ACEi and ARB combination may increase risk of cancer

January 01, 0001

ACEi and ARB combination may increase risk of cancer

The risk of cancer from antihypertensive drugs has been much debated, with a recent analysis showing increased risk with angiotensin-receptor blockers (ARBs). The researchers from USA, Norway, Israel, Denmark and the UK assessed the association between antihypertensive drugs and cancer risk in a comprehensive analysis of data from randomised clinical trials. They undertook traditional direct comparison meta-analyses, multiple comparisons (network) meta-analyses, and trial sequential analyses. They identified 70 randomised controlled trials with 324,168 participants.

They recorded no difference in the risk of cancer with ARBs, ACEi, CCBs, diuretics or other controls versus placebo. There was an increased risk with the combination of ACEi plus ARBs; however, this risk was not apparent in the random-effects model (odds ratio 1.15). No differences were detected in cancer- related mortality for ARBs, ACEi, â blockers, CCBs, diuretics, other controls and ACEi plus ARBs (1.10). In direct comparison meta-analyses, similar results were recorded for all antihypertensive classes, except for an increased risk of cancer with ACEi and ARB combination (OR 1.14, significant) and with CCBs (1.06, significant). However, they noted no significant differences in cancer-related mortality.

"On the basis of trial sequential analysis, (the) results suggest no evidence of even a 5—10% relative risk (RR) increase of cancer and cancer-related deaths with any individual class of antihypertensive drugs studied. However, for the ACEi and ARB combination, the cumulative Z curve crossed the trial sequential monitoring boundary, suggesting firm evidence for at least a 10% RR increase in cancer risk … increased risk of cancer with the combination of ACEi and ARBs cannot be ruled out."

This is worth watching as the use of the combination increases and would benefit from some biologically plausible explanation.

For the full abstract, click here.

The Lancet Oncology published online 30 November 2010 © 2010 Elsevier Limited
Antihypertensive drugs and risk of cancer: network meta-analyses and trial sequential analyses of 324,168 participants from randomised trials. Sripal Bangalore, Sunil Kumar, Sverre E Kjeldsen et al. Correspondence to Dr Sripal Bangalore: [email protected]

Category: A. General/Unspecified, K. Circulatory. Keywords: antihypertensive, drugs, risk, cancer, analysis of randomised clinical trials, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 17 December 2010

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