title: The incidence of cancer deaths among hypertensive patients in a large Chinese population: a cohort study.
abstract: Current evidence is mixed regarding the association between antihypertensive prescriptions and cancer mortality. We evaluated this association in a large Chinese hypertensive population. We followed for five years all patients who were prescribed their first-ever antihypertensive agents between 2001 and 2005 in a public healthcare sector of Hong Kong. The association between antihypertensive drug class and cancer mortality was evaluated by Cox proportional hazard models with propensity score matching. Age, gender, socioeconomic status, service settings, district of residence, proportion of days covered reflecting medication adherence, and the number of comorbidities were adjusted. From 217,910 eligible patients, 9500 (4.4%) died from cancer within five years after their first-ever antihypertensive prescription. Most cancer deaths occurred in the digestive (38.9%) and respiratory system (30.4%); the breast (6.2%); and the lympho-hematopoietic tissues (5.3%). The proportion of patients who died from cancer was the highest in the calcium channel blocker (CCB) group (6.5%), followed by thiazide diuretics (4.4%), angiotensin converting enzyme inhibitors (4.2%) and β-blockers (2.6%). When compared with β-blockers, patients prescribed CCBs (Adjusted Hazard Ratio [AHR]=1.406, 95% C.I. 1.334-1.482, p<0.001) were more likely to die from cancer. Thiazide users were also more likely to suffer from cancer deaths (AHR=1.364, 95% C.I. 1.255-1.483, p<0.001), but became insignificant in stratified analysis. The association between cancer mortality and use of CCB, and perhaps thaizide, may alert physicians to the need for more meticulous and comprehensive care of these patients in clinical practice. We recommend prospective studies to evaluate cause-and-effect relationships of these associations.
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong; CUHK Shenzhen Research Institute, Chinese University of Hong Kong, No. 10, 2nd Yuexing Road, Nanshan District, Shenzhen, PR China.
authors.forename: Martin C S
authors.initials: MC
authors.lastname: Wong
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong; CUHK Shenzhen Research Institute, Chinese University of Hong Kong, No. 10, 2nd Yuexing Road, Nanshan District, Shenzhen, PR China.
authors.forename: Wilson W S
authors.initials: WW
authors.lastname: Tam
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong; CUHK Shenzhen Research Institute, Chinese University of Hong Kong, No. 10, 2nd Yuexing Road, Nanshan District, Shenzhen, PR China.
authors.forename: X Q
authors.initials: XQ
authors.lastname: Lao
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong; CUHK Shenzhen Research Institute, Chinese University of Hong Kong, No. 10, 2nd Yuexing Road, Nanshan District, Shenzhen, PR China.
authors.forename: Harry H X
authors.initials: HH
authors.lastname: Wang
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong.
authors.forename: Mandy W M
authors.initials: MW
authors.lastname: Kwan
authors.affiliation: Hospital Authority Information Technology Services - Health Informatics Section, Suite Nos. 2-15, 7/F Exchange Tower, 33 Wang Chiu Road, Kowloon Bay, Hong Kong.
authors.forename: Clement S K
authors.initials: CS
authors.lastname: Cheung
authors.affiliation: Hospital Authority Information Technology Services - Health Informatics Section, Suite Nos. 2-15, 7/F Exchange Tower, 33 Wang Chiu Road, Kowloon Bay, Hong Kong.
authors.forename: Ellen L H
authors.initials: EL
authors.lastname: Tong
authors.affiliation: Hospital Authority Information Technology Services - Health Informatics Section, Suite Nos. 2-15, 7/F Exchange Tower, 33 Wang Chiu Road, Kowloon Bay, Hong Kong.
authors.forename: N T
authors.initials: NT
authors.lastname: Cheung
authors.affiliation: JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Shatin, NT, Hong Kong; CUHK Shenzhen Research Institute, Chinese University of Hong Kong, No. 10, 2nd Yuexing Road, Nanshan District, Shenzhen, PR China. Electronic address: siangriffiths@cuhk.edu.hk.
authors.forename: Sian M
authors.initials: SM
authors.lastname: Griffiths
authors.affiliation: Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Monash University, Australia and the University of Warwick, UK.
authors.forename: Andrew J S
authors.initials: AJ
authors.lastname: Coats
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D044466:Asian People / Q000208:ethnology*; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: Antihypertensive agents; Associated factors; Cancer mortality; Chinese population; Hypertensive patients