Antihypertensive medications and survival in patients with cancer: a population-based retrospective cohort study.
BACKGROUND
The association between antihypertensive medications and survival in cancer patients remains unclear.


OBJECTIVE
To explore the association between classes of antihypertensive drugs and survival in cancer patients.


METHODS
Provincial Cancer Registry data was linked with a Provincial Drug Program Information Network (DPIN) for patients with lung (n=4241), colorectal (n=3967), breast (n=4019) or prostate (n=3355) cancer between the years of 2004 and 2008. Cox regression analyses were used to compare survival of patients using beta blockers (BBs), angiotensin-converting enzyme inhibitors/receptor blockers (ACEi/ARB), calcium channel blockers (CCBs) or thiazide diuretics (TDs) to survival of patients who did not use any of these antihypertensive drugs. Survival of patients using only one class of antihypertensive drugs were compared to each other, with BBs as the reference class.


RESULTS
Compared to the antihypertensive drug non-user cohort, BBs had no effect on survival for any of the cancers. ACEi/ARBs use was weakly associated with increased deaths for breast cancer (HR: 1.22, 95% CI: 1.04-1.44) and lung cancer (HR: 1.11, 95% CI: 1.03-1.21) patients. Deaths were also increased with CCB use in patients with breast cancer (HR: 1.22, 95% CI: 1.02-1.47) and with TD use in lung cancer patients (HR: 1.1, 95% CI: 1.01-1.19). There was strong evidence (p-value <0.0001) of an increase in deaths with TD use for colorectal (HR: 1.28, 95% CI: 1.15-1.42), and prostate (HR 1.41, 1.2-1.65) cancer patients. When including only antihypertensive drug users prescribed one drug class, lung cancer patients receiving CCBs had improved survival compared to BBs (HR 0.79, 95% CI: 0.64-0.98).


CONCLUSIONS
Some classes of antihypertensive agents are associated with a decreased survival in certain cancers. The decrease could be due to more comorbidities in antihypertensive drug users. However, CCB use was associated with improved survival in lung cancer patients.
Department of Medicine, University of Manitoba, Winnipeg, Canada.
Signy
S
Holmes
E Jane
EJ
Griffith
Grace
G
Musto
Gerald Y
GY
Minuk
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000959:Antihypertensive Agents
ACEi/ARBs; Antihypertensives; Beta blockers; Breast; Calcium channel blockers; Cancer; Colorectal and prostate; Lung; Thiazide diuretics