An analysis of the orthostatic blood pressure changes in cancer patients

Abstract Background/Introduction The autonomic nervous system plays a crucial role in orthostatic blood pressure (BP) changes, including orthostatic hypotension (OH) and lesser-known orthostatic hypertension (OHT). The orthostatic normal response (ON) occurs when cardiovascular (CV) mechanisms compensate for reduced venous return upon standing. However, circulatory disruptions due to CV autonomic dysfunction, often seen in cancer, can lead to various forms of orthostatic intolerance. OH is linked to worse prognosis, though little is known about its prevalence in cancer patients. OHT, likely caused by sympathetic activation, may herald, like OH, an increased risk of many cardiovascular diseases (CVDs). Purpose Our study aimed to determine the prevalence of different types of orthostatic reactions in cancer patients compared to cancer-free population. Methods A total of 400 patients (221 females and 179 males, mean age 63.7 ± 10.4 years) were recruited. Group I (n = 220) included hospitalized patients with active treated cancer (chemotherapy, radiotherapy), group II (n = 180) patients hospitalized for other reasons but with no cancer diagnosis. Patients with significant anaemia requiring blood transfusion, diarrhea or after recent surgical procedures were excluded. The collected data included demographic and medical history, type of cancer, comorbidities, used drugs, and orthostatic BP changes. OH was defined as BP decrease on standing ≥ 20 mmHg for systolic or ≥ 10 mmHg for diastolic BP in 1 or 3 minute; or systolic BP decrease < 90 mmHg. OHT was defined as BP increase on standing ≥ 20 mmHg for systolic or ≥ 10 mmHg for diastolic BP in 1 or 3 min; or systolic BP increase > 140 mmHg. In the absence of the above diagnostic criteria, measurements were categorized as ON. Results ON in total studied population was observed in 202 patients (50.5%), OH in 88 patients (22.0%), and OHT in 110 patients (27.5%). In cancer patients compared to non-cancer population we have observed higher rate of abnormal orthostatic reactions, driven mainly by higher prevalence of OH. Instead, OHT occurred at a similar level in both groups (53/220; 24.1% in group I vs 57/180; 31.7% in group II). In the analysis of the different types of cancer, we noticed that OHT was significantly more frequent in patients with male genitourinary cancers (n = 9/21; 42.9%), compared to other groups of malignancies. Conclusions Cancer patients are characterized by a higher risk of orthostatic BP intolerances, especially OH. The prevalence of OHT differs with respect to the type of cancer, being the highest among patients with prostate cancer, who frequently have CVDs. Screening and monitoring of orthostatic changes in BP may improve the care of cancer patients. This might lead to the recommendation of routine orthostatic challenge tests for this population.