toremifene and Hypertension

The main purpose of this research was to study an impact of hormonotherapy on changes of the arterial blood pressure in patients with breast cancer. Case histories of 135 patients with the breast cancer and accompanying arterial hypertension (AH) were investigated. According to prescription of hormonotherapy, all patients were divided into two groups. In the first group were included 62 patients; they were treated with 20 mg Tamoxifen. In the second group were included 73 patients; they were treated with 60 mg of Toremifen. In both investigated groups the medicine has been prescribed inside, daily, not less than during two years. Arterial hypertension (AH) was diagnosed when blood pressure was above 140/90 mmHg. In each group there were two subgroups--patients which do not underwent course of treatment for AH and patients which underwent course of treatment for AH. The research revealed that antihypertensive therapy of patients with the breast cancer and accompanying arterial hypertension in most cases allows to prevent progression of AH. Besides, it is necessary to notice that hormonotherapy with Tamoxifen, in comparison with Toremifen, in a greater degree promotes progressing of AH. For antihypertensive treatment Moeksipril was recommended. Monotherapy with Moeksipril showed good antihypertensive effect in patients with mild AH.

Topics: Adult; Antineoplastic Agents; Antineoplastic Agents, Hormonal; Blood Pressure; Breast Neoplasms; Disease Progression; Drug Therapy, Combination; Echocardiography; Electrocardiography; Female; Follow-Up Studies; Humans; Hypertension; Middle Aged; Neoplasm Staging; Practice Guidelines as Topic; Retrospective Studies; Tamoxifen; Toremifene; Treatment Outcome

To explore the mechanism(s) by which antiestrogens may protect against the development of cardiovascular disorders, we measured the production of vasodilatory, antiaggregatory prostacyclin (PGI2) and that of vasoconstrictive, proaggregatory thromboxane A2 (TxA2) before and after 6 months' use of antiestrogens in postmenopausal patients after operation for stage II breast cancer (n = 38). Urine samples were assayed by high performance liquid chromatography and radio-immunoassays for 2,3-dinor-6-ketoprostaglandin F1 alpha (= metabolite of PGI2, dinor-6-keto) and for 2,3-dinor-thromboxane B2 (= metabolite of TxA2, dinor-TxB2). In addition, in 35 of these 38 patients we assayed the capacity of platelets to produce thromboxane A2 during standardized blood clotting. The 4 patients using low-dose aspirin had low thromboxane production, and were excluded from further analysis of the data. An antiestrogen regimen consisting either of tamoxifen (n = 15) or of toremifene (n = 19) caused no changes in production of PGI2 or TxA2, or in their ratio, and in this regard, these antiestrogens behaved similarly. Hypertensive patients (n = 7) using different anti-hypertensive agents were characterized by reduced urinary out-put of dinor-6-keto (18.5 +/- 6.1 vs 35.5 +/- 18.5 ng/mmol, mean +/- SD, p < 0.05) and reduced platelet capacity to produce TxA2 (62.6 +/- 67.8 vs 134.6 +/- 75.6 ng/mL, p < 0.05). The patients (n = 15) who had used estrogen replacement therapy (ERT) up until diagnosis of breast cancer showed reduced dinor-TxB2 excretion (15.5 +/- 12.7 vs 29.9 +/- 20.9 ng/mmol, p < 0.05) before initiation of antiestrogens, and elevated dinor-6-keto output during the antiestrogen regimen (32.4 +/- 21.2 vs 22.7 +/- 8.7 ng/mmol, p = 0.07). Smokers (n = 6) had elevated dinor-TxB2 output before and during antiestrogen use. Thus we conclude that the cardiovascular protection provided by an antiestrogen regimen is unlikely to be mediated through vaso- and platelet active PGI2 and TxA2.

Topics: Aged; Breast Neoplasms; Epoprostenol; Estrogen Antagonists; Estrogens; Female; Humans; Hypertension; Menopause; Middle Aged; Molecular Structure; Smoking; Tamoxifen; Thromboxane A2; Toremifene