Abstract
Introduction: The potential risk of cancer associated with antihypertensive drugs has been disputed for decades as additional outcomes from randomized controlled trials (RCTs), observational studies, and meta-analyses showed conflicting results.
Objective: To assess the risk of cancer in patients exposed to major antihypertensive drug classes.
Methods: We searched bibliographic databases for RCTs published between 1950 to December 2015 studying angiotensin-receptor blockers (ARB), angiotensin-converting enzyme inhibitors (ACEi), beta-blockers (BB), calcium channel blockers (CCB), and thiazide diuretics (TZ). RCTs with at least one year duration of planned active treatment and a minimum of 100 participants per treatment arm were eligible.
Main Outcome Measures: Cancer and cancer-related deaths from the RCTs. Both fixed-effect and random-effects models were conducted and results were expressed as odds ratio (OR).
Results: We identified 91 RCTs enrolling 391, 790 participants with an average follow-up of 3.4 years. There was no evidence of excess risk for cancer with ARB, ACEi, BB, and TZ (refer Fig.1). For CCBs, there was an increased risk of cancer (OR 1.07 95%CI 1.02, 1.1) with minimal heterogeneity (I2=13%). Subgroup analysis did not differ significantly between dihydropyridines (DHP) and non-dihiydropyridines subclasses. There was no statistically significant association between antihypertensive drug classes and risk of cancer deaths.
Conclusions: Our results suggest that ARB, ACEi, BB, and TZ are not associated with increased risk of cancer. CCB therapy shows an increased risk of cancer. Further investigation on the risk of cancer with CCB is warranted.