Pharmacologic blood pressure lowering was not associated with an increased or decreased risk of incident cancer of any type (HR 1.03) over a median follow-up of 4 years.
Meta-Analysis (n=314,016)
Randomly allocated
Yes
Does pharmacologic blood pressure lowering affect the risk of incident cancer in participants without known cancer at baseline?
Long-term pharmacologic blood pressure lowering does not increase the risk of incident cancer or cancer-related death, providing reassurance for its lifelong use.
Effect estimate: HR 1.03 (95% CI 0.99-1.06)
BACKGROUND: Pharmacologic blood pressure (BP) lowering is typically a lifelong treatment, and both clinicians and patients may have concerns about the long-term use of antihypertensive agents and the risk for cancer. However, evidence from randomized controlled trials (RCTs) regarding the effect of long-term pharmacologic BP lowering on the risk for new-onset cancer is limited, with most knowledge derived from observational studies. OBJECTIVES: The aim of this study was to assess whether long-term BP lowering affects the risk for new-onset cancer, cause-specific cancer death, and selected site-specific cancers. METHODS: Individual-level data from 42 RCTs were pooled using a one-stage individual participant data meta-analysis. The primary outcome was incident cancer of all types, and secondary outcomes were cause-specific cancer death and selected site-specific cancers. Prespecified subgroup analyses were conducted to assess the heterogeneity of the BP-lowering effect by baseline variables and over follow-up time. Cox proportional hazards regression, stratified by trial, was used for the statistical analysis. For site-specific cancers, analyses were complemented with Mendelian randomization, using naturally randomized genetic variants associated with BP lowering to mimic the design of a long-term RCT. RESULTS: Data from 314,016 randomly allocated participants without known cancer at baseline were analyzed. Over a median follow-up of 4 years (Q1-Q3: 3-5 years), 17,954 participants (5.7%) developed cancer, and 4,878 (1.5%) died of cancer. In the individual participant data meta-analysis, no associations were found between reductions in systolic or diastolic BP and cancer risk (HR per 5 mm Hg reduction in systolic BP: 1.03 95% CI: 0.99-1.06; HR per 3 mm Hg reduction in diastolic BP: 1.03 95% CI: 0.98-1.07). No changes in relative risk for incident cancer were observed over follow-up time, nor was there evidence of heterogeneity in treatment effects across baseline subgroups. No effect on cause-specific cancer death was found. For site-specific cancers, no evidence of an effect was observed, except a possible link with lung cancer risk (HR for systolic BP reduction: 1.17; 99.5% CI: 1.02-1.32). Mendelian randomization studies showed no association between systolic or diastolic BP reduction and site-specific cancers, including overall lung cancer and its subtypes. CONCLUSIONS: Randomized data analysis provided no evidence to indicate that pharmacologic BP lowering has a substantial impact, either increasing or decreasing, on the risk for incident cancer, cause-specific cancer death, or selected site-specific cancers.
Nazarzadeh et al. (Tue,) conducted a meta-analysis in Hypertension (n=314,016). Pharmacologic blood pressure lowering vs. Placebo, higher BP target, or other drug class was evaluated on Incident cancer of all types (HR 1.03, 95% CI 0.99-1.06). Pharmacologic blood pressure lowering was not associated with an increased or decreased risk of incident cancer of any type (HR 1.03) over a median follow-up of 4 years.