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Blood Pressure, Hypertension, and Antihypertensive Medication Use and Risk of Total and Fatal Prostate Cancer in Black and White Men in the Atherosclerosis Risk in Communities (ARIC) Study

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Abstract

Black men are disproportionately burdened by hypertension and prostate cancer (PCa), and some cohorts suggest hypertension is associated with increased PCa risk. We investigated the association of hypertension and antihypertensive use with total (N = 889; 290 Black, 599 White) and fatal (N = 127; 42 Black, 85 White) PCa risk in 6658 (1578 Black, 5080 White) men in the Atherosclerosis Risk in Communities study. In adjusted Cox models, time-updated untreated stage 1 hypertension (systolic/diastolic blood pressure 130–139/80–89 mmHg) was associated with a higher risk of fatal PCa compared to untreated normal blood pressure (hazard ratio (HR) = 1.95; 95% confidence interval (CI) = 1.03–3.70). Compared to untreated normal/elevated blood pressure (combined given few events in those with untreated normal blood pressure), the association was significant in Black (HR = 3.35; 95% CI = 1.27–8.83), but not White (HR = 1.21; 95% CI = 0.58–2.55) men. Ever antihypertensive use was associated with a lower risk of fatal PCa compared to never use (HR = 0.52; 95% CI = 0.31–0.87), including short-term (< 10 years) and long-term (310 years) use (p-trend = 0.02) with similar inverse associations in Black and White men. Hypertension and antihypertensive use were not significantly associated with total PCa. The positive association of untreated stage 1 hypertension and fatal PCa warrants additional confirmation, especially in Black men, and characterization of the underlying mechanism.

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The data, analytic methods, and study materials will be made available to other researchers for purposes of reproducing the results or replicating the procedure.

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Acknowledgements

The authors thank the staff and participants of the ARIC study for their important contributions. Cancer data were provided by the Maryland Cancer Registry, Center for Cancer Prevention and Control, Maryland Department of Health, with funding from the State of Maryland and the Maryland Cigarette Restitution Fund. The collection and availability of cancer registry data is also supported by the Cooperative Agreement NU58DP007114, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Funding

The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract Nos. (75N92022D00001, 75N92022D00002, 75N92022D00003, 75N92022D00004, 75N92022D00005). Studies on cancer in ARIC are also supported by the National Cancer Institute (U01 CA164975). This research was additionally supported by an NCI Cancer Center Support Grant (P30 CA006973) and the Maryland Cigarette Restitution Fund at Johns Hopkins. Dr. Marrone was supported by NIH/NCI grants T32 CA09314 and K99 CA246097. Dr. Gomez contributed to this article as an employee of the University of Mississippi Medical Center. Currently, he is employed at the National Institutes of Health. The content of this work is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the US Government.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Michael T. Marrone, Corinne E. Joshu & Elizabeth A. Platz

  2. Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA

    Anna E. Prizment

  3. University of Minnesota Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    Anna E. Prizment

  4. Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA

    Wanmei Wang

  5. Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA

    Eldrin Bhanat & Christian R. Gomez

  6. Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA

    Eldrin Bhanat & Christian R. Gomez

  7. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA

    Kenneth R. Butler

  8. Mind Center, University of Mississippi Medical Center, Jackson, MS, USA

    Kenneth R. Butler & Thomas H. Mosley

  9. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    David Couper & Thomas H. Mosley

  10. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    Corinne E. Joshu & Elizabeth A. Platz

  11. Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Elizabeth A. Platz

  12. Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA

    Christian R. Gomez

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  1. Michael T. Marrone
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Contributions

Conceptualization: MTM, EAP, CRG; data curation: MTM, EAP, CEJ, DC, KRB, THM; statistical analysis: MTM, WM, EAP; writing—original draft: MTM; writing—review and editing: all authors.

Corresponding author

Correspondence to Michael T. Marrone.

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Ethics Approval

Participants gave written informed consent, and institutional review boards at each study site approved the study protocol.

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Informed consent was obtained from all ARIC study participants included in this study.

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Competing Interests

MTM is a current employee of Sobi Inc. All other authors have no relevant financial or non-financial interests to disclose.

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Marrone, M.T., Prizment, A.E., Wang, W. et al. Blood Pressure, Hypertension, and Antihypertensive Medication Use and Risk of Total and Fatal Prostate Cancer in Black and White Men in the Atherosclerosis Risk in Communities (ARIC) Study. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01885-y

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