Antihypertensive Drugs and Cancer Risk

The risk of cancer from antihypertensive drugs has been much debated for more than 40 years, with inconsistent or conflicting findings. Recent study findings presented at the European Society of Cardiology (ESC) Congress 2020 suggest that there is no link between the use of antihypertensives and risk of cancer.

"Our results should reassure the public about the safety of antihypertensive drugs with respect to cancer, which is of paramount importance given their proven benefit for protecting against heart attacks and strokes," said study author Ms Emma Copland, an epidemiologist at the University of Oxford, United Kingdom.

It was the largest study on cancer outcomes in participants of randomised trials investigating antihypertensive medication. Researchers enrolled around 260,000 people from 31 trials. They recorded the incidence of cancer from reports of investigators. Much of this information has not been published before, making the current analysis the most detailed yet.

The study team investigated five antihypertensive drug classes separately:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Beta-blockers
• Calcium channel blockers (CCBs)
• Diuretics

They estimated the effect of each drug class on the following criteria:

• The risk of developing any type of cancer.
• The risk of death from cancer.
• The risk of developing breast, colorectal, lung, prostate, and skin cancers.

They also examined differences according to age, gender, body size, smoking status, and previous antihypertensive medication use before taking part in the trial.

During an average of four years, they found around 15,000 new diagnoses of cancer. They compared each drug class against all other control groups, including placebo, standard treatment, and other drug classes and found no evidence to support the association between the use of antihypertensives and risk of cancer. This finding was consistent regardless of age, gender, body size, smoking status, and previous antihypertensive medication use.

Researchers report that the hazard ratio (HR) for any cancer was 0.99 with ACE inhibitors, 0.97 with ARBs, 0.98 with beta-blockers, 1.06 with CCBs, and 1.01 with diuretics. They noted no important effect of any individual drug class on overall cancer risk. Similarly, they found no evidence that any type of antihypertensive medication affects the probability of developing breast, colorectal, lung, prostate, or skin cancer. They also observed no indication of an increased risk of cancer with longer duration use of antihypertensives.

Ms Copland concluded, "Our study has addressed an ongoing controversy about whether antihypertensive medication increases the risk of developing cancer. We used the largest individual-level randomised evidence on antihypertensive medication to date and provide evidence for the safety of blood pressure-lowering drugs in relation to cancer".

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