Abstract
PurposeWe explored renal cell cancer (RCC) survival among users of antihypertensive medication as hypertension is proposed to be a risk factor for RCC and ACE-inhibitors and angiotensin receptor blockers (ARBs) have been associated with improved prognosis of RCC.MethodsFinnish cohort of 13,873 participants with RCC diagnosed between 1995–2012 was formed from three national databases. RCC cases were identified from Finnish Cancer Registry, medication usage from national prescription database and co-morbidities from Care Registry of Healthcare. Logistic regression was used to calculate odds ratios for metastatic tumor extent at the time of diagnosis. Risk of RCC specific death after diagnosis was analyzed using Cox regression adjusted for tumor clinical characteristics.ResultsA total of 5,179 participants died of RCC during the follow-up. No risk association was found for metastatic tumor extent for any drug group. ACE-inhibitors, but no other drug group were associated with decreased risk of RCC specific death overall (HR 0.88, 95% CI 0.82–0.95) compared to non-users. In time-dependent analysis high-dose use of ACE-inhibitors (392 Defined Daily Dose (DDD)/year), HR 0.54, 95% CI 0.45–0.66) and ARBs (786.1 DDD/year, HR 0.66, 95% CI 0.50–0.87) associated with improved RCC survival. No information of TNM-classification or tobacco smoking was available.ConclusionACE-inhibitors and ARBs in high dose associated with improved RCC specific survival. This may reflect overall benefit of treating hypertension with medication targeting renin-angiotensin system (RAS) system among RCC patients. Further studies are needed to explore the role of RAS in RCC.
Highlights
Incidence of renal cell cancer (RCC) has rather constantly increased since year 2000 worldwide
A case–control study conducted in Canada found that especially the use of angiotensin receptor blockers (ARB) and ACE-inhibitors were associated with increased risk of kidney cancer especially after three years of exposure [11]
There was no statistical difference between men and women considering antihypertensive medication use
Summary
Incidence of renal cell cancer (RCC) has rather constantly increased since year 2000 worldwide. Use of antihypertensive medication has been associated with the increased risk of developing RCC, the topic is controversial and it is proposed to some extent reflect the risk association between hypertension and RCC [7, 8]. Recent study results propose hypertension to be an independent risk factor for the development of RCC. The observation was coherent with larger European cohort study, in which elevated blood pressure was found to be an independent risk factor even after smoking and antihypertensive medication use were considered [10]. A case–control study conducted in Canada found that especially the use of angiotensin receptor blockers (ARB) and ACE-inhibitors were associated with increased risk of kidney cancer especially after three years of exposure [11]
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