Onco-hypertension: hypertension induced by VEGF pathway inhibition

Cancer therapies are increasingly linked to a wide spectrum of cardiovascular toxicities, presenting significant challenges in the long-term care of oncology patients. Among these, therapy-induced hypertension stands out as one of the most consistent and clinically relevant adverse effects, especially with agents targeting the VEGF pathway. Understanding the mechanisms behind this form of hypertension is critical, as it not only represents a modifiable cardiovascular risk factor but may also serve as a biomarker of therapeutic efficacy in certain cancer treatments. Clinical evidence underscores the importance of early detection and aggressive blood pressure control to improve both cardiovascular and oncologic outcomes. The most well-characterized and clinically significant subtype of therapy-related hypertension is that induced by VEGF pathway inhibitors, owing to its high incidence, rapid onset, and well-defined mechanistic basis. In this review, we specifically examine VEGFi-associated hypertension as a prototypical model of onco-hypertension. Evidence-based strategies for managing therapy-induced hypertension emphasize early detection and individualized treatment plans. Renin-angiotensin system inhibitors (RAAS inhibitors) are frequently recommended as first-line agents due to their favorable cardiovascular profile and potential synergistic effects with some cancer therapies. Calcium-channel blockers (CCBs) also demonstrate strong efficacy and are often used in combination regimens to achieve optimal blood pressure control. Successful management requires a multidisciplinary approach, integrating expertise from oncology, cardiology, and primary care. Proactive surveillance, patient education, and risk stratification are essential components of care. As the field of cardio-oncology continues to evolve, structured blood pressure management remains a cornerstone of safe and effective cancer care, ensuring that patients receive optimal therapeutic benefit while minimizing cardiovascular risk.