Background: Cardiovascular diseases (CVDs) and cancer are leading causes of mortality and morbidity worldwide. Despite the widespread use of antihypertensive medications (AHTN), the potential risk of kidney cancer (KC) with AHTN use is unclear.
Objectives: In this pilot study, to identify associations between AHTN use and KC incidence among Korean adults with hypertension.
Methods: In this population-based retrospective study, we included patients aged over 20 years with a diagnosis of hypertension and no history of any cancers from the Korean National Health Insurance database (2006-2019), of which we were able to access a population of 1 million individuals. We then compared AHTN users to non-users, with the definition of AHTN use including angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, calcium channel blockers, and diuretics. The primary outcome was KC incidence and the secondary outcome was all-cause mortality. We conducted multivariate Cox proportional hazards regression analyses, and we performed subgroup analyses according to age, sex, and comorbidities including dyslipidemia, diabetes, and chronic obstructive pulmonary disease. In addition, we performed sensitivity analyses treating AHTNs as time-varying exposures.
Results: A total of 52,217 AHTN users and 33,305 non-users were included in this study. Overall the median (Q1-Q3) age of study participants was 53 (44-62) years. The incidence of KC was 87 cases (0.17%) and 32 cases (0.10%) in AHTN users and non-users, respectively. The all-cause mortality occurred in 3,221 patients (6.17%) and 3,112 patients (9.34%) in AHTN users and non-users, respectively. AHTN users showed a non-significant trend towards an increased risk of KC incidence compared to non-users (hazard ratio (HR) 1.36, 95% confidence interval (CI) 0.90-2.07). In contrast, AHTN users were significantly associated with a decreased risk of all-cause mortality (HR 0.50, 95% CI 0.48-0.53). AHTN users were significantly associated with an increased risk of KC incidence among patients without dyslipidemia (HR 1.88, 95% CI 1.13-3.15). In the time-varying approach, AHTN use was significantly associated with an increased risk of KC incidence (HR 1.58, 95% CI 1.08-2.33).
Conclusions: AHTN use was not significantly associated with an increased risk of KC incidence, while it was found to be significantly associated with a decreased risk of all-cause mortality. We await our ability to conduct further research using a larger hypertensive cohort and to conduct a meta-analysis to definitively answer our questions regarding AHTN usage and KC incidence.
.jpg "Minji Jung, PharmD and PhD (she/her/hers) photo")
