Inhibitors of Angiogenesis and Blood Pressure

Essential hypertension seems to be associated with a reduction (rarefaction) in the number of parallel-connected arterioles and capillaries, with consequent important consequences in terms of tissue perfusion. Antiangiogenic therapies are being increasingly used in the treatment of solid tumors; however, hypertension represents a common side effect of these agents. Mechanisms involved include an impairment of nitric oxide signaling pathway, activation of endothelin system, microvascular rarefaction, the development of salt sensitivity, and an increased oxidative stress; as a consequence an increased blood pressure may be considered a biomarker for cancer response. In the future full understanding of the mechanisms causing antiangiogenic therapy-induced hypertension will provide clinically more useful biomarkers for predicting both toxicity and therapeutic efficacy. On the other hand, early identification and treatment of hypertension are essential to maintain an effective therapeutic dose of these agents, and whether one antihypertensive agent is superior to another in controlling antiangiogenic therapy-induced hypertension remains to be established.