineurin inhibitors | Salt and water retention | cyclosporine tacrolimus | Â |
Non-steroidal anti-inflammatory drugs (NSAIDs) | Inhibit the production of prostaglandins Decrease in prostaglandins I2 and E2 | ibuprofen naproxen diclofenac mefenamic acid etoricoxib | Â |