2099P - The role of ambulatory blood pressure measurement in TKI-induced arterial hypertension diagnosis

Background

Arterial hypertension (AH) is common class-effect of tyrosine-kinase inhibitors (TKI) and the leading course of dose reduction/interruption of TKI-treatment. The aim of our study was to evaluate blood pressure (BP) phenotypes in patients with metastatic solid tumors just after initiation of TKI treatment.

Methods

Thirty-three patients with metastatic solid tumors (renal, hepatocellular and thyroid cancer) treated with lenvatinib (19 (58%) male), age 61,7 +/- 8,9 years), were examined. Clinical BP was measured before initiation, on 2nd Day and every month on TKI-treatment during 6 months in the morning in the seated position. 24-hour ambulatory BP monitoring (ABPM) was performed using the conventional method during 2nd Day of the TKI-treatment. BP level were classified in accordance with ESC guideline (2018) and CTCAE 5.0. We analyzed the prevalence of the following BP-phenotypes: a non-dipping BP pattern, and white coat, masked, and masked isolated nocturnal AH. All patients were recommended to take lenvatinib in the morning at 10.00. 12 (36%) has arterial hypertension in anamnesis and target blood pressure was achieved before initiation of TKI-treatment.

Results

42,4% of patients had AH Grade 1-3 by CTCAE 5.0. According to the clinical BP measurements on 2nd Day 30.3% of patients had AH ( ESC, 2018 ), in the same time AH was confirmed by ABPM in 90,9% of cases. All patients have non-dipping BP pattern. When comparing the results of clinical BP measurements and ABPM data, masked AH was diagnosed in 57,6% patients, true AH - in 30,3%, 12,1% were true normotensive, white-coat AH was not observed. Masked isolated nocturnal hypertension was prevalent BP-phenotype in initially normotensive patients with solid tumors on the second day of TKI-treatment (prevalence ratio 1.49; 95% CI: 1.08–1.65).

Conclusions

AH is early adverse reaction of TKI-treatment and besides ABPM could be important component for early diagnosis of such type of secondary AH. Masked isolated nocturnal hypertension was more common phenotype among initially normotensive patients with TKI intake.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

E. Khachaturian.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.