Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea

Mi Hyang Jung; Ju Hee Lee; Chan Joo Lee; Jeong Hun Shin; Si Hyuck Kang; Chang Hee Kwon; Dae Hee Kim; Woo hyeun Kim; Hack Lyoung Kim; Hyue Mee Kim; In Jeong Cho; Iksung Cho; Jinseub Hwang; Soorack Ryu; Chaeyeong Kang; Hae Young Lee; Wook Jin Chung; Sang Hyun Ihm; Kwang Il Kim; Eun Joo Cho; Il Suk Sohn; Sungha Park; Jinho Shin; Sung Kee Ryu; Moo Yong Rhee; Seok Min Kang; Wook Bum Pyun; Myeong Chan Cho; Ki Chul Sung

doi:10.1111/jch.14187

Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea

Mi Hyang Jung, Ju Hee Lee, Chan Joo Lee, Jeong Hun Shin, Si Hyuck Kang, Chang Hee Kwon, Dae Hee Kim, Woo hyeun Kim, Hack Lyoung Kim, Hyue Mee Kim, In Jeong Cho, Iksung Cho, Jinseub Hwang, Soorack Ryu, Chaeyeong Kang, Hae Young Lee, Wook Jin Chung, Sang Hyun Ihm, Kwang Il Kim, Eun Joo ChoIl Suk Sohn, Sungha Park, Jinho Shin, Sung Kee Ryu, Moo Yong Rhee, Seok Min Kang, Wook Bum Pyun, Myeong Chan Cho, Ki Chul Sung

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

The potential cancer risk associated with long-term exposure to angiotensin receptor blockers (ARBs) is still unclear. We assessed the risk of incident cancer among hypertensive patients who were treated with ARBs compared with patients exposed to angiotensin-converting enzyme inhibitors (ACEIs), which are known to have a neutral effect on cancer development. Using the Korean National Health Insurance Service database, we analyzed the data of patients diagnosed with essential hypertension from January 2005 to December 2012 who were aged ≥40 years, initially free of cancer, and were prescribed either ACEI or ARB (n = 293,962). Cox proportional hazard model adjusted for covariates was used to evaluate the risk of incident cancer. During a mean follow-up of 10 years, 24,610 incident cancers were observed. ARB use was associated with a decreased risk of overall cancer compared with ACEI use (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.72-0.80). Similar results were obtained for lung (HR 0.73, 95% CI 0.64-0.82), hepatic (HR 0.56, 95% CI 0.48-0.65), and gastric cancers (HR 0.74, 95% CI 0.66-0.83). Regardless of the subgroup, greater reduction of cancer risk was seen among patients treated with ARB than that among patients treated with ACEIs. Particularly, the decreased risk of cancer among ARB users was more prominent among males and heavy drinkers (interaction P <.005). Dose-response analyses demonstrated a gradual decrease in risk with prolonged ARB therapy than that with ACEI use. In conclusion, ARB use was associated with a decreased risk of overall cancer and several site-specific cancers.

Original language	English
Pages (from-to)	879-887
Number of pages	9
Journal	Journal of Clinical Hypertension
Volume	23
Issue number	4
DOIs	https://doi.org/10.1111/jch.14187
State	Published - Apr 2021

Bibliographical note

Publisher Copyright:
© 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

Keywords

angiotension II type 1 receptor blockers
antihypertensive agents
hypertension
neoplasms

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10.1111/jch.14187

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Jung, M. H., Lee, J. H., Lee, C. J., Shin, J. H., Kang, S. H., Kwon, C. H., Kim, D. H., Kim, W. H., Kim, H. L., Kim, H. M., Cho, I. J., Cho, I., Hwang, J., Ryu, S., Kang, C., Lee, H. Y., Chung, W. J., Ihm, S. H., Kim, K. I., ... Sung, K. C. (2021). Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea. Journal of Clinical Hypertension, 23(4), 879-887. https://doi.org/10.1111/jch.14187

@article{49da054fc3bb486eaa7193ea4b59195e,

title = "Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea",

abstract = "The potential cancer risk associated with long-term exposure to angiotensin receptor blockers (ARBs) is still unclear. We assessed the risk of incident cancer among hypertensive patients who were treated with ARBs compared with patients exposed to angiotensin-converting enzyme inhibitors (ACEIs), which are known to have a neutral effect on cancer development. Using the Korean National Health Insurance Service database, we analyzed the data of patients diagnosed with essential hypertension from January 2005 to December 2012 who were aged ≥40 years, initially free of cancer, and were prescribed either ACEI or ARB (n = 293,962). Cox proportional hazard model adjusted for covariates was used to evaluate the risk of incident cancer. During a mean follow-up of 10 years, 24,610 incident cancers were observed. ARB use was associated with a decreased risk of overall cancer compared with ACEI use (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.72-0.80). Similar results were obtained for lung (HR 0.73, 95% CI 0.64-0.82), hepatic (HR 0.56, 95% CI 0.48-0.65), and gastric cancers (HR 0.74, 95% CI 0.66-0.83). Regardless of the subgroup, greater reduction of cancer risk was seen among patients treated with ARB than that among patients treated with ACEIs. Particularly, the decreased risk of cancer among ARB users was more prominent among males and heavy drinkers (interaction P <.005). Dose-response analyses demonstrated a gradual decrease in risk with prolonged ARB therapy than that with ACEI use. In conclusion, ARB use was associated with a decreased risk of overall cancer and several site-specific cancers.",

keywords = "angiotension II type 1 receptor blockers, antihypertensive agents, hypertension, neoplasms",

author = "Jung, {Mi Hyang} and Lee, {Ju Hee} and Lee, {Chan Joo} and Shin, {Jeong Hun} and Kang, {Si Hyuck} and Kwon, {Chang Hee} and Kim, {Dae Hee} and Kim, {Woo hyeun} and Kim, {Hack Lyoung} and Kim, {Hyue Mee} and Cho, {In Jeong} and Iksung Cho and Jinseub Hwang and Soorack Ryu and Chaeyeong Kang and Lee, {Hae Young} and Chung, {Wook Jin} and Ihm, {Sang Hyun} and Kim, {Kwang Il} and Cho, {Eun Joo} and Sohn, {Il Suk} and Sungha Park and Jinho Shin and Ryu, {Sung Kee} and Rhee, {Moo Yong} and Kang, {Seok Min} and Pyun, {Wook Bum} and Cho, {Myeong Chan} and Sung, {Ki Chul}",

note = "Publisher Copyright: {\textcopyright} 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.",

year = "2021",

month = apr,

doi = "10.1111/jch.14187",

language = "English",

volume = "23",

pages = "879--887",

journal = "Journal of Clinical Hypertension",

issn = "1524-6175",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "4",

}

Jung, MH, Lee, JH, Lee, CJ, Shin, JH, Kang, SH, Kwon, CH, Kim, DH, Kim, WH, Kim, HL, Kim, HM, Cho, IJ, Cho, I, Hwang, J, Ryu, S, Kang, C, Lee, HY, Chung, WJ, Ihm, SH, Kim, KI, Cho, EJ, Sohn, IS, Park, S, Shin, J, Ryu, SK, Rhee, MY, Kang, SM, Pyun, WB, Cho, MC & Sung, KC 2021, 'Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea', Journal of Clinical Hypertension, vol. 23, no. 4, pp. 879-887. https://doi.org/10.1111/jch.14187

TY - JOUR

T1 - Effect of angiotensin receptor blockers on the development of cancer

T2 - A nationwide cohort study in korea

AU - Jung, Mi Hyang

AU - Lee, Ju Hee

AU - Lee, Chan Joo

AU - Shin, Jeong Hun

AU - Kang, Si Hyuck

AU - Kwon, Chang Hee

AU - Kim, Dae Hee

AU - Kim, Woo hyeun

AU - Kim, Hack Lyoung

AU - Kim, Hyue Mee

AU - Cho, In Jeong

AU - Cho, Iksung

AU - Hwang, Jinseub

AU - Ryu, Soorack

AU - Kang, Chaeyeong

AU - Lee, Hae Young

AU - Chung, Wook Jin

AU - Ihm, Sang Hyun

AU - Kim, Kwang Il

AU - Cho, Eun Joo

AU - Sohn, Il Suk

AU - Park, Sungha

AU - Shin, Jinho

AU - Ryu, Sung Kee

AU - Rhee, Moo Yong

AU - Kang, Seok Min

AU - Pyun, Wook Bum

AU - Cho, Myeong Chan

AU - Sung, Ki Chul

PY - 2021/4

Y1 - 2021/4

N2 - The potential cancer risk associated with long-term exposure to angiotensin receptor blockers (ARBs) is still unclear. We assessed the risk of incident cancer among hypertensive patients who were treated with ARBs compared with patients exposed to angiotensin-converting enzyme inhibitors (ACEIs), which are known to have a neutral effect on cancer development. Using the Korean National Health Insurance Service database, we analyzed the data of patients diagnosed with essential hypertension from January 2005 to December 2012 who were aged ≥40 years, initially free of cancer, and were prescribed either ACEI or ARB (n = 293,962). Cox proportional hazard model adjusted for covariates was used to evaluate the risk of incident cancer. During a mean follow-up of 10 years, 24,610 incident cancers were observed. ARB use was associated with a decreased risk of overall cancer compared with ACEI use (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.72-0.80). Similar results were obtained for lung (HR 0.73, 95% CI 0.64-0.82), hepatic (HR 0.56, 95% CI 0.48-0.65), and gastric cancers (HR 0.74, 95% CI 0.66-0.83). Regardless of the subgroup, greater reduction of cancer risk was seen among patients treated with ARB than that among patients treated with ACEIs. Particularly, the decreased risk of cancer among ARB users was more prominent among males and heavy drinkers (interaction P <.005). Dose-response analyses demonstrated a gradual decrease in risk with prolonged ARB therapy than that with ACEI use. In conclusion, ARB use was associated with a decreased risk of overall cancer and several site-specific cancers.

AB - The potential cancer risk associated with long-term exposure to angiotensin receptor blockers (ARBs) is still unclear. We assessed the risk of incident cancer among hypertensive patients who were treated with ARBs compared with patients exposed to angiotensin-converting enzyme inhibitors (ACEIs), which are known to have a neutral effect on cancer development. Using the Korean National Health Insurance Service database, we analyzed the data of patients diagnosed with essential hypertension from January 2005 to December 2012 who were aged ≥40 years, initially free of cancer, and were prescribed either ACEI or ARB (n = 293,962). Cox proportional hazard model adjusted for covariates was used to evaluate the risk of incident cancer. During a mean follow-up of 10 years, 24,610 incident cancers were observed. ARB use was associated with a decreased risk of overall cancer compared with ACEI use (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.72-0.80). Similar results were obtained for lung (HR 0.73, 95% CI 0.64-0.82), hepatic (HR 0.56, 95% CI 0.48-0.65), and gastric cancers (HR 0.74, 95% CI 0.66-0.83). Regardless of the subgroup, greater reduction of cancer risk was seen among patients treated with ARB than that among patients treated with ACEIs. Particularly, the decreased risk of cancer among ARB users was more prominent among males and heavy drinkers (interaction P <.005). Dose-response analyses demonstrated a gradual decrease in risk with prolonged ARB therapy than that with ACEI use. In conclusion, ARB use was associated with a decreased risk of overall cancer and several site-specific cancers.

KW - angiotension II type 1 receptor blockers

KW - antihypertensive agents

KW - hypertension

KW - neoplasms

UR - http://www.scopus.com/inward/record.url?scp=85099909365&partnerID=8YFLogxK

U2 - 10.1111/jch.14187

DO - 10.1111/jch.14187

M3 - Article

C2 - 33492766

AN - SCOPUS:85099909365

SN - 1524-6175

VL - 23

SP - 879

EP - 887

JO - Journal of Clinical Hypertension

JF - Journal of Clinical Hypertension

IS - 4

ER -

Effect of angiotensin receptor blockers on the development of cancer: A nationwide cohort study in korea

Abstract

Bibliographical note

Keywords

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