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A comparative analysis of ACE Inhibitors and ARBs as cancer risk factors

Belle Tamir Brahms1, Shani Afek1,2, Michael Hopp3

  • 1Department of Family Medicine, Clalit Health Services, Sharon-Shomron, Israel.

Plos One
|July 23, 2026
PubMed
Abstract

Insights

Long-term use of angiotensin-converting enzyme inhibitors (ACEIs) was linked to lower cancer odds compared to angiotensin receptor blockers (ARBs). This study evaluated cancer incidence in patients exclusively using ACEIs or ARBs.

Area of Science:

  • Cardiovascular Medicine
  • Oncology
  • Pharmacology

Background:

  • Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are common treatments for hypertension.
  • While their cardiovascular and renal benefits are known, their long-term impact on cancer risk is unclear.

Purpose of the Study:

  • To compare cancer incidence between patients exclusively treated with ACEIs and those exclusively treated with ARBs.
  • To investigate the long-term oncologic safety profiles of these RAAS-modulating therapies.

Main Methods:

  • Retrospective cohort study using electronic health records from Clalit Health Services.
  • Included hypertensive adults aged 40+ free of cancer, comparing exclusive ACEI users (346,405) and ARB users (77,018).
  • Analyzed cancer incidence from 2002-2024, adjusting for age, sex, and exposure duration.

Main Results:

  • Overall cancer incidence differed between the ACEI and ARB groups.
  • ACEI therapy was associated with lower overall odds of cancer compared to ARB therapy.
  • Specific cancer type associations varied, with lower odds for ACEI users in several common malignancies; no significant difference was found for leukemia.

Conclusions:

  • Long-term cancer risk appears to differ between exclusive ACEI and ARB users.
  • Findings suggest potential differences in oncologic safety profiles, though causal inference is limited.
  • Further research is needed to understand the biological basis and clinical significance of these observed associations.

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