title: Hypertension, antihypertensive treatment and cancer incidence and mortality: a pooled collaborative analysis of 12 Australian and New Zealand cohorts.
abstract: BACKGROUND
  Observational studies examining associations between hypertension and cancer are inconsistent. We explored the association of hypertension, graded hypertension and antihypertensive treatment with cancer incidence and mortality.
  
  
  METHODS
  Eighty-six thousand five hundred and ninety-three participants from the Australian and New Zealand Diabetes and Cancer Collaboration were linked to the National Death Index and Australian Cancer Database. Cox proportional hazards models estimated hazard ratios and 95% confidence intervals (95% CI) for the association of treated and untreated hypertension with cancer incidence and mortality.
  
  
  RESULTS
  Over a median follow-up of 15.1 years, 12 070 incident and 4350 fatal cancers were identified. Untreated and treated hypertension, compared with normotension, were associated with an increased risk for cancer incidence [hazard ratio 1.06, 95% CI (1.00-1.11) and 1.09 (1.02-1.16) respectively], and cancer mortality (1.07, 0.98-1.18) and (1.15, 1.03-1.28), respectively. When compared with untreated hypertension, treated hypertension did not have a significantly greater risk for cancer incidence (1.03, 0.97-1.10) or mortality (1.07, 0.97-1.19). A significant dose-response relationship was observed between graded hypertension and cancer incidence and mortality; Ptrend = 0.053 and Ptrend = 0.001, respectively. When stratified by treatment status, these relationships remained significant in untreated, but not in treated, hypertension.
  
  
  CONCLUSIONS
  Hypertension, both treated and untreated, is associated with a modest increased risk for cancer incidence and mortality. Similar risks in treated and untreated hypertension suggest that the increased cancer risk is not explained by the use of antihypertensive treatment.
authors.affiliation: aDepartment of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute bDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria cCenter for Research on Ageing, Health and Wellbeing, Research School of Population Health, the Australian National University, Canberra, Australian Capital Territory dThe Health Observatory Discipline of Medicine, the University of Adelaide, Adelaide, South Australia, Australia eCenter for Research in Epidemiology and Population Health, INSERM, France fSchool of Population Health, the University of Western Australia gSchool of Medicine and Pharmacology, the University of Western Australia, Western Australia, Crawley, hSchool of Public Health, the University of Queensland, Queensland, Brisbane iCancer Epidemiology Center, Cancer Council Victoria, Melbourne, Victoria jPopulation Research and Outcome Studies, the University of Adelaide kSchool of Psychology and Flinders Center for Ageing Studies, Flinders University, Adelaide, South Australia lWestmead Millennium Institute, the University of Sydney, Sydney, New South Wales mIMPACT Strategic Research Center School of Medicine, Deakin University, Geelong, Victoria nDepartment of Medicine, NorthWest Academic Center, the University of Melbourne, Melbourne, St Albans oSchool of Public Health, Curtin University, Western Australia, Perth pMacarthur Clinical School, University of Western Sydney, Western Sydney, Campbelltown qDepartment of Rural Health, the University of Melbourne, Melbourne, Shepparton rUNSW Australia Lipid Research Department, St Vincent's Hospital, Sydney, New South Wales sSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria tThe George Institute for Global Health, the University of Sydney, Sydney, New South Wales, Australia uNuffield Department of Population Health, the George Institute for Global Health, University of Oxford, Oxford, UK *Joint senior authorship.
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authors.initials: LA
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authors.forename: Andrew
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mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D009520:New Zealand / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents