Hypertension is a commonly reported comorbidity in patients diagnosed with chronic myeloid leukemia (CML), and its management represents a challenge in patients treated with 2nd- or 3rd-generation tyrosine kinase inhibitors (TKIs), considering their additional cardiovascular (CV) toxicity. The renin angiotensin system (RAS) contributes to hypertension genesis and plays an important role in atherosclerosis development, proliferation, and differentiation of myeloid hematopoietic cells. We analyzed a cohort of 192 patients with hypertension at CML diagnosis, who were treated with 2nd- or 3rd-generation TKIs, and evaluated the efficacy of RAS inhibitors (angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs)) in the prevention of arterial occlusive events (AOEs), as compared with other drug classes. The 5-year cumulative incidence of AOEs was 32.7 ± 4.2%. Patients with SCORE ≥ 5% (high-very-high) showed a significantly higher incidence of AOEs (33.7 ± 7.6% vs 13.6 ± 4.8%, p = 0.006). The AOE incidence was significantly lower in patients treated with RAS inhibitors (14.8 ± 4.2% vs 44 ± 1%, p < 0.001, HR = 0.283). The difference in the low and intermediate Sokal risk group was confirmed but not in the high-risk group, where a lower RAS expression has been reported. Our data suggest that RAS inhibitors may represent an optimal treatment in patients with hypertension and CML, treated with 2nd or 3rd^G TKIs.

高血压是诊断为慢性粒细胞白血病 (CML) 的患者中常见的合并症，考虑到第二代或第三代酪氨酸激酶抑制剂 (TKI) 的额外心血管 (CV) 毒性，高血压的管理对他们来说是一个挑战。肾素血管紧张素系统 (RAS) 有助于高血压的发生，并在动脉粥样硬化的发展、增殖和髓系造血细胞分化中发挥重要作用。我们分析了 192 名确诊为 CML 的高血压患者，他们接受了第二代或第三代 TKI 治疗，并评估了 RAS 抑制剂（血管紧张素转换酶抑制剂 (ACEi) 和血管紧张素 II 受体阻滞剂 (ARB)）的疗效) 与其他药物类别相比，在预防动脉闭塞事件 (AOE) 方面。AOE 的 5 年累积发生率为 32.7 ± 4.2%。SCORE ≥ 5%（高-非常高）的患者表现出显着更高的 AOE 发生率（33.7 ± 7.6% vs 13.6 ± 4.8%，p = 0.006）。接受 RAS 抑制剂治疗的患者的 AOE 发生率显着降低（14.8 ± 4.2% 对 44 ± 1%，p < 0.001，HR = 0.283）。低和中 Sokal 风险组的差异得到证实，但在高风险组中没有，据报道，高风险组的 RAS 表达较低。我们的数据表明 RAS 抑制剂可能代表了高血压和 CML 患者的最佳治疗方法，这些患者接受了第 2 或第 3 ^G TKI 治疗。