Investigation of the effect of the drug on arterial blood pressure and left ventricle diastolic functions in patients taking vascular endothelial growth factor (VEGF) inhibitors

Vascular Endothelial Growth Factor (VEGF) is one of the primary regulators of angiogenesis. It triggers and promotes endothelial cell growth following its activation. VEGF inhibitors was entered clinical use in 2004 with the FDA approval of the molecule called bevacizumab for use in colorectal carcinoma, and they are effective molecules that are increasingly used in cancer treatment by preventing the formation of new vessels. (3,4) Hypertension is quite common among the side effects seen with the use of VEGF inhibitors.(5) The patients were selected among those who applied to Cardiology Outpatient Clinic in September 2020 and November 2021 for cardiac evaluation before VEGF inhibitor treatment which decided by Celal Bayar University Oncology Outpatient Clinic with clinic indication.Echocardiographic imaging and 24-hour blood pressure holter examination were performed before the treatment, and after 30-45 days of treatment (30 days for oral medications, after the 3rd cycle for bevacizumab treatment), control echocardiographic examinations and 24-hour ambulatory blood pressure examinations were repeated. Results were evaluated and if necessary, antihypertensive treatments were arranged. Echocardiographic examination revealed a statistically significant increase in the patient's interventricular septum (IVS), ascending aorta, and mitral annular plane systolic excursion (MAPSE) measurements. (IVS: 9.6±2.2--10.37±1.34 (p: 0.021), Asendan aorta: 35.04±3.16--35.73±2.93 (p: 0.048), MAPSE: 13.87±2.42--14.66±2.64 (p: 0.020)) Although the relationship between interventricular septum thickness and hypertension is well known, considering that a significant portion of the patient's blood pressures (even if an increase was observed compared to pre-treatment values) below the hypertension diagnostic limit values and echocardiographic controls were made within 30-45 days, it was thought that this change in patients (with the ascending aorta and MAPSE values), might be due to measurement. No statistically significant difference was found in the systolic or diastolic functions of the patients. With the evaluation of mean ambulatory blood pressure measurement results of the patients all day, day and night; an increase was found in all systolic and diastolic measurements in all day mean, day, and night measurements. A statistically significant increase was observed in mean systolic, mean diastolic, daytime systolic, and daytime diastolic measurements. (Mean systolic: 118.33±10.92--123.81±14.54 p( 0.017), Mean diastolic: 69.85±8.26--73.43±10.0 p(0.018), Daytime systolic: 120.52±10.96--126.36±14.17 p(0.011), Daytime diastolic: 72.17±8.19--75.87±10.11 p( 0.023)). As a result of our study, it was observed that VEGF inhibitors increased the mean arterial blood pressure (all-day mean, day-time, and night-time measurements) and both systolic and diastolic blood pressure, regardless of hypertension history. In this context, it is important to routinely follow up more closely with the patients who will receive VEGF inhibitor therapy in their oncological evaluation.