These are anti-cancer drugs with VEGF inhibitors, of which high blood pressure is a known and common side effect
A salt-restricted diet can prevent patients from getting high blood pressure from certain anticancer drugs. This has emerged from research by the Erasmus MC Cancer Institute.
These are anti-cancer drugs with VEGF inhibitors, of which high blood pressure is a known and common side effect. The low-salt diet meant that some of the patients did not have to take antihypertensives. Others took significantly lower doses.
Lifestyle intervention
Researchers Dr. Leni van Doorn and Dr. Jorie Versmissen recently published the study in the British Journal of Cancer. The study is unique: a study is rarely done in which the effect of lifestyle interventions on the cardiovascular side effects of cancer therapies is prospectively investigated.
The patient group studied by Van Doorn and Versmissen is complicated. ‘Patients who use these VEGF inhibitors no longer recover. The treatment can sometimes be given for a longer period of time. You can then consider whether it is realistic to ask this patient group to follow a salt-restricted diet. But we saw that this group of patients is highly motivated. They like to be in control and like to be able to do something themselves to take less medication.’
More pleasant
Some participants continued the salt-restricted diet after the study. ‘They indicated that the salt restriction made them feel much more comfortable. They now go to the Schiedam baker themselves who baked salt-free bread for our study,’ tell Versmissen and Van Doorn. Dietitian Wesley Visser, who coordinated the study from the dietetics department, was amazed at the dedication shown by the study participants.
VEGF inhibitors or angiogenesis inhibitors inhibit the formation of new blood vessels in and to the tumor. As a result, it receives little or no blood, so that the tumor does not grow or spreads more slowly. The agents are used in renal cell cancer, liver cancer and thyroid cancer, among other things, and are prescribed to thousands of people every year.
Injury
However, a common side effect is high blood pressure, which can then cause damage to the heart and blood vessels. Sometimes that blood pressure is so high that the anti-cancer medication has to be stopped temporarily. ‘Our study now shows that high blood pressure can be prevented with a salt-restricted diet. As a result, no or less use of blood pressure medication is necessary and anti-cancer treatment can be continued safely,’ say Versmissen and Van Doorn.
49 people participated in the study, 16 of whom developed high blood pressure due to the VEGF inhibitors. They followed the low-salt diet, in which they were not allowed to consume more than 4 grams of salt per day. ‘That is quite strict, but none of the participants found it so hard that they stopped. We received positive reactions from a number of
Over time, high blood pressure decreased by an average of 7 millimeters of mercury (mmHg). Twelve patients were satisfied with the low-salt diet and did not need to take any additional medication. In two participants, the antihypertensive medication could be reduced and discontinued during the course of the study. Reason enough to implement the results of the study in clinical practice, the researchers think.
Unique
Unique to the study was the collaboration between internal oncology, dietetics, vascular medicine and nephrology. ‘There are many anti-cancer drugs that have cardiovascular side effects, both during and after treatment,’ says Versmissen.
‘To date, too little attention has been paid to this, but with the increasing survival rate, this is becoming increasingly important. We hope that this study is an impetus for more research. This is already happening to an increasing extent at Erasmus MC. There is a weekly multidisciplinary meeting to discuss these side effects.’
Dr. Leni van Doorn is a nurse specialist General Healthcare at the Department of Internal Oncology. Dr. Jorie Versmissen is an internist and specializes in blood pressure treatment. She is also a clinical pharmacologist.
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