A Study of Blood Pressure Control During Cancer Treatment

Inclusion criteria

• Age ≥ 18 years
• Female assigned at birth
• Biopsy proven breast cancer (stage I-IV)
• Treatment with therapy anthracycline-based chemo (with or without HER2-targeted therapy), with >/= 2 cycles of anthracycline chemotherapy planned.
• SBP ≥130 mm Hg
• Willing and able to comply with the requirements of the protocol.
• Participant must have and be willing to use their bluetooth enabled wifi or cellular mobile device
• (For participants in the CPET cohort): Able to complete an acceptable baseline CPET, in the absence of high-risk ECG findings or other inappropriate response to exercise as determined by the PI, as defined by any of the following criteria:

• Achieving a plateau oxygen consumption, concurrent with an increase in power output;
• A respiratory exchange ratio ≥ 1.10;
• Attainment of maximal predicted heart rate, as defined by a peak heart rate within 10bpm of the age predicted maximal heart rate (220 - Age[years]);
• Volitional exhaustion, as measured by a rating of perceived exertion (RPE) ≥ 18 on the BORG scale.

Exclusion criteria

• eGFR < 30 ml/min/1.73m2 (based upon Cockcroft-Gault, etc.)
• Individuals with arm circumference too large to allow accurate BP measurement with available BP devices
• Inability to accurately measure blood pressure in at least one arm (e.g., bilateral upper extremity lymphedema)
• Cardiac comorbidity, including any of the following:

• Acute coronary syndrome within 3 months prior to randomization.
• Symptomatic heart failure (NYHA class III/IV) within past 6 months
• History of stroke
• Cardiac transplantation
• Other medical disorder or condition that in the opinion of the investigator would impair the subject's ability to participate or adhere to study interventions
• (For participants in the CPET cohort): Subjects must not have any of the following absolute contraindications to cardiopulmonary exercise testing:

• Acute myocardial infarction (within 30 days of any planned study procedures),
• Unstable angina
• Uncontrolled arrhythmias causing symptoms or hemodynamic compromise,
• Symptomatic severe aortic stenosis
• Recurrent syncope
• Active endocarditis
• Acute myocarditis or pericarditis
• Acute pulmonary embolus or pulmonary infarction (within 3 months of any planned study procedures)
• Thrombosis of lower extremities (within 3 months of any planned study procedures)
• Suspected dissecting aneurysm
• Uncontrolled asthma
• Pulmonary edema
• Room air desaturation at rest ≤85%
• Respiratory failure
• Acute noncardiopulmonary disorder that may affect exercise performance or be aggravated by exercise (i.e., infection, renal failure, thyrotoxicosis)
• Mental impairment leading to inability to cooperate.