Hypertension on VEGF-pathway inhibitors is common, dose-related and usually manageable. Measure blood pressure before starting, weekly during the first cycle and at every visit afterwards; home readings help. Start or intensify antihypertensives at the usual thresholds rather than waiting for severe readings. Dihydropyridine calcium-channel blockers such as amlodipine and ACE inhibitors are commonly used; avoid diltiazem and verapamil with drugs metabolised by CYP3A4. Reserve dose holds for severe or uncontrolled hypertension, as the drug label directs.
- Baseline BP, then weekly in cycle one
- Amlodipine or an ACE inhibitor are usual first choices
- Prefer an ACE inhibitor or ARB if proteinuria is present
- Hold for severe or symptomatic hypertension, then restart at reduced dose once controlled
Why it matters
Uncontrolled blood pressure is one of the commonest reasons these drugs are stopped early.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for oncology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free