Risk assessment for cancer development associated with the use of antihypertensives

Autor: Levicki, Rea, Benčić, Martina Lovrić, Jelaković, Bojan
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Cardiologia Croatica
Volume 14
Issue 5-6
ISSN: 1848-5448
1848-543X
Popis: Brojna su klinička istraživanja ispitivala mogući karcinogeni učinak anihipertenzivnih lijekova. Istraživan je njihov učinak na nastanak karcinoma prostate, kože, dojke, bubrega i pluća. Dokazano je da ukupni rizik od nastanka karcinoma pri uporabi svih antihipertenziva nije povišen. Za pojedine skupine karcinoma dokazano je smanjenje rizika od nastanka maligne bolesti uz uporabu antihipertenzivne terapije. Dobivene su vrijednosti jednake pri dugotrajnoj uporabi lijekova (> 7,5 godina); s duljinom primjene terapije ne dolazi do očekivanog porasta rizika, dok se u nekim istraživanjima vrijednost relativnog rizika s duljinom uporabe antihipertenziva smanjuje. Nijedna skupina antihipertenziva nije bila vezana s povišenim relativnim rizikom od nastanka karcinoma prostate, štoviše, uporaba beta-blokatora i dugogodišnja uporaba alfa-blokatora imala je protektivan učinak. Agencija za lijekove i medicinske proizvode i Europska agencija za lijekove obavještavaju o povišenom riziku od nastanka nemelanomskog raka kože uz uporabu hidroklorotiazida. Hrvatsko društvo za hipertenziju preporučuje razmotriti u kliničkoj praksi omjer koristi i rizika terapije hidroklorotiazidom, adekvatno informirati pacijenta te zajedno s njim donijeti odluku o daljnjoj uporabi hidroklorotiazida u terapiji. Relativni rizik za nastanak karcinoma dojke pri uporabi blokatora kalcijskih kanala, ali i drugih antihipertenziva nije bio povišen, vrijednosti su bile jednake onima u kontrolnim skupinama. Vjerojatnije je da je rizik od nastanka karcinoma bubrega vezan za samu patogenezu arterijske hipertenzije, a ne uz uporabu diuretske terapije. Zaključno, osim dokazane povezanosti uporabe hidroklorotiazida s nastankom nemelanomskog raka kože, valjanih dokaza za moguću karcinogenost drugih antihipertenziva još nema pa stoga preporučujemo u kliničkoj praksi nastaviti slijediti postojeće smjernice za liječenje arterijske hipertenzije uz reevaluaciju odluke o terapiji hidroklorotizadom u skladu s preporukama Hrvatskoga društva za hipertenziju.
Numerous clinical trials have evaluated the potential cancerogenic effect of antihypertensive medications. Their influence on the development of prostate, skin, breast, kidney, and lung cancer has been examined. It was demonstrated that using antihypertensives does not elevate the total risk for cancer development. For some cancer groups there was even a reduction in risk of the development of malignant diseases under antihypertensive therapy. The results were the same in long-term use of the medications (>7.5 years), and longer application of the treatment did not lead to the expected increase in risk, with some studies finding a reduction in relative risk values with longer use of antihypertensives. No group of antihypertensives was associated with increased relative risk for the development of prostate cancer, and the use of beta-blockers and long-term use of alfa-blockers even had a protective effect. HALMED and the European Medicines Agency reported increased risk for the development of non-melanoma skin cancer with the use of hydrochlorothiazide. The Croatian Society of Hypertension recommends evaluating of the risk-benefit ratio of hydrochlorothiazide therapy in clinical practice, adequately informing the patient, and then deciding on the further use of hydrochlorothiazide in therapy together with the patient. The relative risk of breast cancer development was not increased due to the use of calcium channel blockers or other hypertensives, and the values did not differ from the control groups. It is more likely that the risk of kidney cancer development is associated with the pathogenesis of arterial hypertension rather than the use of diuretic therapy. In conclusion, apart from the demonstrated association between the use of hydrochlorothiazide and the development of non-melanoma skin cancer, there is still no valid evidence for the possible cancerogenic effect of other antihypertensives; in clinical practice we therefore recommend continuing to follow current guidelines for the treatment of arterial hypertension with a reevaluation of the use of hydrochlorothiazide therapy as recommended by the Croatian Society of Hypertension.
Databáze: OpenAIRE
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