TOPLINE

Patients treated exclusively with angiotensin-converting enzyme inhibitors (ACEIs) had lower overall cancer incidence than those treated exclusively with angiotensin receptor blockers (ARBs) over 23 years of follow-up. ACEI therapy was linked to lower odds for breast, prostate, melanoma, non-Hodgkin lymphoma, kidney, and colorectal cancers, but higher odds for lung, bladder, and pancreatic cancers.

METHODOLOGY

• Retrospective cohort study using electronic health records from a healthcare organization in Israel analyzed cancer incidence among adults with hypertension (53.0% women) who were treated exclusively with ACEIs or ARBs; all participants were free of cancer as of January 1, 2000.
• A total of 346,405 exclusive ACEI users and 77,018 exclusive ARB users were included after excluding patients who switched between medication classes or were noncompliant with therapy.
• Mean treatment duration was 10.2 years among ACEI users and 9.5 years among ARB users, with mean age at treatment initiation of 66.8 years for ACEI users and 68.7 years for ARB users.
• Active cancer follow-up spanned from January 2002 through December 2024, allowing for a 2-year exposure window, with up to 23 years of observation.
• Primary outcome was diagnosis of any cancer; secondary outcomes included the 10 most prevalent cancer types diagnosed during follow-up.

TAKEAWAY

• ACEI therapy was associated with lower overall odds of cancer compared with ARB therapy (odds ratio [OR], 0.851; 95% CI, 0.838-0.865).
• The odds of breast cancer (OR, 0.830), prostate cancer (OR, 0.841), melanoma (OR, 0.736), non-Hodgkin lymphoma (OR, 0.877), kidney cancer (OR, 0.893), and colorectal cancer (OR, 0.878; P < .05 for all) were lower among ACEI users than among ARB users.
• The odds of lung cancer (OR, 1.136), bladder cancer (OR, 1.226), and pancreatic cancer (OR, 1.140; P < .05 for all) were higher among ACEI users than among ARB users.
• The risk for leukemia was not significantly different among the groups.

IN PRACTICE

"The findings do not support changes in current prescribing recommendations but contribute additional evidence to the ongoing evaluation of the long-term safety profiles of RAAS-modulating therapies," wrote the authors of the study.

SOURCE

The study was led by Belle Tamir Brahms, Department of Family Medicine, Clalit Health Services, Sharon-Shomron, Israel. It was published online on July 23 in PLoS One.

LIMITATIONS

Being a retrospective observational study, it cannot establish causality. Residual confounding remains possible despite adjustment for demographic and exposure-related factors. The study population came from a single national healthcare organization and may not fully represent populations from other healthcare systems.

DISCLOSURES

No specific funding was reported for this work. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.