Managing High Blood Pressure and Heart Disease When You Have Cancer

Approved by the Cancer.Net Editorial Board, 05/2021

It is important to tell your cancer care team if you have been diagnosed with high blood pressure or heart disease. This is because cancer and cancer treatment can make high blood pressure and heart disease worse. These conditions can also make it more difficult to treat cancer or make it hard to finish cancer treatment as planned. But there are ways you and your health care team can work together to protect your heart and manage these conditions during your cancer treatment.

What is high blood pressure?

High blood pressure is also called hypertension. Blood pressure measures the force of the blood moving through the body. It shows how hard the heart is working to push blood through the circulatory system.

Blood pressure is measured using 2 numbers. The "systolic blood pressure" is the top number of the blood pressure reading. It is the pressure of your heart forcing blood into the arteries as it beats. The "diastolic blood pressure" is the bottom number of the reading. It is the force of blood in the arteries in between heartbeats.

Because high blood pressure does not always cause symptoms, many people do not know they have high blood pressure. It is important to know your blood pressure because hypertension can lead to problems like heart disease.

What is heart disease?

Heart disease can refer to different kinds of heart conditions. Some heart conditions are congenital, meaning you are born with them, and some develop as you get older. The most common kind of heart disease in the United States is called coronary artery disease. This is when plaque buildup in the arteries slows down or blocks blood flow to the heart.

Other types of heart disease include:

  • Irregular heartbeats, called heart arrhythmia

  • Heart defects, usually diagnosed soon after birth, but which can be found later in childhood or adulthood

  • Cardiomyopathy, when the heart muscle gets larger or thicker

  • Heart infection

  • Heart valve problems

In some cases, heart disease can lead to heart attack, congestive heart failure, or other severe health problems.

How does cancer treatment affect blood pressure and the heart?

High blood pressure and heart disease can be caused by certain cancer treatments. You are more likely to get these and other heart-related side effects of cancer treatment if you already have blood pressure or heart problems. There are many types of heart problems that cancer treatment can cause or worsen.

Cancer treatments linked to high blood pressure or heart disease include:

Anthracycline chemotherapies. Anthracycline drugs that can cause heart problems include daunorubicin (Cerubidine), doxorubicin (Adriamycin, Doxil), epirubicin (Ellence), idarubicin (Idamycin), and valrubicin (Valstar).

Other chemotherapy drugs. Mitoxantrone (Novantrone) can cause heart problems. Cisplatin (Platinol) can cause severe high blood pressure.

Radiation therapy to the chest. Higher doses to large areas of the heart cause more heart problems. Combining radiation therapy and chemotherapy may also increase the risk of heart damage.

Some types of targeted therapy. Many different targeted therapies can cause heart problems or high blood pressure. These include axitinib (Inlyta), bevacizumab (Avastin), dasatinib (Sprycel), lapatinib (Tykerb), pazopanib (Votrient), sorafenib (Nexavar), sunitinib (Sutent), and trastuzumab (Herceptin).

Sometimes, the most effective cancer treatment option may worsen your high blood pressure or heart disease. Other times, there may be equally effective treatments available that are less likely to affect your arteries or heart. Your doctor will help you weigh the benefits and risks of each treatment option.

How to talk to your cancer care team about your blood pressure and heart disease

It is important to talk with your health care team about your history of high blood pressure and heart disease. Your oncologist will work with your cardiologist or primary care doctor to reduce your heart risks before, during, and after treatment.

Some medical clinics have cardio-oncologists. These doctors specialize in treating heart conditions for people with cancer and cancer survivors.

Use your personal medical record to share which blood pressure or heart medications you take. Also, let your primary care team know if you have had treatment for cancer or other major illnesses before and what kind. There is a list of questions below to help you communicate with your cancer care team about your overall heart health.

Can I start cancer treatment if I have high blood pressure or heart disease?

If you already have high blood pressure or heart disease, called pre-existing disease, it is best when your heart condition is being managed successfully before cancer treatment begins.

Your health care team will also do a complete physical and heart evaluation. This will tell them how healthy your arteries are and how well your heart works. This evaluation may include checking your heart function. Your doctor will likely use an imaging test called echocardiography (echo) to look at your pre-existing heart problems. Other heart tests may include a cardiac magnetic resonance imaging (MRI) scan and a multigated acquisition (MUGA) scan.

As a result of this medical evaluation, your health care team may:

Work to lower your blood pressure. If your blood pressure is too high, your doctor may work with you to control it before treatment starts.

Adjust your medications. There may be reactions between your blood pressure or heart medications and the cancer drugs you are prescribed. To prevent these reactions, your doctor may recommend changing your blood pressure and heart medications during cancer treatment. Or, your medication's dose may be changed.

You may also be prescribed additional drugs that can help prevent more damage to your heart or arteries during your treatment. These are called "cardioprotective medicines." Beta-blockers and ACE inhibitors can lower blood pressure. The drug dexrazoxane (Zinecard) can help prevent heart problems from anthracyclines.

Clear you for certain cancer treatments. For example, pre-existing heart disease can increase anesthesia and surgery risks. Anesthesia is medicine that keeps you from feeling pain during surgery. Your health care team will use your heart evaluation to make sure you can safely have surgery.

Perform a heart procedure. In rare cases, a heart surgery or procedure may be needed before cancer treatment can be safe. For instance, clogged heart arteries may need to be unblocked.

Recommend lifestyle changes. Your doctor may suggest lifestyle changes that can lower your blood pressure and take stress off your heart. These may include quitting smoking, eating a heart-healthy diet, and getting regular physical activity. Talk with your doctor before starting an exercise program.

How is high blood pressure or heart disease managed during cancer treatment?

Your health care team will closely watch your blood pressure and heart health during treatment. Monitoring may include:

Regular blood pressure testing. Your health care team may check your blood pressure during clinic visits. They may also ask you to take your blood pressure at home.

Imaging tests. Imaging tests can spot new damage in your heart or vessels caused by cancer treatment. They may include some of the same tests you had before treatment began, such as an echo or MUGA scan.

If a heart-related problem occurs, your doctor may be able to manage them without interrupting or changing cancer treatment. Or the doctor may recommend a reduction in the dose or timing of a treatment, or it may be necessary to switch treatments.

How is high blood pressure or heart disease managed after cancer treatment?

After cancer treatment is complete, your health care team will continue to monitor your heart health. You may need to adjust your blood pressure or heart medications again. For instance, sometimes your blood pressure may drop after you finish a treatment that caused it to rise even higher. That means you may need a lower dose of high blood pressure medication.

Your health care team may also check your heart function after treatment ends. They are looking for signs of new or worsening heart disease. That is because some cancer treatments that affect your heart do not always cause problems right away. Long-term side effects can happen months or years after treatment. Evaluating and treating these side effects is an important part of cancer survivorship care.

Questions to ask the cancer care team

  • Can the recommended cancer treatment affect my high blood pressure or heart disease?

  • Are there other effective treatments that are less likely to affect my blood pressure or heart?

  • Are there ways to keep my blood pressure and heart problems from getting worse during treatment?

  • How often should my blood pressure be checked during cancer treatment? Should I monitor my blood pressure at home?

  • What should my blood pressure numbers be?

  • What blood pressure numbers are too high or too low for me?

  • What new heart problems could my cancer treatment cause?

  • What symptoms of high blood pressure or heart problems should I watch for?

  • Who should I tell if I have any new or worsening symptoms of high blood pressure or heart disease? How soon?

  • What lifestyle changes can I make that can help me manage my high blood pressure or heart disease during and after cancer treatment?

  • What type of screening tests will be used to monitor my heart during and after cancer treatment?

  • How long after cancer treatment will my blood pressure and heart need to be monitored?

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