Hypertension Severity Impacts Declines in Left Ventricular Ejection Fraction Among Women Receiving Adjuvant Chemotherapy for Breast Cancer
Date Thesis Awarded
Honors Thesis -- Open Access
Bachelors of Science (BS)
Background: American College of Cardiology/American Heart Association hypertension guidelines do not clearly address the pharmacological treatment of increases in blood pressure (BP) in women receiving potentially cardiotoxic chemotherapy for the treatment of breast cancer.
Methods and Results: Magnetic resonance measures of left ventricular ejection fraction (LVEF) were performed in women with stage I-III breast cancer prior to and three months after initiating potentially cardiotoxic chemotherapy. Measurements of brachial BP were collected according to AHA recommendations. Using multivariable analysis, we assessed the association between change in LVEF and pre-existing ACC/AHA stages of hypertension (HTN) after accounting for pre-treatment LVEF, diabetes status, age, and body mass index (BMI). We also analyzed the effect of the number of anti-HTN medicines on LVEF decline in the same patient population. All analyses were performed blind to all participant identifiers. Participants (n=227, female) were aged 56±0.69 (Mn±SE) years and were 75% White and 20% Black. Cancer therapies included combinations of anthracyclines (43.2%), trastuzumab (22.9%), paclitaxel (48.0%), and cyclophosphamide (50.7%). After accounting for pre-treatment LVEF, diabetes status, age, and BMI, participants with Stage II HTN experienced a significant decline (p=0.0116) in LVEF relative to individuals with normal blood pressure. No association was found between the number of anti-HTN medicines and LVEF decline.
Conclusion: Relative to women with normal blood pressure, women with Stage II HTN experienced a larger decline in LVEF three months after initiating potentially cardiotoxic chemotherapy for breast cancer, independent of HTN treatment. This finding raises the possibility that lower blood pressure targets among women receiving adjuvant treatment for breast cancer may associate with improved preservation of LVEF. Clinical Trial Numbers: NCT02791581 (NIH #: R01CA199167) and NCT01719562 (NIH #: R01CA167821)
Garg, Riya, "Hypertension Severity Impacts Declines in Left Ventricular Ejection Fraction Among Women Receiving Adjuvant Chemotherapy for Breast Cancer" (2022). Undergraduate Honors Theses. William & Mary. Paper 1899.
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