Antihypertensive Drugs and Cancer Risk

Current Status and Future Perspective of Onco-Hypertension

BACKGROUND

Hypertension and cancer are both increasing with age. Recently, the new concept of "Onco-Hypertension" has been proposed to address the mutual risks posed by hypertension and cancer and to provide comprehensive care for patients with these two conditions in an aging society.

METHODS

In this review, we provide an overview of the current status and future perspective of the "Onco-Hypertension," including our research findings.

RESULTS

Hypertension and cancer share common risk factors and may be interrelated in pathogenesis: Hypertension is involved in the development of certain cancers, and cancer survivors have a higher incidence of hypertension. With recent advances in cancer therapy, the number of cancer survivors has increased. Cancer survivors not only have a higher risk of incident hypertension but also an increased risk of future cardiovascular events, highlighting the growing importance of comprehensive care.

CONCLUSIONS

There exists a diverse array of epidemiological and pathophysiological relationships between hypertension and cancer. It is imperative to move the emerging scientific field of "Onco-Hypertension" forward through relentless research efforts.

Effect of Intensive Blood Pressure Control on Cardiovascular Outcomes in Cancer Survivors

BACKGROUND

To evaluate whether cancer modifies the effect of intensive blood pressure control on major cardiovascular outcomes.

METHODS

Using data of the SPRINT (Systolic Blood Pressure Intervention Trial), we compared the risk of the composite outcomes of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death in patients with and without a history of cancer. Using Cox proportional hazards regression, we tested interactions between history of cancer and intensive blood pressure control on major cardiovascular outcomes.

RESULTS

The study included a total of 9336 patients, with a mean age of 67.9±9.4 years, among whom 2066 (22.2%) were cancer survivors. Over a median follow-up of 3.2 years, 561 primary cardiovascular outcomes were observed. Cancer survivors had a similar risk of experiencing the primary outcome compared with patients without cancer after multivariable adjustment (adjusted hazard ratio, 0.94 [95% CI, 0.77-1.15]). Intensive blood pressure control reduced risk of the primary cardiovascular outcome similarly for cancer survivors (hazard ratio, 0.70 [95% CI, 0.51-0.97]) and patients without cancer (HR, 0.76 [95% CI, 0.63-0.93]; P for interaction 0.74).

CONCLUSIONS

In SPRINT study, intensive blood pressure treatment reduced the risk of major cardiovascular events in cancer survivors to a similar extent to that of patients without cancer. Cancer history not requiring active treatment in last 2 years should not be an obstacle to intensive treatment of hypertension. This post hoc analysis should be considered as hypothesis-generating and merit further clinical trial.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

Association between antihypertensive drugs and oral cancer: a drug target Mendelian randomization study

Background: Recent reports have suggested that antihypertensive drugs may play an oncogenic role in common cancers, but it is still uncertain whether this could influence the risk of oral cancer. Through two-sample Mendelian randomization (MR), we sought to assess the causal effect of antihypertensive drugs on oral cancer outcomes. Methods: To proxy the exposure of antihypertensive drugs, we utilized two genetic instruments, including expression quantitative trait loci of drug target genes and genetic variants within or around drug target genes related to blood pressure from genome-wide association studies. Inverse-variance-weighted MR (IVW-MR) and summary-data-based MR (SMR) were employed to compute the instrument effect estimates. Results: It was observed through IVW-MR analysis that there is a positive relationship between KCNH2 (target of beta-adrenoceptor blockers)-mediated blood pressure and oral cancer (odds ratio [OR] = 1.197, 95% confidence interval [CI] = 1.028-1.394). Similarly, SMR analysis demonstrated that a higher expression of KCNH2 (target of beta-adrenoceptor blockers) was linked to a greater risk of oral cancer (OR = 2.223, 95% CI = 1.094-4.516). Both analyses yielded no consistent evidence of other associations. Conclusion: This two-sample MR study proposed a latent causal association between KCNH2 (target of beta-adrenoceptor blockers) inhibition and diminished risk of oral cancer.

Immune Checkpoint Inhibitors Do Not Increase Short-Term Risk of Hypertension in Cancer Patients: a Systematic Literature Review and Meta-Analysis

Background:

Immune checkpoint inhibitors (ICIs) are becoming widely used for novel cancer treatments. Immune-related adverse events, including cardiac toxicity, are frequently observed following immune checkpoint inhibitor (ICI) use. However, little is known regarding the association between ICIs initiation and hypertension in cancer patients.

Methods:

A systematic literature search was performed using PubMed, EMBASE, Cochrane Library, and Web of Science Core Collection. The risk of hypertension associated with ICI initiation in randomized controlled trials (RCTs) was evaluated. Hypertension was categorized according to the Common Terminology Criteria for Adverse Events. The odds ratios of grades I to V and grades III to V hypertension were calculated using a random-effects meta-analysis.

Results:

Thirty-two RCTs (n=19 810 cancer patients) were included. At a median follow-up of 36 months, the median overall survival was 15 months in the ICI group. ICI initiation was not significantly associated with hypertension (grades I–V: odds ratio, 1.12 [95% CI, 0.96–1.30]; grades III–V: odds ratio, 0.95 [95% CI, 0.78–1.16]). Additionally, no significant differences in hypertension risk were evident in ICI combination therapies with various drugs, including anti-VEGF (vascular endothelial growth factor) agents. In a subgroup analysis based on clinical setting (placebo RCT versus nonplacebo RCT), there were discrepancies between the results obtained with different methodologies, with patients in the nonplacebo RCTs having higher grades I–V hypertension (I 2 =88.6%, P for heterogeneity=0.003).

Conclusions:

ICI initiation was not associated with short-term risk of hypertension in cancer patients, and the association was similar regardless of concomitant treatment with other anticancer drugs.