Renin angiotensin system inhibitors reduce the incidence of arterial thrombotic events in patients with hypertension and chronic myeloid leukemia treated with second- or third-generation tyrosine kinase inhibitors.

Adult Aged Aged, 80 and over Angiotensin Receptor Antagonists / therapeutic use Angiotensin-Converting Enzyme Inhibitors / therapeutic use Cohort Studies Drug Therapy, Combination Female Humans Hypertension / complications Incidence Leukemia, Myelogenous, Chronic, BCR-ABL Positive / complications Male Middle Aged Protein Kinase Inhibitors / classification Renin-Angiotensin System / drug effects Risk Factors Survival Analysis Thrombosis / epidemiology

Arterial occlusive events Chronic myeloid leukemia Hypertension Renin angiotensin system inhibitors TKI

Journal

Annals of hematology

ISSN: 1432-0584

Titre abrégé: Ann Hematol

Pays: Germany

ID NLM: 9107334

Informations de publication

Date de publication:
Jul 2020

Historique:

received: 29 04 2020

accepted: 20 05 2020

pubmed: 1 6 2020

medline: 24 7 2020

entrez: 1 6 2020

Statut: ppublish

Résumé

Hypertension is a commonly reported comorbidity in patients diagnosed with chronic myeloid leukemia (CML), and its management represents a challenge in patients treated with 2nd- or 3rd-generation tyrosine kinase inhibitors (TKIs), considering their additional cardiovascular (CV) toxicity. The renin angiotensin system (RAS) contributes to hypertension genesis and plays an important role in atherosclerosis development, proliferation, and differentiation of myeloid hematopoietic cells. We analyzed a cohort of 192 patients with hypertension at CML diagnosis, who were treated with 2nd- or 3rd-generation TKIs, and evaluated the efficacy of RAS inhibitors (angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs)) in the prevention of arterial occlusive events (AOEs), as compared with other drug classes. The 5-year cumulative incidence of AOEs was 32.7 ± 4.2%. Patients with SCORE ≥ 5% (high-very-high) showed a significantly higher incidence of AOEs (33.7 ± 7.6% vs 13.6 ± 4.8%, p = 0.006). The AOE incidence was significantly lower in patients treated with RAS inhibitors (14.8 ± 4.2% vs 44 ± 1%, p < 0.001, HR = 0.283). The difference in the low and intermediate Sokal risk group was confirmed but not in the high-risk group, where a lower RAS expression has been reported. Our data suggest that RAS inhibitors may represent an optimal treatment in patients with hypertension and CML, treated with 2nd or 3rd

Identifiants

DOI: 10.1007/s00277-020-04102-6 PMID: 32474619

pubmed: 32474619

doi: 10.1007/s00277-020-04102-6

pii: 10.1007/s00277-020-04102-6

doi:

Substances chimiques

Angiotensin Receptor Antagonists 0

Angiotensin-Converting Enzyme Inhibitors 0

Protein Kinase Inhibitors 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

1525-1530

Subventions

Organisme : Regione Autonoma della Sardegna

ID : F.S.E. 2014-2020 Partenariato:10.5.12

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