VEGF Inhibitor Hypertension — RACP Adult Medicine MCQ
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Correct answer: B — Renal artery stenosis
VEGF inhibitors (sunitinib, sorafenib, bevacizumab, pazopanib) cause hypertension in 30–80% of patients through multiple mechanisms: reduced nitric oxide synthesis (VEGF normally upregulates endothelial NO synthase), microvascular rarefaction (loss of capillaries), and increased endothelin-1 production. Hypertension is a class effect and may paradoxically be a biomarker of drug efficacy. Management follows standard antihypertensive guidelines; ACE inhibitors or dihydropyridine CCBs are preferred.
Reference: ESC – 2022 – Cardio-Oncology Guidelines; AMH – 2025 – VEGF Inhibitors