A Prospective Comparison of Azilsartan and Amlodipine for Bevacizumab-induced Hypertension and Proteinuria in Colorectal Cancer

Q: What clinical problem does this study address?

Bevacizumab often induces hypertension and proteinuria during treatment for colorectal cancer, and the best antihypertensive choice is unclear.

Q: How were participants assigned and how long were they followed?

Patients with SBP/DBP ≥140/90 mmHg during bevacizumab therapy were randomized 1:1 to azilsartan or amlodipine and followed for 18 weeks.

Sep 28, 2026

Uploaded by PakDamar76

Bevacizumab therapy for colorectal cancer frequently causes hypertension and proteinuria, yet the optimal antihypertensive strategy remains uncertain, with few prospective comparisons of ARBs versus CCBs. This study prospectively evaluated whether azilsartan or amlodipine more effectively controls blood pressure and reduces proteinuria during bevacizumab treatment. Patients with elevated SBP/DBP were randomized 1:1 and followed for 18 weeks with UPCR and blood pressure outcomes assessed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background/Aim

Patients and Methods

Results

Conclusion

Introduction

doi: 10.21873/invivo.14210 A Prospective Comparison of Azilsartan and Amlodipine for Bevacizumab-induced Hypertension and Proteinuriain Colorectal Cancer SATORU NIHEI1,2, HARUKI UJIIE3, KAZUKI SAITO1, TATSUKI IKEDA1, JUNICHI ASAKA1,2, MIZUNORI YAEGASHI4, KOICHI ASAHI5 and KENZO KUDO1,2 1 Department of Pharmacy, Iwate Medical University Hospital, Iwate, Japan; 2 Division of Clinical Pharmaceutics and Pharmacy Practice, Department of Clinical Pharmacy, School of Pharmacy, Iwate Medical University, Iwate, Japan; 3 Division of Integrated Information for Pharmaceutical Sciences, Department of Clinical Pharmacy, School of Pharmacy, Iwate Medical University, Iwate, Japan; 4 Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan; 5 Division of Nephrology and Hypertension, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan Abstract Background/Aim: Bevacizumab (Bev) often induces hypertension and proteinuria. Optimal antihypertensive management in this setting remains unclear, and studies comparing angiotensin II receptor blockers (ARBs) and calcium channel blockers (CCBs) are limited. The objective of this study was to compare the effects oftheARBazilsartanand the CCB amlodipine on hypertension and proteinuria. Patients and Methods: Patients with demonstrated systolic/diastolic blood pressure (SBP/DBP) ≥140/90 mmHg during Bev therapy for colorectal cancer were randomly assigned 1:1 to either the azilsartan group or the amlodipine group and were followed up for 18 weeks. The primary outcome was urinary protein-to-creatinine ratio (UPCR) . Secondary outcomes included BP changes and achievement of target BP (<140/90 mmHg) . After week six, the attending physician adjusted the antihypertensive medication as needed. Results: Thirty patients were enrolled, and 26 (13 per group) completed 18 weeks of treatment. Mean baseline SBP was 156.8±9.2 mmHg in the azilsartan group and 158.0±9.4 mmHg in the amlodipine group. At week six, SBP decreased to 151.4±21.9 mmHg and 144.5±15.2 mmHg, respectively, with a significant reduction in the amlodipine group. At week 18, SBP was 136.5±12.9 mmHg vs. 138.7±14.9 mmHg. Target BP was achieved in 23% of patients at week six and in 40-50% at week 18, with no difference between groups. No significant difference in UPCR was observed at anytime point. Subgroup analysis revealed that patients with proteinuria consistently had higher BP. continued ✉ Satoru Nihei (ORCID iD: 0000-0003-3179-677X), Department of Pharmacy, Iwate Medical University Hospital, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate 028-3695, Japan. Tel: +81 196137111, e-mail: [satoru@iwate-med.ac.jp](satoru@iwate-med.ac.jp) Received October 2, 2025 | Revised October 21, 2025 | Accepted October 22, 2025 This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. ©2026 The Author(s) . Anticancer Research is published by the International Institute of Anticancer Research. Conclusion: These findings emphasize that adequate BP control, rather than antihypertensive class, maybe critical in managing Bev-induced proteinuria. Keywords: Bevacizumab, hypertension, proteinuria, renin-angiotensin system inhibitor, azilsartan, calcium channel blocker, amlodipine. Introduction Bevacizumab (Bev), a monoclonal antibody targeting vascular endothelial growth factor (VEGF), is widely used in the treatment of various solid tumors, including colorectal cancer, non-small cell lung cancer, and hepatocellular carcinoma. Inhibition of VEGF signaling suppresses tumor angiogenesis and prolongs survival (1), but frequently induces renal vascular adverse events such as hypertension and proteinuria (2-4) . These events impede treatment continuation and directly impact patient prognosis and quality of life (5, 6), making their appropriate

FAQs

What clinical problem does this study address?

Bevacizumab often induces hypertension and proteinuria during treatment for colorectal cancer, and the best antihypertensive choice is unclear.

How were participants assigned and how long were they followed?

Patients with SBP/DBP ≥140/90 mmHg during bevacizumab therapy were randomized 1:1 to azilsartan or amlodipine and followed for 18 weeks.

Which outcomes were used to compare azilsartan and amlodipine?

The primary outcome was urinary protein-to-creatinine ratio (UPCR), with secondary outcomes including blood pressure changes and achievement of target BP (<140/90 mmHg).

Sep 28, 2026

Uploaded by PakDamar76