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Ibrutinib is an effective treatment for several B-cell malignancies, including mantle cell lymphoma, chronic lymphocytic leukemia, and Waldenstrom macroglobulinemia. However, it can cause cardiotoxicity. Under the direction of Daniel Addison, MD, a team of researchers recently found that hypertension caused or worsened by treatment with ibrutinib results in a greater than two-fold increased risk of major adverse cardiovascular events. In this interview with i3 Health, Dr. Addison discusses what should be done about ibrutinib-related hypertension in patients with B-cell malignancies.
Can you comment on the significance of your study's results?
Daniel Addison, MD: This is the first real-world study to evaluate the relationship between ibrutinib and hypertension. It is also the first study to link ibrutinib-related hypertension with subsequent cardiac arrhythmias.
Should patients with B-cell malignancies who have pre-existing hypertension be prescribed something other than ibrutinib?
Dr. Addison: Not necessarily. If this is the best option for cancer treatment, it might be reasonable to use ibrutinib with close monitoring for cardiovascular disease. This decision should be made in conjunction with a cancer physician.
Should patients taking ibrutinib be initiated on antihypertensives as a preventative measure?
Dr. Addison: No, unless they have under-treated pre-existing hypertension or other cardiac risk factors. Our results suggest that those who develop high blood pressure should be started on antihypertensives early on.
What additional measures should be taken to prevent hypertension and subsequent cardiotoxic events in patients taking ibrutinib?
Dr. Addison: Treatment of elevated blood pressure before and after ibrutinib initiation is important and may help to prevent other cardiotoxic events that could occur down the line.
About Dr. Addison
Daniel Addison, MD, is an Assistant Professor of Cardiovascular Medicine and Co-Director of the Cardio-Oncology Program at The Ohio State University College of Medicine. He is a clinical investigator and practicing cardiologist who specifically employs novel techniques, including advanced cardiac imaging, to understand the pathophysiologic mechanisms and potential targets of interventions for cardiovascular disease among cancer survivors who are at risk of cardiovascular events. His research team currently focuses on the early detection, mechanisms, and preventative strategies of cardiovascular disease related to novel targeted therapies and immunotherapies.
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