Recommendations for initial assessment, surveillance, and management of blood pressure in patients receiving VEGF (vascular endothelial growth factor) signaling pathway inhibitors

Pretreatment assessment and screening

1. Standardized blood pressure measurements, preferably on two separate occasions

2. History and physical examination for formal assessment of specific cardiovascular risk factors, more detailed laboratory and/or diagnostic tests may be required to adequately screen for cardiovascular risks (eg, lipid panel, electrocardiogram)

3. Use this information to determine the appropriate intensity of monitoring and target for blood pressure control during therapy

4. Treat preexisting hypertension and address other comorbidities that might, through more attentive management, prolong life and support more aggressive cancer therapy

Monitoring during treatment

1. Actively monitor blood pressure throughout treatment with more frequent assessments during the first cycle (when the bulk of blood pressure elevation is expected to occur)

2. Monitoring every two to three weeks after the first cycle

Management

1. Patients who develop hypertension during therapy (≥130 mmHg/80 Hg, or increases in diastolic blood pressure ≥20 mm from baseline) should initiate anti-hypertensive therapy, have current therapy titrated to better control blood pressure, or have another agent added. The goal for blood pressure in patients receiving VEGF inhibitors is maximum blood pressure of 130/80. Target should be adjusted lower for patients with preexisting risk factors for adverse consequences of high blood pressure (eg, diabetes, chronic kidney disease).

2. Manage blood pressure elevations aggressively to avoid complications, pay attention to agent selection, dose and scheduling of follow-up visits to control adverse effects of the antihypertensive agent

3. Consultation with a hypertension specialist may be needed if there is difficulty achieving goal blood pressure

4. Consider discontinuation or dose reduction of VEGF inhibitor therapy if diastolic blood pressure is not controlled with anti-hypertensive medication

Adapted from: Maitland ML, Bakris GL, Black HR, et al. Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors. J Natl Cancer Inst 2010; 102:596.

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Recommendations for initial assessment, surveillance, and management of blood pressure in patients receiving VEGF (vascular endothelial growth factor) signaling pathway inhibitors