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%). 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.

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

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2025年12月27日

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Conghui Shang,
Hao Wang,
Jindong Chen,
Shuhui Cao,
Yingjia Sun,
Ziyi Sheng,
Tianqing Chu,
Liang Zhao

摘要

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%).

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.