From EHA June 2022. Treating hypertension in patients receiving BTK inhibitors

[Jm954]

My own Ibrutinib induced hypertension has been tricky to treat and Losartan, which did suit me, had to be stopped as it was contraindicated. Now on Amlopidine and it's not effective at all so going back to Losartan now that I'm off Ibrutinib.

Interesting in that he says that more than one class of antihypertensive is often needed and that the drug Hydrochlorothiazide (HCTZ), a thiazide-type diuretic that has been used clinically for more than half a century, is very effective. The drug has been widely used to treat hypertension globally and is relatively very safe although I'm not sure I'd want a diuretic with the inconvenience of increased toilet breaks.

It's a short video of just over 2 minutes vjhemonc.com/video/gsvmshyk...

Jackie

[DebKat999]

Thank you Jackie, this is very interesting. I am currently on both Amlodipine and HCTZ. I am one of those people where something more was needed to adequately control my BP.

I do vaguely remember a slight increase in visits to the bathroom at first, but that didn't last long, and now no such effect has been apparent for a long time.

Debbie x

[mrsjsmith]

Thank you Jackie,

Seems trial and error ! I started on Amlodopine after trying my neighbours BP machine and finding I was 220 over 120 ! Luckily lovely ambulance crew decided I was safer at home in the middle of a pandemic. But it was giving me headaches and now I have been on Lacidipine for some time with no problems 🤞

Colette

[janvog in reply to mrsjsmith]

Time to get your own BP machine and use it twice a day. They only cost average $ 40.

[country76]

I took Lisinopril with hydrochlorothiazide and it work very well for me for years. Unfortunately at the same time, I started Ibrutinib I was told that I was allergic to it because my sodium dropped, and given Lisinopril alone. That didn't work, of course, it didn't, I wasn't happy. Naturally, My Blood pressure shot up and they tried several different drugs. I switched to Alacabrutinib which didn't increase my BP so high and I am now taking one Lisinopril in an AM and PM plus 2 Amlopodine in AM and on a low sodium diet which as you can guess eliminates most food choices. That is a challenge for me. This seems to keep my BP in control as long as I am careful what I eat. If I could go back on both my BP would be fine.

[jimvan]

Hi. Thanks for the report. I've been taking ibrutinib for 5 years, and it did have the effect of raising my blood pressure (while well controlling my CLL). I started taking Losartan 50 mg which had little effect, and was moved to 100 mg of Losartan once daily. That seems to be holding my bp steady with a small diastolic decrease, and I seem to be tolerating Losartan well. Was there a specific contraindication for Losartan in your case? I'd like to know so I can keep watch on myself. Thanks! Be well, Jim

[Jm954 Administrator in reply to jimvan]

Hi Jim,Losartan is part of a class of antihypertensive drugs that the FLAIR trial showed was contraindicated with Ibrutinib because of an excess of sudden cardiac deaths in that group caused by ventricular arrhythmia. In the UK there was a change of anti HT for lots of people on Ibrutinib.

Jackie

[Davidcara]

Had and have hypertension before ibrutinib, during ibrutinib, and now during zanubrutinib, but improving. My lay person take, if no contraindications: Ace Inhibitor such as Lisinopril, add diuretic such as HCTZ, if issues with low potassium could use spiroaldactone, calcium channel blocker such as amlodipine.

That’s my triple therapy regimen. Have decreased the dose of all, since changing from ibrutinib to zanubrutinib.

[SofiaDeo]

Once you are accustomed to the thiazide, the "increased urination" generally stops. In addition, there is some data that after a year on a standard 25mg dose, patients could cut that dose in half and still see antihypertensive effect. This was a study done by the VA in older (mostly male) patients.

Lower doses of 2 drugs is shown to cause less side effects than a single drug at a higher dose:

hcplive.com/view/half-dose-...

The big downside for us IMO, is that it is photosensitizing, and has been (dose related) linked to lip cancer:

pubmed.ncbi.nlm.nih.gov/292...

Although some commented that "smoking", a known contributor to cancer, was not looked at or included:

jaad.org/article/S0190-9622...

The authors disagreed with the "smoking" letter:

jaad.org/article/S0190-9622...

And people are continuing to research the mechanisms behind this, since HCTZ is widely prescribed:

pubmed.ncbi.nlm.nih.gov/344...

[Davidcara in reply to SofiaDeo]

Interesting about cutting thiazide in half after a year.