Abstract
Elevated Renal cell carcinoma (RCC) risk has been associated with the use of several antihypertensive medications but has not yet been elucidated in the populations prescribed alpha-1 blockers that are commonly used in the treatment of hypertension and lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS-BPH). The aim of the present study was to investigate the association between alpha-1 blocker use and the risk of developing RCC using a nationwide population-based database in Taiwan. Patients who were treated with alpha-1 blockers for at least 28 days were identified through the Taiwan National Health Insurance Research Database from 2000 to 2010. The unexposed participants were matched with the exposed cases according to age, sex, and index year at a ratio of 3:1. Cox proportional hazards regression, stratified by sex and comorbidities and adjusted for age, was performed to estimate hazard ratios (HRs) for the risk of subsequent RCC. Among 2,232,092 subjects, patients who received alpha-1 blocker treatment had a higher risk of RCC than the unexposed group. Taking into account hypertension and BPH, the adjusted HR was significantly higher in male alpha-1 blocker users who had no BPH and either the presence (HR: 1.63, 95% confidence interval [CI] = 1.22–2.18) or absence (HR: 2.31, 95% CI = 1.40–3.81) of hypertension than in men not receiving these drugs. Taken together, male alpha-1 blocker users who had no comorbidity of BPH exhibited an increased risk for developing RCC independent of hypertension. Further study is warranted to elucidate the underlying mechanisms of this association.
Highlights
Renal cell carcinoma (RCC) is the most common malignant form of kidney cancer that arises from the renal epithelium
Several retrospective observational studies have found a link between elevated RCC risk and the use of antihypertensive medications, including diuretics, calcium channel blockers, beta-blockers, and angiotensinconverting enzyme inhibitors [5,6,7,8], it is unclear whether the increased risk is caused by hypertension itself or by the use of antihypertensive medication
We aimed to investigate the relationship between alpha-1 blocker use and the risk of RCC using the National Health Insurance Research Database (NHIRD), a population-based database derived from the claims data of the National Health Insurance program of Taiwan [23]
Summary
Renal cell carcinoma (RCC) is the most common malignant form of kidney cancer that arises from the renal epithelium. RCC accounts for 5% and 3% of all oncological diagnoses in men and in women, respectively [1] and is an often lethal malignancy for which there is no effective preventative and therapeutic strategy. The incidence of RCC is approximately 1.6 to 2.0 times higher in men than in women after adjustment for age, and the estimated incidence increases in the older population, with a peak between 60 and 70 years of age [2]. Hypertension is a risk factor for RCC; the relationship was identified in several large prospective cohort studies [3, 4]. In this regard, effective blood pressure control may lower the risk of RCC. Several retrospective observational studies have found a link between elevated RCC risk and the use of antihypertensive medications, including diuretics, calcium channel blockers, beta-blockers, and angiotensinconverting enzyme inhibitors [5,6,7,8], it is unclear whether the increased risk is caused by hypertension itself or by the use of antihypertensive medication
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