High Blood Pressure: How to manage your blood pressure during cancer treatment

Your blood pressure is the force of your blood against the walls of your arteries as your heart pumps. Every time your heart beats (this is the heart contracting), it pumps blood into the arteries. Your blood pressure is highest when your heart beats and lowest when the heart rests between beats. Blood pressure readings use two numbers, read one over the other. The top number (systolic pressure) measures blood pressure when the heart beats. The bottom number (diastolic pressure) measures blood pressure in between heartbeats. A normal blood pressure reading is 120/80 or slightly lower. If you have a blood pressure reading of 140/90 or higher, you’re considered to have high blood pressure (also known as hypertension).

High blood pressure usually doesn’t have any symptoms, so you may not realize you have it.

High blood pressure, also known as hypertension, is a condition that can damage the arteries, heart and other organs. It is common for cancer patients to have high blood pressure because some cancer treatments, including certain types of chemotherapy, hormone therapy and targeted therapy, may have side effects on the cardiovascular system.

If left untreated, high blood pressure may lead to a heart attack, heart disease, heart failure, stroke, kidney damage and peripheral arterial disease, among other health problems. And, while patients with high blood pressure are not considered at high risk from COVID-19, the U.S. Centers for Disease Control and Prevention (CDC) points out that many patients with hypertension have other conditions, such as obesity, diabetes and heart conditions, that do put them at higher risk. The CDC recommends that patients with high blood pressure stick to their medication and treatment regimens.

How does high blood pressure affect the heart and body?

High blood pressure affects the heart by injuring the walls of the arteries. The force on the arteries is so great, it creates small tears in the artery walls. Plaque (which consists of particles of fat, cholesterol and other substances) then gets trapped in the tears, building up in the arteries and preventing the normal flow of blood to the heart, brain, kidneys, arms and legs.

Through natural aging, your arteries harden and become much less elastic. Uncontrolled high blood pressure speeds up this progression, accelerating hardening of the arteries.

Damaged arteries cannot deliver adequate blood flow to the body’s organs. As a result, these “damaged” organs suffer because they do not receive proper blood supply. This may lead to a heart attack, stroke or other life-threatening illnesses.

Hypertension and cancer treatment

Some medications used to treat cancer can cause a rapid onset of elevated blood pressure, also called hypertension. The class of cancer treatment medications that are most associated with a rise in blood pressure are anti-VEGF medications. Vascular endothelial growth factor (VEGF) is a protein that stimulates the formation of small blood vessels. Medications that block VEGF help block the blood flow supply to tumors, helping shrink or eradicate the cancer. However, the medications frequently affect other blood vessels in the body which can lead to high blood pressure. Regardless of which cancer treatment you are receiving, your cardio-oncology team will help control your blood pressure so that you can receive the anti-cancer treatment that you need.

Monitoring your blood pressure

Even before starting treatment, it is important to know your blood pressure and make sure it is at the current recommended goal, below 130/80. This goal can be reached by diet and exercise and/or the use of medications. Once you start an anti-cancer medication, keep a log of your blood pressures. If you start to notice a pattern of the blood pressures increasing, especially to anything higher than 140/90, it may be necessary to visit a cardio-oncologist to initiate some new blood pressure medications.

How to measure your blood pressure

A home blood pressure machine may be obtained at a local drug store or department store for around $20 – $40. It is recommended that you sit in a resting mode for five minutes before taking the reading. Sit with both feet on the floor and do not cross your legs. Do not talk while the machine is inflating and taking the reading. The measurement should be taken at approximately the same day time each day, preferably in the morning before breakfast.

Controlling high blood pressure during and after cancer treatment

The good news is that your blood pressure can normally be controlled with common antihypertensive (anti-high blood pressure) medications which people have been taking routinely for years. These medications will likely allow you to continue your anti-cancer therapy with limited or no interruption.

Once you complete your cancer treatment, you should continue to follow up with your cardio-oncologist to determine if you need to continue your blood pressure medication or if you may be able to slowly reduce the dose.

Dealing with high blood pressure and cancer

High blood pressure is a common side effect of cancer treatment, particularly chemotherapy and targeted therapy. Some hormone therapies may also cause high blood pressure.

Researchers are studying the effects of various cancer medications on the heart and cardiovascular system to determine why they raise blood pressure. Scientists at Duke University Medical Center suggest that angiogenesis inhibitors such may cause patients’ blood pressure to spike because the drugs block the growth of new blood vessels, reducing the level of nitric oxide, which helps regulate blood vessel health.

Some chemotherapy drugs may also interact with heart medications. Oncologists need to carefully consider medications patients are receiving for high blood pressure when planning cancer treatment to avoid possible drug interactions. If a patient has a severe reaction to a drug while they are receiving a chemotherapy infusion, treatment will need to be stopped immediately.

Also, if high blood pressure is poorly controlled, patients’ hearts may not function normally. They may struggle with the physical effects of cancer treatment and have to stop treatment.

It’s vital to get your blood pressure checked regularly and to know the signs of high blood pressure: severe headache, confusion or fatigue, vision problems, chest pain, irregular heartbeat, difficulty breathing, blood in the urine and pounding in the chest, neck or ears. Some patients may not feel any ill effects from hypertension, which is why it is sometimes called the “silent killer.”

Patients who have high blood pressure and cancer need to:

  • Communicate their medical history to their doctors
  • Take steps to improve their overall health and help manage their blood pressure
  • Be diligent about checkups and regular blood pressure testing
  • Undergo screening tests to help doctors monitor for heart disease and other problems
  • Ask their doctors plenty of questions to make sure they fully understand the diseases, as well as treatments

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Tips to help manage your blood pressure

Living a healthier lifestyle may help to help prevent high blood pressure. Here are some other tips:

  • Maintain a healthy weight.
  • Exercise regularly. Exercising at least 30 minutes a day, six days a week is recommended for those who are able.
  • Know your blood pressure and strive to keep it in the normal range. In general, a “normal” blood pressure rate is 120/80.
  • Check your blood pressure regularly. Ask your doctor how often you should test your blood pressure and be sure to follow that schedule.
  • Eat healthy and watch added sugars in the diet. Sugar, more specifically, carbohydrates, cause insulin to be released, and insulin, other than being a potent growth factor, may increase blood pressure via several mechanisms including increased renal sodium reabsorption, activation of the sympathetic nervous system, modification of transmembrane ion transport, and hypertrophy of resistance vessels. If you are insulin resistant due to obesity, or metabolic syndrome, discuss this with your PCP to find ways to improve this
  • See your primary care physician and oncologist regularly for checkups.
  • Take medication your doctor prescribes to help control blood pressure as directed.
  • Reduce the amount of salt/sodium in your diet. Sodium may increase blood pressure, so limiting or reducing the amount you take in may be helpful.
  • Limit alcohol consumption or cut it out completely.
  • Watch excess caffeine intake.
  • If you smoke, quit.
  • Reduce stress. Try meditation, guided imagery or other relaxation techniques.

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