Aromatase Inhibitors and Escalating Blood Pressure

Hello - I’m in the same boat as the others here. I’m 73. I have existing cardiovascular disease and put me on Anastrozole. (I wasn’t aware of the potential risk). My blood pressure started going up in the third month - 177/111. I stopped taking it and my blood pressure is better.
They also wanted to give me semi-annual Prolia shots because the AI’s cause bone loss. I already have osteopenia and osteoporosis in my forearms. Lots of side effects with the Prolia too - for me, particularly if you have dental problems (me again!). I read that Prolia does build some bone back…but the bone loss escalates after you go off of it and you may have to take it lifelong.
I feel like I have to choose between 3 evils: cancer reoccurance, osteoporosis, and strokes/heart attacks! My cancer reoccurance % is very low, so I’m choosing my bones and my heart. I think all of the AI’s could cause cardiovascular issues - that’s how I ended up on this site.

My blood pressure had been borderline high for several years prior to my BC diagnosis, but I kept it in check through diet and exercise. Three months into Letrozole and it was sky high and unmanageable. I was put on Lisinopril hctz and it immediately came down. Not happy that I have to be on it, but I rest well knowing my BP is in check. Otherwise my side effects have mainly been arthritis in my hands and feet. My doctor suggested switching me to Exemestane as it supposedly causes less of that. I will give it a try although I’m worried about new side effects that I didn’t have with Letrozole. Not sure if this is related to AI’s, but now my A1c is in pre-diabetes range, so I’m on Berberine 2x a day. Managing these side effects is like playing whack-a-mole, but it’s a trade off I’m willing to accept at this stage in my life.

At my last Dr.s appointment, my blood pressure was a little high. I have never had high blood pressure so I couldn't figure it out. However, I have been on Exemestane for quite awhile and didn't realize it could raise your blood pressure. I'll be talking to my Dr. this week and asking to be put on something else!!

@carolcollins2220, does your oncologist coordinate care with your cardiologist?

Some centers have a specialty called cadio-oncology.

Mayo Clinic offers expertise in addressing heart problems (called cardio-oncology), potential or current issues. The Cardio-Oncology Clinic (https://www.mayoclinic.org/departments-centers/cardio-oncology-clinic/overview/ovc-20442193) evaluates people prior to cancer treatment and patients who have experienced side effects due their treatment.

How is your blood pressure being managed? Any changes to treatment or heart meds necessary?

Hi - they are not coordinating care. Thank you so much for responding to my post! I wasn’t aware of an oncology cardio doctor. I’ve researched in my local area and found that there is a Cardio Oncology Center at Cedars Sinai here in Los Angeles. I will be contacting them. Again, that you so much! Carol

I think that is very smart to value how your heart will do on these drugs, especially if you're low risk for recurrence, because I don't notice the BC docs take that into consideration much. If a person is older, is already on several blood pressure meds ( I am on 3 types), we have to be wary of going on IA's even though that's considered a first line of defense. Glad I'm going to see a doc in Cardio-Oncology (should have been recommended earlier!) so she can watch what they're doing from a CVD point of view. BC doc is now are recommending I go on Fulvestrant shots instead. I did a lot of research on that med yesterday, and it works in a different way than AI's to block hormones, it's considered a SERD. It's new though, and who knows? I want more testing as we go along on my heart. What I found out is that AI's work by reducing the estrogen available to tumor cells; Fulvestrant works by blocking estrogen from binding to cancer cells. I can provide links to studies/reports if anyone wants to read them. For bones, I'm sticking with extra calcium & D in pills & diet, & more weight-bearing exercises. Zometa will just have to wait.

Thanks for this info. My original oncologist didn’t ask or research my file and wanted me to try Anastrozole, which I did. She left the practice and the new onco looked at my records and told me to talk to my cardiologist re CVD. That’s where I’m at today. I looked up Fulvestrant on my Medicare drug plan and it’s not covered. The cost would be $626 per month. Again, thanks for your response!

I wonder if your Doc could petition the drug company to give you the med (If you wanted it) at a reduced price?

SingleCare offers a coupon that you might be able to get 6 doses for about $250. There are different discounts by location.
https://www.singlecare.com/prescription/fulvestrant#:~:text=How%20much%20does%20Fulvestrant%20cost%20without%20insurance?,6%2C%205ml%20of%20250mg/5ml%20Syringe%20of%20Fulvestrant.
AstraZeneca has a webpage with supports for lowering costs for fulvestrant. Lower drug costs are not available for Medicare patients, but they have links for outside organizations that MAY help.
https://www.myaccess360.com/patient/faslodex-fulvestrant/patient-affordability.html
It looks like Medicare would maybe pay for fulvestrant if you had the injection in a hospital. These days many clinics bill like they are a hospital so an out patient clinic may qualify. I’d suggest talking to the insurance clerk at your medical facility. They often know what hoops to jump through to get something paid - because they’ve been doing the paperwork for it with other patients. Doctors often aren’t aware of what their own insurance staff handle.

I could give it a try. Thanks!