Study Unveils Complexities of BP Management with Bruton's Tyrosine Kinase Inhibitors in Lymphoid Malignancies

In a groundbreaking study, researchers have delved into the optimal approaches for managing hypertension (HTN) in patients undergoing Bruton's tyrosine kinase inhibitor (BTKi) treatment, a revolutionary therapy for lymphoid malignancies. They found that managing HTN in patients undergoing BTKi treatment can be complex and may necessitate multiple anti-hypertensive medications.

The study results were published in the journal Blood Advances.  

While BTKis, such as ibrutinib, have proven to be generally well-tolerated and less toxic than traditional chemotherapy options, this research sheds light on the potential challenge of new or worsening HTN associated with their use. While Bruton's tyrosine kinase inhibitors (BTKis) are typically well-tolerated and exhibit lower toxicity compared to chemotherapy options for lymphoid malignancies, notable concern arises as BTKis, including ibrutinib, may trigger the onset or exacerbation of hypertension (HTN).

The optimal management of HTN associated with BTKis remains a relatively unexplored territory. The study, which included 196 patients with lymphoid malignancies on BTKis and concurrent anti-hypertensive medications, aimed to identify effective strategies for blood pressure management. Patients were categorized into two groups based on their HTN status: those with pre-existing hypertension before starting BTKi treatment (prior-HTN) and those who developed HTN after initiating BTKi therapy (de novo HTN).

The analysis considered patients with a minimum of 3 months of follow-up data. Using generalized estimating equations, the researchers explored the associations between time-varying mean arterial pressures (MAPs) and different anti-hypertensive drug categories.

Findings:

• Among the significant findings, 118 patients had prior-HTN, while 78 developed de novo HTN.
• Notably, patients with prior HTN experienced a statistically significant mean MAP reduction when taking a combination of beta blockers (BBs) with hydrochlorothiazide (HCTZ), showing a reduction of -5.05 mmHg (95% CI -10.0 to -0.0596; p = 0.047).
• Similarly, patients with de novo HTN exhibited a significant MAP reduction when prescribed either an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) with HCTZ, demonstrating a reduction of -5.47 mmHg (95% CI -10.9 to -0.001; p = 0.05).
• These regimens were also associated with the highest percentages of normotensive MAPs.
• The study's findings suggest that managing HTN in patients undergoing BTKi treatment is intricate and may require a multifaceted approach involving multiple anti-hypertensive medications.
• For patients with prior-HTN, combination regimens with BBs and HCTZ appeared to be beneficial, while those with de novo HTN showed improved outcomes with ACEi/ARBs combined with HCTZ.

The researchers underscore the importance of further prospective studies to validate these encouraging results. This breakthrough study not only enhances our understanding of blood pressure management in the context of cutting-edge lymphoid malignancy treatments but also underscores the critical need for personalized approaches to ensure the well-being of patients navigating these innovative therapeutic landscapes. 

Further reading: Hypertension Treatment in Patients Receiving Ibrutinib: A Multicenter Retrospective Study. Doi: https://doi.org/10.1182/bloodadvances.2023011569