Oxford, UK—Whether blood pressure medications increase the risk of cancer has been debated for more than 40 years, but research has been inconsistent and conflicting.

Now, a large study presented at the virtual European Society of Cardiology conference finds no evidence that anti-hypertensives heighten the risk of cancer.

“Our results should reassure the public about the safety of antihypertensive drugs with respect to cancer, which is of paramount importance given their proven benefit for protecting against heart attacks and strokes,” said study author Emma Copland, MSc, an epidemiologist at the University of Oxford, United Kingdom.

The review of randomized trials involved 260,000 people in 31 trials. Researchers asked investigators for information on which participants developed cancer, and much of the information has not previously been published.

The study team investigated five antihypertensive drug classes separately: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, calcium channel blockers (CCBs), and diuretics.

The investigators estimated the effect of each drug class on the following:
• Risk of developing any type of cancer, 
• Risk of dying from cancer, and 
• Risk of developing breast, colorectal, lung, prostate, and skin cancers. 

Researchers also sought to determine if the risk was affected by age, gender, body size, smoking status and previous antihypertensive medication use before taking part in the trial.

While around 15,000 new diagnoses of cancer occurred over an average of 4 years, no evidence was found that the use of any antihypertensive drug class increased the risk of cancer. 

Furthermore, researchers said their determination was consistent regardless of age, gender, body size, smoking status and previous antihypertensive medication use.

Each drug class was compared against all other control groups, including placebo, standard treatment, and other drug classes. Researchers report that the hazard ratio (HR) for any cancer was 0.99 (95% confidence interval [CI]), 0.94-1.04) with ACE inhibitors, 0.97 (95% CI, 0.93-1.02) with ARBs, 0.98 (95% CI, 0.89-1.08) with beta blockers, 1.06 (95% CI, 1.01-1.11) with CCBs and 1.01 (95% CI, 0.95-1.07) with diuretics. 

In addition, no drug class appeared to affect the probability of developing a specific type of cancer such as breast, colorectal, lung, prostate or skin. Longer duration of use also didn’t seem to have an effect, according to the authors.

“Our study has addressed an ongoing controversy about whether antihypertensive medication increases the risk of developing cancer,” Copland said. “We used the largest individual-level randomized evidence on antihypertensive medication to date and provide evidence for the safety of blood pressure lowering drugs in relation to cancer.”
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