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Calcium Channel Blocker Versus Renin-Angiotensin System Inhibitor in Risk of Kidney Cancer Among Patients With
Minji Jung1, Shufeng Li1,2, Zhengyi Deng1
1Department of Urology, Stanford University Medical Center, Stanford, California, USA.
Background:
Use of antihypertensive medications could be associated with an increased risk of kidney cancer. Despite their various mechanisms of action, whether this association differs between different classes of medications remains unclear.
Objective:
The objective of this study is to compare the risk of kidney cancer between first-line treatment options of antihypertensive medications in a hypertensive population.
Method:
In this retrospective cohort study, we used the MarketScan Databases (2007-2021). We included individuals older than 30 years of age with a diagnosis of hypertension who received first-line medications for hypertension, which included three classes: angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (dCCB). We applied a propensity score matching method and created three separate cohorts: (1) ARB versus ACEI, (2) dCCB versus ACEI, and (3) dCCB versus ACEI. For non-dCCB, we repeated the analyses. The primary outcome was kidney cancer incidence. To assess kidney cancer risk, we applied multivariable conditional Cox proportional hazards models.
Results:
In the first cohort, ARB use was associated with an increased risk of kidney cancer compared to ACEI use (hazard ratio [HR] 1.10, 95% confidence interval [CI] 1.02-1.18). In the second cohort, dCCB use was associated with an increased risk of kidney cancer compared to ACEI use (HR 1.29, 95% CI 1.18-1.40). In the third cohort, dCCB use was associated with a higher risk of kidney cancer compared to ARB use (HR 1.17, 95% CI 1.08-1.28). Null association was shown when comparing non-dCCB with ACEI or ARB use.
Conclusion:
Use of dCCB showed a higher risk of kidney cancer compared to ACEI or ARB use in patients with hypertension.
Insights
Dihydropyridine calcium channel blockers (dCCB) use is linked to a higher kidney cancer risk compared to ACE inhibitors (ACEI) or ARB use. This finding is crucial for hypertension treatment decisions.
Area of Science:
- Nephrology
- Oncology
- Pharmacology
Background:
- Antihypertensive medications may increase kidney cancer risk.
- The differential risk across drug classes is not well understood.
Purpose of the Study:
- To compare kidney cancer risk among first-line antihypertensive drug classes.
- Focus on angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and dihydropyridine calcium channel blockers (dCCB).
Main Methods:
- Retrospective cohort study using MarketScan Databases (2007-2021).
- Included hypertensive patients aged >30 years on ACEI, ARB, or dCCB.
- Propensity score matching and multivariable Cox models used to assess kidney cancer incidence.
Main Results:
- Angiotensin receptor blocker (ARB) use showed increased kidney cancer risk versus ACE inhibitors (ACEI) (HR 1.10).
- Dihydropyridine calcium channel blocker (dCCB) use showed increased kidney cancer risk versus ACEI (HR 1.29) and ARB (HR 1.17).
- No significant association found for non-dCCB classes.
Conclusions:
- Dihydropyridine calcium channel blockers (dCCB) are associated with a higher risk of kidney cancer compared to ACE inhibitors (ACEI) and ARB.
- Findings highlight potential differential risks of antihypertensive drug classes for kidney cancer.
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