Over the past several years, cancer treatments have expanded from usual chemotherapy
standards with introduction of newer targeted therapies. As with chemotherapy, the targeted therapies
also have unique side effects affecting various organ systems producing toxicities, such as cardiac and
This manuscript focuses on hypertension induced by vascular endothelial growth factor (VEGF)
inhibitors and tyrosine kinase inhibitors (TKI). Hypertension due to these cancer therapies is
important because these agents are now frequently used in common cancers. In addition, patients with
cancer may not be treated in a comprehensive cancer center with experts available to manage the cancer and other side
effects either from the malignancy or treatment of the malignancy. Especially in rural areas, patients are often managed or
co-managed by a primary care provider with input from an oncologist that may not be nearby.
Our aim is to provide an overview of the latest Federal Drug Administration (FDA) approved VEGF inhibitors and TKI’s
causing hypertension so that others managing patients on these treatments may easily recognize hypertension attributable
to these agents and feel comfortable and confident in providing appropriate management and treatment of this side effect.
This update includes characteristics, such as mechanism of action, metabolism and route of administration, and
management and treatment of hypertension with aspects such as the timing, duration and monitoring of these agents. In
addition, an algorithm for monitoring and treating hypertension before, during and after treatment with these therapies is
included. It is imperative for patients to have hypertension promptly treated to prevent complications so they may
continue with these agents with the least interruption or discontinuation of treatment, ensuring the best benefit available in
their cancer trajectory.