Long‐term use of antihypertensive drugs and risk of cancer

Assimes, Themistocles L.; Elstein, Eleanor; Langleben, Adrian; Suissa, Samy

doi:10.1002/pds.1656

Cited by 67 publications

(76 citation statements)

References 40 publications

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“…4,15,16,[29][30][31]35 All but 2 of the 16 case-control studies reported the number of cases (n = 27 987) and controls (n = 119 879). 5,6,[9][10][11][12][13]18,19,21,[23][24][25]28 The proportion of participants who used an ACE inhibitor or angiotensin-receptor blocker was 7.3% among the cases and 7.9% among the controls. Tables 1 and 2 show the general characteristics of the studies included in the analyses.…”

Section: Articles Screened N = 3735mentioning

confidence: 99%

“…A beneficial effect was also found when the analysis was limited to the 11 studies with long-term follow-up (RR 0.89, 95% CI 0.83-0.96). 4,6,13,15,18,[22][23][24]27,31,33 When the analyses were restricted to studies that investigated the effect of only ACE inhibitors on cancer risk, the 12 cohort and nested case-control studies showed a nonsignificant protective effect (RR 0.93, 95% CI 0.86-1.01), 4,12,15,16,19,21,23,29−33 and the 8 studies with longterm follow-up showed a significant protective effect (RR 0.89, 95% CI 0.80-0.98). 4,13,15,18,22,23,31,33 No significant change was observed when we excluded two studies with crude estimates.…”

Section: Effect Of Medication Use On Risk Of Cancermentioning

confidence: 99%

“…4,12,13,16,24,29,35 When studies were stratified by site of cancer, a decreased risk of cancer associated with use of ACE inhibitors or angiotensin-receptor blockers was identified for esophageal cancer (RR 0.73, 95% CI 0.57-0.94) and an increased risk was observed for melanoma ( were excluded. When analyses were restricted to studies with long-term follow-up, no association between use of ACE inhibitors or angiotensinreceptor blockers and individual cancers was found except for a beneficial effect on smokingrelated cancers (RR 0.79, 95% CI 0.64-0.98; I 2 = 0.0%; data not shown).…”

Section: Effect Of Medication Use On Risk Of Cancermentioning

confidence: 99%

“…Some ACE in - hibitors have known photosensitizing properties, 62 which may enhance photo damage to the skin by ultraviolet radiation and thereby increase the risk of skin cancer. 63 Among studies reporting kidney cancer risk, cohort and nested casecontrol studies 23,24 compared users of ACE inhibitors with patients with hypertension taking other medications, whereas conventional casecontrol studies led to no significant association between risk of kidney cancer and use of ACE inhibitors or angiotensin-receptor blockers. Therefore, a likely explanation for our finding may be that hypertension itself increased the risk of kidney cancer, an inference supported by several epidemiologic studies.…”

Section: −53mentioning

confidence: 99%

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Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies

Yoon¹,

Yang²,

Jeon³

et al. 2011

CMAJ

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R ecent meta-analyses have shown a possible increased risk of cancer associated with angiotensin-receptor blockers used alone or combined with angiotensin-convertingenzyme (ACE) inhibitors.1,2 Despite the strong internal validity of randomized controlled trials (RCTs) used in prior meta-analyses, it is difficult to interpret these results because of the short duration of follow-up for cancer detection.3 A previous retrospective cohort study with a mean follow-up of 6.6 years showed that the use of ACE inhibitors was associated with a significantly de creased risk of overall cancer, and cancer of the lung, breast and female reproductive organs and smoking-related cancers. 4 Despite the inconsistent results reported by previous observational studies regarding this issue, 4−35 we conducted a meta-analysis of cohort and casecontrol studies to assess the association between use of these medications and the risk of cancer. Methods Literature searchWe searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library up to January 2011 using common keywords related to ACE inhibitors, angiotensin-receptor blockers and cancer. The search terms were as follows: "angiotensin-converting enzyme inhibitor" or "angiotensin receptor blocker" or trade names of the medications AND "cancer" or "carcinoma" or "neoplasm" or "malignancy" or names of specific types of cancer. (For details about the search strategy, see Appendix 1, at www.cmaj.ca /lookup /suppl/doi:10.1503 /cmaj .101497 /-/DC1.) We also reviewed the bibliographies of relevant articles to identify additional publications. Studies were restricted to those involving humans. We performed a meta-analysis of observational studies to assess the association.

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Section: Articles Screened N = 3735mentioning

confidence: 99%

Section: Effect Of Medication Use On Risk Of Cancermentioning

confidence: 99%

Section: Effect Of Medication Use On Risk Of Cancermentioning

confidence: 99%

Section: −53mentioning

confidence: 99%

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Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies

Yoon¹,

Yang²,

Jeon³

et al. 2011

CMAJ

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“…The results are equivocal with a number of studies demonstrating an increased risk of cancer after HTDT and others finding either no effect or a protective effect (1)(2)(3)(4)(5)(6)(7). Angiogenesis may be a factor underlying the relationship between cancer and HTDT.…”

Section: Introductionmentioning

confidence: 95%

Rapid Decreases in Blood Pressure from Antihypertensive Treatment were Associated with Increased Cancer Mortality in the Systolic Hypertension in the Elderly Program

Swerdel

Janević

Cabrera

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Research on the association between antihypertensive drug treatment (HTDT) and cancer is equivocal. We tested the hypothesis that large, rapid decreases in blood pressure following HTDT are associated with higher cancer mortality.Methods: Data from the Systolic Hypertension in the Elderly Program (SHEP) with 15-year cause-specific follow-up for mortality were used. We used changes from baseline in seated and standing systolic blood pressure (SBP) measurements at 3, 6, 9, and 12 months after the initiation of HTDT. Hazard ratios adjusted for demographics, comorbidities, and competing risk of non-cancer-related deaths were estimated to determine the association between SBP change, as a continuous or time-dependent measure, and cancer-related death.Results: SHEP participants taking antihypertensive medication who exhibited a decrease in seated SBP of 29 mm Hg or more (50th percentile and above) at 3 months were at a 58% greater risk of cancer-related death during a 15-year follow-up compared with those with no decrease in SBP (P ¼ 0.007, 42% increased risk P ¼ 0.02 for standing SBP). Those participants whose maximal seated SBP change occurred in the first 3 months of treatment had 2.6-times greater risk of cancer mortality compared with those whose maximal seated SBP change occurred at 12 months (P ¼ 0.004).Conclusions: Large SBP decreases early in HTDT were associated with an increased risk of cancer-related death during a 15-year follow-up. Further studies are needed to confirm and explore the potential mechanisms for this association.Impact: Rapid decreases in blood pressure following HTDT may be a risk factor for cancer. Cancer Epidemiol Biomarkers Prev; 23(8); 1589-97. Ó2014 AACR.

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Cigarette Smoking and the Incidence of Breast Cancer

Xue¹,

Willett²,

Rosner³

et al. 2011

Arch Intern Med

155

160

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Background Tobacco smoke contains carcinogens which may increase the risk of breast cancer (BC). Conversely, cigarette smoking also has anti-estrogenic effects, which may reduce the risk of BC. The association between smoking and BC remains controversial. Methods Prospective cohort study of 111,140 participants of the Nurses’ Health Study from 1976 to 2006 for active smoking and 79,010 women from 1982 to 2006 for passive smoking. Results During 3,005,863 person-years (PYs) of follow-up, 8,772 incident cases of invasive BC were reported. After adjustment for potential confounders, the hazard ratio (HR) of BC was 1.06% (95% CI 1.01% – 1.11%) for ever smokers relative to never smokers. BC incidence was associated with higher quantity of current (P for trend=0.02) and past smoking (P for trend=0.003), younger age of initiation (P for trend=0.01), longer duration (P for trend=0.01) and more PKY (PKY) of smoking (P for trend=0.005). While premenopausal smoking was associated with a slightly higher incidence of BC (HR=1.11, 95% CI 1.07 – 1.15 for increase of every 20-PKY) especially smoking before first birth (HR=1.18, 95% CI 1.10 – 1.27 for increase of every 20-PKY), the direction of the association between postmenopausal smoking and BC was reversed (HR=0.93, 95% CI 0.85 – 1.02 for increase of every 20-PKY). Passive smoking in childhood or adulthood was not associated with BC risk. Conclusion Results from this large prospective cohort study suggest that active smoking especially smoking before first birth may be associated with a modest increase in the risk of BC.

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Long‐term use of antihypertensive drugs and risk of cancer

Abstract: The long-term use of commonly prescribed classes of antihypertensive drugs does not appear to promote or initiate cancer.

Cited by 67 publications

References 40 publications

Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies

Use of angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers and cancer risk: a meta-analysis of observational studies

Rapid Decreases in Blood Pressure from Antihypertensive Treatment were Associated with Increased Cancer Mortality in the Systolic Hypertension in the Elderly Program

Cigarette Smoking and the Incidence of Breast Cancer

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