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摘要: 癌症是全世界死亡的主要原因之一，不断演进的抗癌药物使癌症患者的生存期明显延长。心血管疾病逐步取代癌症本身成为癌症患者致死和致残的主要原因，高血压是其中最常见的心血管疾病之一，所以监测及管理肿瘤患者的血压对降低化疗引起的心脏毒性风险和降低长期心血管疾病的风险至关重要。本文主要回顾与高血压发生相关的常见抗肿瘤药物，包括血管内皮生长因子抑制剂、小分子酪氨酸激酶抑制剂、蛋白酶体抑制剂、烷基化剂和免疫抑制剂等相关高血压的流行病学、潜在机制及针对性的管理建议，并讨论癌症患者应用血管内皮生长因子信号通路抑制剂相关血压的评估和管理策略。Abstract: Cancer is one of the leading causes of death worldwide, and the evolution of anti-cancer drugs has significantly prolonged the life expectancy of cancer patients. Cardiovascular diseases have gradually replaced cancer as the leading cause of morbidity and mortality in cancer patients. Among these cancer patients, hypertension is one of the most common cardiovascular diseases. Therefore, monitoring and managing blood pressure in cancer patients is crucial to reducing the risk of cardiotoxicity caused by chemotherapy and the risk of cardiovascular diseases. In this review, we reviewed common antitumor drugs related to hypertension, including vascular endothelial growth factor (VEGF) inhibitors, small molecule tyrosine kinase inhibitors, protease inhibitors, alkylating agents, and immunosuppressants. We also discussed epidemiology, underlying mechanisms, and corresponding management advice of these antitumor drugs. Finally, we discussed the blood pressure assessment and management strategy for cancer patients using VEGF pathway inhibitors.
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Key words:
- hypertension /
- cardio-oncology /
- cardiotoxicity
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图 1 VEGF信号通路抑制剂相关高血压的管理方法
Figure 1. Management of VEGF signaling pathway inhibitor related hypertension
表 1 抗肿瘤药物相关高血压的发生率、机制及管理
Table 1. Incidence rate, mechanism and management of anti-tumor drug-related hypertension
药物种类 机制 高血压发生率/% 治疗 VEGF抑制剂 内皮功能障碍，抑制NO途径(NO和前列环素I减少)，内皮素-1增加，血管重塑，全身血栓性微血管病和氧化应激，毛细血管稀疏，肾钠排泄减少 17~80 CCB(如氨氯地平)、ACEI(如赖诺普利) 酪氨酸激酶抑制剂 NOS活性降低，RAAS激活 17~47 ACEI或CCB 蛋白酶体抑制剂 血管紧张素诱导高血压，主动脉血管重构，血栓性微血管病 3~15 ACEI或ARB(如氯沙坦) 烷化剂 内皮细胞氧化损伤、内膜厚度增加，血管重塑异常，钠潴留、肾毒性和微量白蛋白血症 36~50 ACEI或ARB 钙调神经磷酸酶抑制剂和其他免疫抑制剂 交感神经过度活动，肾动脉血管收缩，肾钠重吸收增加、纳潴留(远端小管上皮钠通道激活)，NO生成减少，RAAS激活，肾前列腺素合成改变 30~80 CCB、噻嗪类利尿剂(尤其是他克莫司) 阿比特龙 具有盐皮质激素特性的类固醇前体增加(钠和液体滞留) 盐皮质激素拮抗剂、利尿剂 紫杉烷 内皮功能障碍、贝伐单抗和蒽环类药物毒性增强 ACEI、ARB或CCB 
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