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Blood Pressure Lowering and Risk of Cancer: Individual Participant-Level Data Meta-Analysis and Mendelian

Milad Nazarzadeh¹, Emma Copland², Karl Smith Byrne³

¹Deep Medicine, Oxford Martin School, University of Oxford, Oxford, United Kingdom; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom.

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Summary

Long-term blood pressure lowering medications do not significantly increase or decrease cancer risk. This large meta-analysis of randomized trials found no substantial impact on incident cancer or cancer death.

Keywords:

epidemiology genetics hypertension ischemic disease lifestyle risk factors lung cancer prevention renal cell cancer

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Area of Science:

Cardiovascular Medicine
Oncology
Pharmacology

Background:

Concerns exist regarding long-term antihypertensive medication use and cancer risk.
Evidence from randomized controlled trials (RCTs) on this topic is limited, with most data from observational studies.

Purpose of the Study:

To assess the effect of long-term blood pressure lowering on new-onset cancer risk.
To evaluate the impact on cause-specific cancer mortality and site-specific cancers.

Main Methods:

Individual participant data from 42 RCTs were pooled for meta-analysis.
Cox proportional hazards regression was used, with Mendelian randomization for site-specific cancers.
Primary outcome was incident cancer; secondary outcomes included cancer death and specific cancer types.

Main Results:

Analysis of 314,016 participants showed no association between blood pressure reduction and overall cancer risk or death.
No significant effect was observed over follow-up or across baseline subgroups.
A potential link with lung cancer was noted, but not supported by Mendelian randomization.

Conclusions:

Pharmacologic blood pressure lowering does not appear to substantially impact the risk of developing cancer.
There is no evidence suggesting it affects cancer mortality or specific cancer types.