The Association Between Blood Pressure Control and Global Longitudinal Strain in Patients With HER2-Positive Breast Cancer on Trastuzumab- Based Regimens

Hypertension is an established risk factor for cancer therapy–related cardiac dysfunction and is independently associated with heart failure in patients with breast cancer (BC). 1 Katsi V. Magkas N. Georgiopoulos G. et al. Arterial hypertension in patients under antineoplastic therapy: a systematic review. J Hypertens. 2019; 37: 884-901 Crossref PubMed Scopus (20) Google Scholar , 2 Perez E.A. Suman V.J. Davidson N.E. et al. Cardiac safety analysis of doxorubicin and cyclophosphamide followed by paclitaxel with or without trastuzumab in the North Central Cancer Treatment Group N9831 adjuvant breast cancer trial. J Clin Oncol. 2008; 26: 1231-1238 Crossref PubMed Scopus (464) Google Scholar , 3 Romond E.H. Jeong J.H. Rastogi P. et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2012; 30: 3792-3799 Crossref PubMed Scopus (402) Google Scholar Increased afterload and compensatory myocardial remodeling due to hypertension, including increased wall thickness and decreased chamber size, are associated with worsening myocardial mechanics, as evidenced by a decrease in global longitudinal strain (GLS). 3 Romond E.H. Jeong J.H. Rastogi P. et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2012; 30: 3792-3799 Crossref PubMed Scopus (402) Google Scholar ,4 Voigt J.U. Cvijic M. 2- and 3-dimensional myocardial strain in cardiac health and disease. JACC Cardiovasc Imaging. 2019; 12: 1849-1863 Crossref PubMed Scopus (153) Google Scholar A community-based study among adults aged ≥50 years demonstrated that ambulatory blood pressure (BP) control was associated with impaired GLS. 5 Sera F. Jin Z. Russo C. et al. Relationship of office and ambulatory blood pressure with left ventricular global longitudinal strain. Am J Hypertens. 2016; 29: 1261-1267 Crossref Scopus (10) Google Scholar Among patients with BC treated with nonanthracycline trastuzumab-based regimens, the association of BP control with cardiac mechanics is unknown. We hypothesized that poor BP control during cancer therapy would be associated with worsening cardiac mechanics in human epidermal growth factor receptor 2 (HER2)–positive patients with BC exposed to cardiotoxic therapies.