Hypertension Severity Impacts Declines in Left Ventricular Ejection Fraction Among Women Receiving Adjuvant Chemotherapy for Breast Cancer (UPBEAT WF-97415)

Introduction: AHA/ACC hypertension guidelines do not clearly address pharmacological treatment of increases in blood pressure (BP) in women receiving potentially cardiotoxic chemotherapy for treatment of breast cancer. Methods and Results: Magnetic resonance measures of left ventricular ejection fraction (LVEF) were performed in women with stage I-III breast cancer prior to and three months after initiating potentially cardiotoxic chemotherapy. Measurements of brachial BP were collected according to AHA recommendations. Using multivariable analysis, we assessed the association between change in LVEF and pre-existing ACC/AHA stages of hypertension (HTN) after accounting for pre-treatment LVEF, diabetes status, age, and body mass index (BMI). All analyses were performed by those blinded to all participant identifiers. Participants (n=259, female) were aged 56±11 (Mn + SD) years and were 76% white & 19% black (NCT02791581 and NCT01719562). Cancer therapies included combinations of anthracyclines (23%), trastuzumab (10%), paclitaxel (22%) and cyclophosphamide (30%). After accounting for pre-treatment LVEF, diabetes status, age, and BMI, participants with stage 2 HTN experienced a significant decline (p=0.037, Figure) in LVEF relative to individuals with normal blood pressure. Conclusion: Relative to women with normal blood pressure, women with stage 2 HTN experienced a larger decline in LVEF (p=0.037) three months after initiating potentially cardiotoxic chemotherapy for breast cancer. This finding raises the possibility that lower blood pressure targets among women receiving adjuvant treatment for breast cancer may be associated with improved preservation of LVEF.