Renin angiotensin system inhibitors reduce the incidence of arterial thrombotic events in patients with hypertension and chronic myeloid leukemia treated with second- or third-generation tyrosine kinase inhibitors

Olga Mulas, Giovanni Caocci, Fabio Stagno, Massimiliano Bonifacio, Mario Annunziata, Luigiana Luciano, Ester Maria Orlandi, Elisabetta Abruzzese, Nicola Sgherza, Bruno Martino, Francesco Albano, Sara Galimberti, Patrizia Pregno, Monica Bocchia, Fausto Castagnetti, Mario Tiribelli, Gianni Binotto, Antonella Gozzini, Isabella Capodanno, Claudio FozzaDebora Luzi, Fabio Efficace, Maria Pina Simula, Luigi Scaffidi, Fiorenza De Gregorio, Chiara Elena, Malgorzata Monika Trawinska, Daniele Cattaneo, Imma Attolico, Claudia Baratè, Francesca Pirillo, Anna Sicuranza, Gabriele Gugliotta, Rossella Stella, Emilia Scalzulli, Alessandra Iurlo, Robin Foà, Massimo Breccia, Giorgio La Nasa

Research output: Contribution to journalArticlepeer-review

Abstract

Hypertension is a commonly reported comorbidity in patients diagnosed with chronic myeloid leukemia (CML), and its management represents a challenge in patients treated with 2nd- or 3rd-generation tyrosine kinase inhibitors (TKIs), considering their additional cardiovascular (CV) toxicity. The renin angiotensin system (RAS) contributes to hypertension genesis and plays an important role in atherosclerosis development, proliferation, and differentiation of myeloid hematopoietic cells. We analyzed a cohort of 192 patients with hypertension at CML diagnosis, who were treated with 2nd- or 3rd-generation TKIs, and evaluated the efficacy of RAS inhibitors (angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs)) in the prevention of arterial occlusive events (AOEs), as compared with other drug classes. The 5-year cumulative incidence of AOEs was 32.7 ± 4.2%. Patients with SCORE ≥ 5% (high-very-high) showed a significantly higher incidence of AOEs (33.7 ± 7.6% vs 13.6 ± 4.8%, p = 0.006). The AOE incidence was significantly lower in patients treated with RAS inhibitors (14.8 ± 4.2% vs 44 ± 1%, p < 0.001, HR = 0.283). The difference in the low and intermediate Sokal risk group was confirmed but not in the high-risk group, where a lower RAS expression has been reported. Our data suggest that RAS inhibitors may represent an optimal treatment in patients with hypertension and CML, treated with 2nd or 3rdG TKIs.

Original languageEnglish
JournalAnnals of Hematology
DOIs
Publication statusAccepted/In press - Jan 1 2020

Keywords

  • Arterial occlusive events
  • Chronic myeloid leukemia
  • Hypertension
  • Renin angiotensin system inhibitors
  • TKI

ASJC Scopus subject areas

  • Hematology

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