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March 29, 2021The Lancet OncologyOpen Access

Antihypertensive treatment and risk of cancer: an individual participant data meta-analysis

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Why the study?

Some studies have suggested a link between antihypertensive medication and cancer, but the evidence was inconclusive.

Do antihypertensive drug classes increase the risk of cancer compared to placebo or other blood pressure lowering drugs?

Population

260 447 participants across 33 randomised controlled trials

Comparison

ACEIs, ARBs, β blockers, calcium channel blockers, and thiazides vs placebo, inactive control, or other drug class

Design

Individual participant data and network meta-analysis of randomised controlled trials

Follow-up

Median 4·2 years

Authors

ECEmma CoplandPreventive CardiologyDCDexter CanoyPreventive CardiologyMNMilad NazarzadehPreventive Cardiology

Discussion

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Implication

Reassures on cancer safety for routine antihypertensive use; confirms neutral risk across classes in largest RCT IPD meta-analysis.

Key Points

  • This research examines the relationship between antihypertensive treatments and cancer risk using individual participant data.
  • Performed a meta-analysis of individual participant data from 33 randomized controlled trials.
  • Included over 260,000 participants with at least 1,000 years of follow-up per treatment group.
  • Analyzed the effects of various antihypertensive drug classes on cancer events using Cox regression models.
  • No significant associations found between most antihypertensive drug classes and cancer risk (HRs close to 1).
  • Calcium channel blockers showed a slight increase in cancer risk (HR 1.06 [1.01-1.11]).
  • Overall evidence suggests no consistent effect of antihypertensive medication on cancer risk.

Structured PICO

Do antihypertensive drug classes increase the risk of cancer compared to placebo or other blood pressure lowering drugs?

P
Population
260,447 participants from 33 randomised controlled trials (each with at least 1000 participant years of follow-up per treatment group)
I
Intervention
Antihypertensive drug classes (angiotensin-converting enzyme inhibitors [ACEIs], angiotensin II receptor blockers [ARBs], β blockers, calcium channel blockers, and thiazide diuretics)
C
Comparator
Placebo, inactive control, or other blood pressure lowering drug
O
Outcome
Any cancer event, defined as the first occurrence of any cancer diagnosed after randomisationsafety

This large individual participant data meta-analysis provides reassuring evidence that the use of common antihypertensive medications does not significantly increase the risk of cancer.

Limitations

  • Evidence for some comparisons was insufficient to entirely rule out excess risk, in particular for calcium channel blockers

Cite This Study

Copland et al. (2021) studied this question.

synapsesocial.com/papers/6a08537d0df715653be8a7aahttps://doi.org/10.1016/s1470-2045(21)00033-4

Topics

Hypertension management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Antihypertensive drugs use and the risk of prostate cancer: a meta-analysis of 21 observational studies2018 · 59 citations
  2. 2Effects of telmisartan, irbesartan, valsartan, candesartan, and losartan on cancers in 15 trials enrolling 138 769 individuals2011 · 191 citations
  3. 3Prevention of cardiovascular events with calcium channel blocker-based combination therapies in patients with hypertension2011 · 123 citations
  4. 4Irbesartan in Patients with Atrial Fibrillation2011 · 255 citations
  5. 5The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) Trial of Cardiovascular Events in Hypertension. Rationale and Design1998 · 153 citations