‘Aggressive’ combination therapy lowers blood pressure in patients receiving ibrutinib
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Key takeaways:
- Patients treated for hypertension while receiving ibrutinib benefited from combination treatment.
- Effective combinations varied depending on whether patients had preexisting or newly developed hypertension.
The combination treatment of two or more antihypertensive therapies in patients being treated with ibrutinib can significantly reduce blood pressure, data published in Blood Advances showed.
Results from the study highlight an effective treatment for individuals who receive ibrutinib and develop new or worsening high blood pressure, according to study investigators.
“To our knowledge, this is the first and only study to examine how to optimally treat high blood pressure in patients receiving ibrutinib,” Mazyar Shadman, MD, MPH, associate professor in the clinical research division at Fred Hutchinson Cancer Center and University of Washington School of Medicine, said in a press release. “Our findings strongly suggest that aggressive treatment with certain combinations of antihypertensive medications can achieve significantly reduced blood pressures in this patient population.”
Background and methodology
Bruton tyrosine kinase inhibitors (BTKs) are used to treat several lymphoid malignancies. This drug class is typically well-tolerated and with less toxic effects than chemotherapy alternatives, yet these agents can also cause new or worsening hypertension in some patients.
A lack of research on BTK-associated hypertension led study investigators to conduct a retrospective analysis to explore potential optimal treatments.
Researchers randomly selected 196 patients (median age, 67 years; 93% white; 71% male) with lymphoid malignancies who received a BTK inhibitor and antihypertensive drugs with at least 3 months of follow-up data to be sorted into 2 groups: those with hypertension prior to BTK inhibitor initiation and those diagnosed with hypertension following initiation.
Of the entire study cohort, 118 had hypertension prior to initiation and 78 developed hypertension following initiation.
The analysis used generalized estimating equations to assess associations between time varying mean arterial pressures (MAPs) and individual antihypertensive drug categories.
Nearly 90% of patients in the study received ibrutinib (Imbruvica; Janssen, Pharmacyclics).
Results, next steps
Researchers observed statistically significant mean MAP reductions among patients with previously diagnosed hypertension who took beta blockers with hydrochlorothiazide (5.05 mm Hg; 95% CI, 10 to 0.0596) and among patients with newly developed hypertension who received either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with hydrochlorothiazide (5.47 mm Hg; 95% CI, 10.9 to 0.001).
These regimens also correlated with the greatest percentage of normotensive MAPs, according to study investigators.
Treatment of hypertension among patients receiving BTK inhibitors appears to benefit from combination therapy; however, the results of this analysis should be confirmed via prospective studies, they added.
“Our results reinforce that — in this patient population, as in patients with hypertension in general — you need to treat with multiple drugs to achieve successful blood pressure control,” Laura Samples, MD, of Fred Hutchinson Cancer Center and University of Washington School of Medicine, said in a press release. “Large prospective studies are needed to develop formal guidelines on the most effective antihypertensive regimens in patients taking [BTK inhibitors],”
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