Blood Pressure and Risk of Heart Failure in Patients With Cancer

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In a Japanese study reported in the Journal of Clinical Oncology, Kaneko et al found that hypertension in patients with cancer not receiving blood pressure–lowering medication was associated with an increased risk of heart failure and other cardiovascular disease events.

Study Details

The retrospective observational analysis used data from the JMDC Claims Database from January 2005 to April 2020. The study population consisted of 33,991 patients with a history of breast, colorectal, or stomach cancer. Patients receiving treatment with blood pressure–lowering medication or with a history of cardiovascular disease including heart failure were excluded from the analysis. Blood pressure (BP) at baseline was categorized according to the 2017 American College of Cardiology/American Heart Association guideline as: normal = systolic BP (SBP) < 120 mmHg and diastolic BP (DBP) < 80 mmHg; elevated = SBP of 120 to 129 mmHg and DBP < 80 mmHg; stage 1 hypertension = SBP of 130 to 139 mmHg or DBP of 80 to 89 mmHg; and stage 2 hypertension = SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. The primary outcome measure was association of BP with risk of heart failure.

Key Findings

Among all patients included in the analysis, 17,444 had normal BP; 4,733 had elevated BP; 7,502 had stage 1 hypertension; and 4,312 had stage 2 hypertension.

Over a mean follow-up of 2.6 ± 2.2 years, 779 cases of heart failure were recorded. In multivariate analysis, hazard ratios (HRs) for heart failure vs normal BP were 1.15 (95% confidence interval [CI] = 0.93–1.44) for elevated BP, 1.24 (95% CI = 1.03–1.49) for stage 1 hypertension, and 1.99 (95% CI = 1.63–2.43) for stage 2 hypertension.

With regard to other cardiovascular disease events, 57 cases of myocardial infarction, 690 cases of angina pectoris, 368 cases of stroke, and 159 cases of atrial fibrillation were recorded during follow-up.

In multivariate analysis, compared with normal BP:

  • Stage 1 hypertension (HR = 1.27, 95% CI = 1.05–1.54) and stage 2 hypertension (HR = 1.42, 95% CI = 1.14-1.78) were associated with a significantly increased risk of angina pectoris.
  • Elevated BP (HR = 1.46, 95% CI = 1.07–1.98), stage 1 hypertension (HR = 1.46, 95% CI = 1.12–1.92), and stage 2 hypertension (HR = 2.06, 95% CI = 1.54–2.77) were associated with a significantly increased risk of stroke.
  • Stage 2 hypertension (HR = 1.99, 95% CI = 1.29–3.07) was associated with a significantly increased risk of atrial fibrillation. 

The investigators concluded, “Medication-naive stage 1 and 2 hypertension was associated with a greater risk of heart failure and other cardiovascular disease events in patients with cancer. Our results suggest the importance of multidisciplinary collaboration (eg, oncologists and cardiologists) to establish the optimal management strategy for hypertension in patients with cancer.”

Hidehiro Kaneko, MD, of the Department of Cardiovascular Medicine, University of Tokyo, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Ministry of Health, Labour and Welfare, Ministry of Education, Culture, Sports, Science and Technology, and others. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.