 Welcome to the Side Effect Management webinar produced by the Nurse Advisory Board of the Kidney Cancer Association. My name is Nancy Moldauer, and I'm going to be speaking on cardiovascular toxicities. And these short videos are intended to inform our kidney cancer patients and their loved ones' strategies for managing their side effects associated with the targeted therapies. Some general considerations in discussing cardiac side effects. First, prior to starting the therapy, your doctor or nurse may want to review some cardiac risk factors, though they will review your current blood pressure, and if you're taking any anti-hypertensive medications, if there's a history of coronary artery disease, such as high blood pressure, stroke, whether or not you have a history of smoking, a myocardial infarction known as a heart attack. And depending on this information, they will coordinate your care with your primary care physician as it relates to your cardiac status. When you're on these medications, you will always be monitored for shortness of breath, fatigue, weight gain, and cough. Well, how often does hypertension occur with these targeted therapies? And you can see that the incidence of hypertension ranges from about 9% to 40%. Again, this can depend on several factors, the anti-cancer agent being used, whether there's a history of hypertension, and other medical conditions such as diabetes, cigarette smoking, dyslipidemia, and obesity. These are other medical conditions that can also contribute to hypertension. Some of the targeted therapies known to increase blood pressure, and this occurs frequently with the drug synitinib, seraphinib, bevacivamide, thezopinib, and exitinib. Why is it important to lower the blood pressure? Because we want to decrease the incidence of stroke, decrease the incidence of heart attack, and decrease heart failure, all from occurring. Signs and symptoms of hypertension. Many people with high blood pressure will have no signs or symptoms. However, a dull headache, dizzy spells, or more frequent nosebleeds occurring more than normal could be a sign that perhaps your blood pressure is up. These signs and symptoms typically don't occur until the blood pressure has reached sometimes a severe or even life-threatening stage, which is why it is so important to measure your blood pressure at home. It provides your medical team with information on how you are taking your anti-cancer agent. It can also measure response to your high blood pressure medicine. And sometimes people, when they come into the doctor's office, they feel nervous and anxious, which is what we call the white coat influence, and that can increase your blood pressure. It allows us to compare blood pressure measurements at home versus the medical office for the very reason. That's why it's important to see a consistent blood pressure measurement at home. The goal is to have blood pressure less than 140 over 90, unless otherwise indicated by your healthcare team. And sometimes antihypertensive medications may need to be increased or added during the therapy. And it also allows us to review other medications that you're taking during this time. We call hypertension a biomarker of efficacy in patients with metastatic kidney cancer treated with synitinib. And what this means is that for those patients who actually do develop hypertension, it means that there's a positive effect, a positive anti-cancer effect occurring in the tumor. So when you develop hypertension, it means that the anti-cancer medication is working. So to summarize for you, the management of side effects is critical to maintaining your treatment. Prolonged administration of this anti-angiogenic medications can have a cardiac effect. Medications require chronic administration. Hypertension is a frequent adverse event that can be treated with your medical team and be proactive in your care. Monitor your blood pressure per your doctor's instructions. Take your antihypertensive medications and notify your healthcare team immediately if your blood pressure is elevated. Thank you.