Angiotensin receptor-neprilysin inhibitors improve the outcome of lung cancer patients with hypertension undergoing immune checkpoint inhibitors treatment

Sep 29, 2026

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Immune checkpoint inhibitors can improve survival in cancer but may trigger severe immune-related cardiac adverse events, especially in patients with hypertension. This retrospective study evaluated whether angiotensin receptor-neprilysin inhibitors (ARNIs) improve outcomes for lung cancer patients with hypertension treated with ICIs. Between September 2019 and May 2024, ARNIs were linked to significantly better all-cause survival, while cardiovascular event rates and common adverse events such as new-onset arrhythmia were not significantly different.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

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Abstract

Background and Objective

Methods

Results

Conclusions

Introduction

Methods

Shang et al. BMC Cardiovascular Disorders (2026) 26:8 BMC Cardiovascular Disorders [https://doi.org/10.1186/s12872-025-05466-1](https://doi.org/10.1186/s12872-025-05466-1) RESEARCH Open Access Angiotensin receptor-neprilysin inhibitors improve the outcome of lung cancer patients with hypertension undergoing immune checkpoint inhibitors treatment Conghui Shang 1†, Hao Wang 1†, Jindong Chen 1†, Shuhui Cao2, Yingjia Sun3, Ziyi Sheng4, Tianqing Chu2* and Liang Zhao 1* Abstract Background Angiotensin receptor-neprilysin inhibitors (ARNIs) could improve the outcome of patients with hypertension or heart failure. Yet it remains unclear if such protective effect exists in lung cancer patients with hypertension undergoing immune checkpoint inhibitors (ICIs) . Objective This study sought to evaluate the impact of ARNIs on the outcome of lung cancer patients with hypertension treated with ICIs. Methods We performed a retrospective analysis of lung cancer patients with concurrent hypertension undergoing ICIs treatment between September 2019 and May 2024 in Shanghai Chest Hospital. The overall population included patients with or without ARNIs therapy. The primary endpoint was all-cause mortality and the secondary endpoint was a composite of cardiovascular events, including myocarditis, heart failure (HF), acute coronary syndrome (ACS), pericardial effusion (PE), and new-onset arrhythmias. Results The study enrolled 153 patients, with 39 (25 . 5%) patients in ARNIs group and 114 (74 . 5%) patients in control group. Over a median follow-up of 12 months, 42 (27 . 5%) patients died, ARNIs treatment was significantly associated with improved overall survival for lung cancer patients with hypertension and treated with ICIs (89 . 7% vs. 66. 7%, HR = 0 . 27; 95% CI 0 .10–0. 75, log-rank P = 0 . 007) . However, there was no significant difference in cardiovascular outcome between ARNIs and control group (21/114, 18.4% vs. 3/39, 7 . 7%, P = 0 . 112) . During follow-up, a total of 24 cardiovascular adverse events occurred, of which the most common cardiovascular event was new-onset arrhythmia in both ARNIs group (2/3, 66 . 7%) and control group (14/21, 66 . 7%) . †Conghui Shang, Hao Wang and Jindong Chen contributed equally to this work. *Correspondence: Tianqing Chu [ctqxkyy@163.com](ctqxkyy@163.com)[ ](ctqxkyy@163.com)Liang Zhao zhaoliang801 [12@126.com](12@126.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Shang et al. BMC Cardiovascular Disorders (2026) 26:8 Page 2 of 9 Conclusions The use of ARNIs seemed associated with a lower all-cause mortality rate yet similar rate of cardiac events in lung cancer patients with hypertension and treated with ICIs. The findings of this single-center retrospective study warrant validation in larger prospective studies. Keywords Immune checkpoint inhibitors, Angiotensin receptor-neprilysin

FAQs

What question does the study address about ARNIs and ICIs?

It evaluates whether angiotensin receptor-neprilysin inhibitors improve outcomes for lung cancer patients with hypertension who are undergoing immune checkpoint inhibitor therapy.

How were outcomes measured in the study?

All-cause mortality was the primary endpoint, and cardiovascular outcomes were assessed as a composite including myocarditis, heart failure, acute coronary syndrome, pericardial effusion, and new-onset arrhythmias.

What were the main findings regarding survival and cardiovascular events?

ARNIs were significantly associated with improved overall survival, but there was no significant difference in the cardiovascular composite outcome compared with controls.

Sep 29, 2026

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