Antihypertensive Medications and Risk of Melanoma and Keratinocyte Carcinomas: A Systematic Review and Meta-Analysis

Abstract

Some anti-hypertensive medications are photosensitizing. The implications for skin cancer risk remain unclear, as results from prior studies are inconsistent and as new evidence is published. We performed a systematic review and meta-analysis to evaluate the association between anti-hypertensives and common skin cancers (cutaneous squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and melanoma), and to evaluate dose-response relationships. Forty-four articles met inclusion criteria, and 42 could be meta-analyzed. Increased risks were seen for BCC with calcium channel blockers (relative risk [RR] 1.17, 95% CI 1.11-1.22), diuretics (RR 1.06, 95% CI 1.03-1.10), and thiazides (RR 1.10, 95% CI 1.04-1.16); for SCC with calcium channel blockers (RR 1.08, 95% CI 1.01-1.14), diuretics (RR 1.29, 95% CI 1.17-1.43), and thiazides (RR 1.36, 95% CI 1.15-1.61); and for melanoma in angiotensin-converting-enzyme inhibitors (RR 1.09, 95% CI 1.03-1.14), calcium channel blockers (RR 1.08, 95% CI 1.03-1.12), and thiazides (RR 1.09, 95% CI 1.02-1.17). The quality of evidence was low or very low. We observed evidence for dose-response for thiazides with BCC, angiotensin-converting-enzyme inhibitors, diuretics, and thiazides with SCC, and angiotensin-converting-enzyme inhibitors, diuretics, and thiazides with melanoma. Our meta-analysis supports a potential causal association between some antihypertensives, particularly diuretics, and skin cancer risk.