Table 3.
Rate of any and specific cancers by treatment and crude and adjusted hazard ratios in people with hypertension taking angiotensin receptor blocker (ARB) or angiotensin converting enzyme (ACE) inhibitor
| Total cancers | Total person time | Rate per 1000 person years (95% CI) | HR (95% CI) | P value† | ||
|---|---|---|---|---|---|---|
| Crude | Adjusted* | |||||
| Any cancer | ||||||
| Ever used ARB | 5077 | 385 101 | 13.2 (12.8 to 13.6) | 0.99 (0.96 to 1.02) | 1.03 (0.99 to 1.06) | 0.10 |
| ACE inhibitor use only | 15126 | 1 157 222 | 13.1 (12.9 to 13.3) | 1.00‡ | 1.00‡ | |
| Lung cancer | ||||||
| Ever used ARB | 422 | 385 101 | 1.1 (1.0 to 1.2) | 0.72 (0.65 to 0.80) | 0.84 (0.75 to 0.94) | 0.003 |
| ACE inhibitor use only | 1722 | 1 157 222 | 1.5 (1.4 to 1.6) | 1.00‡ | 1.00‡ | |
| Breast cancer | ||||||
| Ever used ARB | 780 | 221 072 | 3.5 (3.3 to 3.8) | 1.11 (1.02 to 1.21) | 1.11 (1.01 to 1.21) | 0.02 |
| ACE inhibitor use only | 1631 | 523 186 | 3.1 (3.0 to 3.3) | 1.00‡ | 1.00‡ | |
| Prostate cancer | ||||||
| Ever used ARB | 700 | 164 029 | 4.3 (4.0 to 4.6) | 1.14 (1.05 to 1.24) | 1.10 (1.00 to 1.20) | 0.04 |
| ACE inhibitor use only | 2325 | 634 035 | 3.7 (3.5 to 3.8) | 1.00‡ | 1.00‡ | |
| Colon cancer | ||||||
| Ever used ARB | 384 | 385 101 | 1.0 (0.9 to 1.1) | 0.99 (0.88 to 1.11) | 1.02 (0.91 to 1.16) | 0.70 |
| ACE inhibitor use only | 1132 | 1 157 222 | 1.0 (0.9 to 1.0) | 1.00‡ | 1.00‡ | |
*Adjusted for age, sex, BMI, smoking, alcohol, diabetes (with or without metformin/insulin use), hypertension, heart failure, statin use, index of multiple deprivation score, calendar year.
†From Cox model with angiotensin receptor blocker/ACE inhibitor status treated as time updated covariate. Estimates from Cox model (for any cancer) suggested that only male sex (1.42, 1.38 to 1.47, older age (5.55, 5.23 to 5.88, for ≥75 v 18-54), smoking (1.49, 1.43 to 1.55), and history of heart failure (1.14, 1.08 to 1.19) were significantly associated with increased cancer risk. There was also evidence of variation by calendar year (P<0.001).
‡Reference category.