Experimental studies implicate the role of the renin-angiotensin system, particularly angiotensin II type-1 and type-2 receptors, in the regulation of cell proliferation, angiogenesis, and tumour progression. A meta analysis done and published in Lancet Oncology showed that patients randomly assigned to telmisartan had a significantly increased risk of new cancer occurrence compared with patients in control groups (7.2%vs 6.0%, risk ratio [RR] 1.08, 95% CI 1.01-1.15; p=0.016). Among specific solid organ cancers examined, only new lung-cancer occurrence was significantly higher in patients randomly assigned to receive ARBs than in those assigned to receive control.
This comes with no surprise given this finding was recently also noted in the large trial that showed that the combination of acei and arbs was causing more hyperkalemia and hypotension. It is interesting though that in animal modes, ACEI and ARBS have an anti VEGF effect and here it is showing increased tumor burden and why just lung cancer( given the location of the enzymes perhaps). I gather it has to be due to Anti TGF-B properties or VEGF biology. But I am not sure
More studies of such need to be done before we say this is final and avoid these drugs.
More studies of such need to be done before we say this is final and avoid these drugs.
Some references
The new on this front at the European Society of Hypertension meeting in Oslo last week was that the addition of the VALUE data to the analysis removed the over-prevalence of new diagnosis cancers. Of related interest is that both beta-blockers and calcium-antagonists went through episodes when they were though to cause cancer, but where more data and more rigorous analysis disproved this. This is probably what we are facing with ARBs too, but that will of course take more data and more analysis. As of today, there is no indication to stop ARB treatment for fear of cancer.
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