Are Cancer Patients Really More Prone to Hypertension?
In recent years, with the rapid advancement of cancer treatment concepts and technologies, both the survival time and quality of life of cancer patients have significantly improved. Many patients with advanced cancer today do not die directly from tumor recurrence. In fact, studies have shown that cardiovascular diseases have become the second leading cause of long-term mortality among cancer survivors.[1-4]
So what is the connection between cancer and hypertension? Can cancer treatment cause high blood pressure? And how should patients with both cancer and hypertension manage their health effectively?
According to the 2016 Position Paper of the European Society of Cardiology (ESC) on Cancer Treatments and Cardiovascular Toxicity and the Consensus Document on Onco-Cardiology Clinical Management from Italy, there is a close relationship between cancer, its treatments, and hypertension. These findings have provided important references for the standardized prevention and management of cardiovascular toxicity during cancer therapy, aiming to improve patients’ quality of life.[5]
Over the past decade, increasing evidence suggests that cancer patients and survivors face a higher risk of developing hypertension compared to the general population.
This can be explained by two main factors:
Firstly, the tumor itself may cause hypertension. Certain tumors, such as pheochromocytomas or adrenal cortical adenomas, can secrete hormones that elevate blood pressure. In addition, cancer-induced cachexia, hypercoagulability, or renal vascular thrombosis can also contribute to hypertension.
Moreover, targeted therapies can trigger hypertension as a side effect. Targeted anti-tumor drugs, while offering strong and selective anti-cancer effects, may lead to adverse reactions including hypertension, skin rash, allergic responses, and cardiac or hepatic toxicity. Among these, hypertension is one of the most common treatment-related side effects.
Not all cancer treatments cause high blood pressure. In most cases, blood pressure changes in cancer patients are associated with targeted therapies. Clinical research, including a study published by Sica DA in the Journal of Clinical Oncology, revealed that targeted agents, especially anti-angiogenic therapies, may lead to transient or persistent hypertension.[6] There are two notable characteristics:
1. Anti-angiogenic therapies may elevate blood pressure while inhibiting tumor growth.
These drugs normalize existing tumor vessels and inhibit the formation of new ones, effectively starving tumors of their blood supply. However, managing treatment-induced hypertension is essential to ensure therapeutic benefit.
2. Different anti-angiogenic drugs cause varying degrees of blood pressure elevation.
In clinical cancer treatment, the incidence and severity of hypertension caused by different anti-angiogenic targeted drugs can vary. Even within the same drug class, the likelihood of developing hypertension is not the same. For example, among tyrosine kinase inhibitors (TKIs), ponatinib has a hypertension incidence rate of over 50%, while pazopanib, axitinib, regorafenib, and cabozantinib range from 31% to 40%. Sunitinib and sorafenib fall between 21% and 30%. In contrast, among monoclonal antibody drugs, bevacizumab has an incidence rate of 21%–30%, while cetuximab and ramucirumab range from 11% to 20%. These differences may be related to various factors, including the mechanisms of the anti-cancer drugs, dosage or treatment regimens, tumor types being treated, age of the patients, and history of hypertension.
Cancer-related hypertension can increase the risk of coronary artery disease, stroke, heart failure, and chronic kidney disease, and may even interrupt ongoing cancer treatments. Therefore, early detection and proactive management of blood pressure are essential.[7]
1. Early Intervention and Strict Blood Pressure Control
For hypertension caused by the cancer itself, treatment is similar to that for essential hypertension—aimed at reducing cardiovascular risks and mortality. At Jiahui International Cancer Center, oncologists develop individualized blood pressure management plans following international clinical guidelines, ensuring continuous blood pressure control throughout cancer therapy.
2. Targeted Therapy-Related Hypertension: Continuous Assessment and Monitoring
For patients receiving targeted therapy, physicians will assess cardiovascular risk factors, organ damage, and overall health status.
Early and strict blood pressure management helps prevent damage to vital organs (heart, brain, kidneys) and reduces the likelihood of hypertension-induced treatment interruptions. Jiahui International provides international-standard monitoring and safety management for patients undergoing targeted therapy, ensuring safe and comprehensive care.
3. Regular Blood Pressure Monitoring Before, During, and After Treatment
Patients with normal blood pressure should self-monitor for at least one week before starting targeted therapy.
Those with pre-existing hypertension should undergo closer monitoring throughout treatment.
Patients with heart or cerebrovascular disease should maintain stricter blood pressure targets.
4. Kidney function assessment is especially crucial for patients with renal cancer receiving anti-angiogenic therapies, as hypertension often develops within the first 8 weeks of treatment.
Cancer patients should not be overly anxious about hypertension. By maintaining regular monitoring, adopting a healthy lifestyle—balanced diet, no smoking or alcohol, weight control, proper exercise, and positive mindset—and following medical advice closely, blood pressure can be effectively managed. With professional guidance, science-based treatment, and timely follow-up, cancer patients can face hypertension calmly and confidently, ensuring both safety and quality of life during their cancer journey.
References:
[1] Totzeck M, et al. Int J Cardiol. 2019;280:163–175.
[2] Bodai BI, Tuso P. Perm J. 2015;19(2):48–79.
[3] Siegel RL, Miller KD, Jemal A. CA Cancer J Clin. 2015;65(1):5–29.
[4] Jovenaux L, et al. Int J Cardiol. 2017;241:387–392.
[5] Zheng ZP, Zhang W, Li CC. Chinese Journal of Gerontology, 2021, 41(9): 4146–4149.
[6] Sica DA. J Clin Oncol. 2006;24(9):1329–1331.
[7] Huang YT, Yu ZQ. Chinese Journal of Hypertension. 2021;29(8):723–727.
