Journal Article

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

Galimberti, Sara, Pirillo Francesca, Efficace Fabio, Scaffidi Luigi, Simula Maria Pina, De Gregorio Fiorenza, Stella, Rossella, Gugliotta Gabriele, Mulas, Olga, Sgherza Nicola, Iurlo Alessandra, Cattaneo, Daniele, Capodanno Isabella, Trawinska, Malgorzata Monika, Martino, Bruno, Binotto Gianni, Luzi Debora, Stagno Fabio, Annunziata, Mario, Foà Robin, Bocchia Monica, Sicuranza, Anna, Fozza Claudio, Scalzulli Emilia, Bonifacio Massimiliano, Baratè Claudia, Breccia Massimo, Luigiana, Luciano, Orlandi, Ester Maria, Attolico Imma, Abruzzese Elisabetta, Albano, Francesco, La Nasa Giorgio, Caocci Giovanni, Gozzini Antonella, Tiribelli Mario, Castagnetti Fausto, Pregno Patrizia, Chiara, Elena

2020

Overview

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 3rdG TKIs.

• Publisher: Springer Nature B.V
• Subject: Diuretics / Hypertension / Leukemia