Arterial stiffness and 24-hour blood pressure profile in women with breast cancer before and after chemotherapy with doxorubicin and cyclophosphamide

Aim. To evaluate arterial stiffness and 24-hour blood pressure (BP) profile in breast cancer (BC) in women with normotension, masked hypertension (MH) and primary hypertension (HTN) before and after chemotherapy (CT) with a combination of doxorubicin and cyclophosphamide.

Material and methods. The study involved 158 women with newly diagnosed stage IIA-IIIA BC. Before chemotherapy, the patients were divided into 2 groups. The first group included 109 women with normal clinical BP, and the second group included 49 women with previously diagnosed stage 1-2 HTN. Before chemotherapy and 7-14 days after its completion, 24-hour ambulatory BP monitoring (ABPM) and noninvasive arteriography were performed. The mean 24-hour systolic BP (SBP) and diastolic BP (DBP), variability, time indices of SBP and DBP, their nighttime decrease and morning rise were analyzed. The pulse wave velocity (PWV) in the aorta, augmentation index (AI), central systolic BP, pulse pressure, systolic and diastolic area indices and their ratio were determined.

Results. According to ABPM conducted before the start of chemotherapy, two subgroups were identified among the examined patients with normal clinical BP. The first group included 55 (50,5%) women with normotension, while the second group — 54 (49,5%) women with newly diagnosed MH. The general trend of ABPM modification after chemotherapy was a decrease in mean 24-hour SBP and DBP, their excessive variability and a tendency towards tachycardia. Doxorubicin and cyclophosphamide-based chemotherapy is associated with an increase in PWV and AI in all groups of subjects, indicating an increase in arterial stiffness. These changes were more pronounced in the case of comorbidity of BC with MH and primary HTN.

Conclusion. In BC women, a comprehensive assessment of the 24-hour BP profile and arterial stiffness, glomerular filtration rate and left ventricular myocardial ejection fraction is an informative tool for the timely detection of chemotherapy vascular toxicity and the prevention of adverse cardiovascular events.

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