Table 1:
Definition of hypertension in patients with cancer and the general adult population according to major guidelines
| IC-OS* | Normal SBP ≤130 mmHg DBP ≤80 mmHg |
Treatment threshold CVD or ASCVD risk ≥ 10%: SBP ≥130 mmHg and/or DBP ≥80 mmHg Otherwise: SBP ≥140 mmHg and/or DBP ≥90 mmHg |
Cancer therapy holding threshold SBP ≥180 mmHg and/or DBP ≥110 mmHg |
Exaggerated hypertensive response SBP increase >20 mmHg or mean arterial BP increase >15 mmHg |
Hypertensive emergency response Very high BP elevations associated with acute hypertension-mediated organ damage (heart, brain, kidneys), requiring immediate BP reduction to limit target organ damage |
|
|---|---|---|---|---|---|---|
| NCI CTCAE V5 |
Grade 1 SBP 120–139 mmHg or DBP 80–89 mmHg |
Grade 2 SBP 140–159 mmHg or DBP 90–99 mmHg if previously WNL. Change in baseline medical intervention indicated; recurrent or persistent (≥24 hours); symptomatic increase by >20 mmHg (diastolic) or to >140/90 mmHg; monotherapy indicated or initiate |
Grade 3 SBP ≥160 mmHg or DBP ≥100 mmHg Medical intervention indicated; > 1 drug or more intensive therapy than previously used indicated |
Grade 4 Life-threatening complications (i.e., transient, or permanent neurologic deficit, hypertensive crisis). Urgent intervention indicated |
||
| ACC/AHA 2017 |
Normal SBP <120 mmHg DBP <80 mmHg |
Elevated SBP120–129 mmHg DBP<80 mmHg |
Stage 1 SBP 130–139 mmHg DBP 80–90 mmHg Drug therapy indicated if ASCVD risk>10% |
Stage 2 SBP >140 mmHg DBP >90 mmHg Drug therapy goal BP<130/80 mmHg |
Hypertensive Crisis SBP >180 mmHg DBP >120 mmHg Urgent BP drug therapy initiation |
|
| ESC 2018 |
Optimal SBP<120 mmHg DBP <80 mmHg |
Normal SBP 120–129 mmHg DBP 80–84 mmHg |
High Normal SBP 130–139 mmHg DBP 85–89 mmHg Drug therapy considered if ASCVD risk>10% or established CVD, CKD, or DM |
Grade 1 SBP 140–159 mmHg DBP 90–99 mmHg First drug therapy target <140/90 mmHg, consider <130/80 mmHg if tolerated, but not SBP <120 mmHg. In older >65 years, target SBP 130–140 mmHg, and DBP <80 mmHg, initiate with two-drug combination |
Grade 2 SBP 160–179 mmHg DBP 100–109 mmHg Drug therapy goal as for Grade 1 |
Grade 3 SBP ≥ 180 mmHg DBP ≥110 mmHg Urgent drug therapy goal as for Grade 1 |
| ISH |
Normal SBP <130 mmHg DBP <85 mmHg |
High normal SBP 130–139 mmHg DBP 85–89 mmHg |
Grade 1 SBP 140–159 mmHg DBP 90–99 mmHg Drug therapy indicated if ASCVD risk>10% or established CVD, CKD, DM Target BP reduction by 20/10 mmHg, ideally to <140/90 mmHg. Optimal targets: <65 years: 120–130/70–79mmHg ≥65 years: <140/90 mmHg |
Grade 2 SBP ≥160 mmHg DBP ≥100 mmHg Immediate drug treatment in all patients |
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ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CAD, coronary artery disease; CKD, chronic kidney disease; CTCAE, Common Terminology Criteria for Adverse Events; CV, cardiovascular; CVD, cardiovascular disease; DBP, diastolic BP; DM, diabetes mellitus; ESC, European Society of Cardiology; HTN, hypertension; IC-OS, International Cardio-Oncology Society; ISH, International Society of Hypertension; NCI, National Cancer Institute; SBP systolic BP. BP values are based on office BP measurement.
Definition of hypertension aspect in the cancer patient