Does the incidence of cancer increase with long-term exposure to angiotensin-receptor blockers?

Does the incidence of cancer increase with long-term exposure to angiotensin-receptor blockers?

A study published recently in PLOS One finds that cancer is increased with cumulative exposure to angiotensin-receptor blockers (ARBs).

The authors carried out a meta-regression analysis, including 15 randomized clinical trials, zeroing in on cumulative exposure to ARBs and cancer outcomes.  They found a significant correlation between the degree of cumulative exposure to ARBs –measured by the size of the dose and the length of therapy–and all cancers combined and lung cancer in particular.  When cumulative exposure to daily high doses exceeded 3 years, there was a statistically significant increase in all cancers combined.

This analysis suggests that one excess cancer diagnosis would occur for every 120 patients treated with an ARB for 4.7 years.

But that’s not the end of the story.  BC pharmacy researchers looked closely at this issue in a study published in the Canadian Journal of Hospital Pharmacy and found that determining the link between ARBs and cancer may be difficult because of reporting bias.

The need to have all outcome data from clinical trials published in the public domain is something we have been advocating for a long time and we have sponsored webinars on this issue.   Without full access to entire data sets, including detailed patient-level data, it is very difficult to know for sure what ARBs do to cancer.

The preponderance of evidence at the moment, as we discuss in Therapeutics Letter 133: Primary Antihypertensive Therapy suggests that low-dose thiazides are still the best drug class for starting antihypertensive therapy, followed by an ACE-Inhibitor.

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