Cancer mortality and atenolol treatment.

Fletcher, A. E.; Beevers, D. G.; Bulpitt, C J; Coles, E C; Dollery, C. T.; Ledingham, J. G. G.; Palmer, AJ; Petrie, J C; Webster, J

doi:10.1136/bmj.306.6878.622

Cited by 26 publications

(14 citation statements)

References 4 publications

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“…This finding stands in contrast to an Australian case-control study reporting a significant 2-fold excess of renal pelvis cancer among women using nondiuretic antihypertensive drugs, especially beta-blockers (McCredie and Stewart, 1992). In addition, an excess of renal cancer has been suggested in 2 prospective surveys (Fletcher et al, 1993;Hole et al, 1993) of hypertensive patients taking beta-blockers, but the subsites were not specified and the relation was attributed to hypertension rather than medication use. Reasons for the differences are not clear, but the negative findings in our study may be Since the use of diuretics, beta-blockers and other antihypertensive drugs is highly correlated with hypertension, it is difficult to differentiate the effects of hypertension and its treatment on cancer risk.…”

Section: Discussioncontrasting

confidence: 79%

Possible relation between hypertension and cancers of the renal pelvis and ureter

et al. 1997

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To evaluate the relationship of selected medical conditions and medications with cancers of the renal pelvis and ureter, we interviewed 308 subjects with renal pelvis cancer, 194 subjects with ureter cancer and 496 control subjects in 3 areas of the United States. After controlling for the effects of smoking, age, gender and geographic residence, a history of hypertension (reported to have been diagnosed more than 5 years before interview) was associated with a small but significantly increased risk (odds ratio [OR] 5 1.3; 95% confidence interval [CI], 1.0-1.8), whereas no relationship was observed with a variety of other medical conditions or medications. Stratified analysis showed that the risk associated with hypertension was twice as high among users of diuretics or other antihypertensive drugs (OR 5 2.4; 95% CI, 1.1-4.9) as it was among those who never used these medications (OR 5 1.2; 95% CI, 0.8-1.7). Our findings suggest that the association previously reported between hypertension and renal cell cancer may extend to cancers of the renal pelvis and ureter. Int. J. Cancer, 70: 265-268, 1997.r 1997 Wiley-Liss, Inc.* Cancers of the renal pelvis and ureter, both lined by transitional epithelium, are uncommon tumors that account for less than 1% of all newly diagnosed cancers in the United States (Devesa et al., 1990). However, the incidence rates have been rising by 2 to 4% annually among both men and women (Devesa et al., 1990). Although there have been relatively few epidemiologic studies, the major risk factor is cigarette smoking, which is believed to account for most of these tumors .Previous studies have linked heavy use of analgesics, especially preparations containing phenacetin, to an elevated risk of renal pelvis and ureter cancers (McCredie et al., 1982(McCredie et al., , 1993McLaughlin et al., 1983;Jensen et al., 1989). However, data from the present study revealed no association (Linet et al., 1995), probably because phenacetin was discontinued many years ago in the United States and the carcinogenic effects may no longer be apparent. To investigate further the role of prior medical conditions and pharmaceutical agents in the development of these cancers, we examined data from a large-scale, population-based, case-control study conducted in 3 geographic areas in the United States. METHODSDetailed methods for this study have already been described Linet et al., 1995). Briefly, cases were individuals aged 20-79, newly diagnosed with microscopically confirmed cancers of the renal pelvis or ureter between January 1, 1983, and December 31, 1986, and living in New Jersey, Iowa or Los Angeles County, California. Non-white cases in these areas were excluded from the study because of very small numbers. Population-based control subjects were frequency-matched to the index cases based on age (5-year group), sex, and geographic area and were chosen by random digit dialing (RDD) (Waksberg, 1978) for cases younger than 65 or selected from Medicare files of the Health Care Financing Administration (HCFA) for ...

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Section: Discussioncontrasting

confidence: 79%

Possible relation between hypertension and cancers of the renal pelvis and ureter

et al. 1997

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“…In contrast to the above observations, one longitudinal and three case-controlled studies found no association between use of β-blockers and malignancy [14,[55][56][57]. In one of the studies [14], the incidence rate of renal cell carcinoma was increased in those receiving β-blockers, although this could have been related to additional diuretic use in the same patients [58].…”

Section: β-Blockerscontrasting

confidence: 50%

Carcinogenicity of antihypertensive therapy

Grossman¹,

Messerli

Goldbourt³

2002

Current Science Inc

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Several studies have suggested that antihypertensive treatment may promote cancer through unknown mechanisms. Early retrospective studies implicated reserpine in breast cancer, but data from prospective studies and meta-analysis of several case-controlled studies showed only a weak association between reserpine and breast cancer which, although statistically significant, is of little clinical concern. Data from case-controlled studies and several cohort studies suggested an association between the use of a diuretic and the occurrence of renal cell cancer, particularly in women. A recent study showed an association between the use of a diuretic and the occurrence of colon cancer. Several prospective studies showed that treatment with atenolol may increase mortality from malignancy. However, other studies that analyzed data from several thousand patients could not confirm this association. In three prospective and a few case-controlled studies, angiotensin converting enzyme inhibitors were not associated with increased mortality from malignancy. In addition, a recent retrospective study showed that long-term use of angiotensin converting enzyme inhibitors had a protective effect against malignancy. Data from three large case-controlled studies and the combined data from eight randomized controlled studies and seven longitudinal studies showed a similar risk for malignancy among users and nonusers of calcium antagonists. Until further data from prospective clinical trials are available, we advise caution about long-term diuretic therapy in women. With regard to other antihypertensive drug classes, we suggest continuing the management of hypertension according to current treatment guidelines with little fear of any substantial cancer risk.

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“…This is consistent with our previous finding of a normal cancer mortality with atenolol treatment where the RR of methyldopa compared with atenolol was 1.5 in men (95% CI 1.0 to 2.2). 40 This excess cancer mortality occurred in earlier years of the study and may reflect confounding variables not fully accounted for by adjusting for the year of presentation and age.…”

Section: Discussionmentioning

confidence: 94%