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2010 Position Paper of the Italian Society of Hypertension (SIIA)

Angiotensin Receptor Blockers and Risk of Cancer

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Abstract

Antihypertensive therapy has been demonstrated to significantly reduce cardiovascular and noncardiovascular mortality in randomized controlled clinical trials. In the past, however, doubts have been raised on the safety of one class of blood pressure lowering drugs, namely the angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]), in terms of increased risk of myocardial infarction. Several comprehensive meta-analyses have definitely demonstrated no significant increased risk of myocardial infarction in patients treated with ARBs compared with placebo or any other active treatments. More recently, a partial meta-analysis has suggested a potential link between the use of this drug class and an increased risk of cancer. Although a further comprehensive network meta-analysis demonstrated the lack of any increased risk of cancer development or cancer mortality in patients treated with different antihypertensive drug classes, including ARBs, compared with placebo, this report has generated claims and uncertainties in the medical community and produced a vast echo in the lay press. The biological plausibility, the potential pathophysiological mechanisms, and the clinical evidence that rule out such hypotheses are discussed here. The present article, which represents a position paper of the Italian Society of Hypertension (SIIA), states that the benefits derived from the use of ARBs outweigh the potential risks, and that the use of these drugs should be maintained according to present indications.

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Acknowledgements

The authors wish to thank Giuliano Tocci, MD, and Francesca Palano, MD, for their help and assistance in the revision of the manuscript. MV has received research grants from Novartis, has served in international advisory boards of Sanofi-Aventis, Bayer, Novartis, Boehringer-Ingelheim and Daichii Sankyo, and has lectured in symposia supported by several drug companies producing ARBs; AM has no conflicts of interest to disclose.

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Authors and Affiliations

  1. Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine, University of Rome “Sapienza“, Sant’ Andrea Hospital, Via di Grottarossa 1035-9, 00189, Rome, Italy

    Massimo Volpe MD, FAHA, FESC (Chair)

  2. IRCCS Neuromed, Pozzilli, Italy

    Massimo Volpe MD, FAHA, FESC (Chair)

  3. Division of Internal Medicine, Hypertension Unit, University of Milan, San Giuseppe Hospital, Milan, Italy

    Alberto Morganti

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  1. Massimo Volpe MD, FAHA, FESC
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  2. Alberto Morganti
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Correspondence to Massimo Volpe MD, FAHA, FESC.

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Volpe, M., Morganti, A. 2010 Position Paper of the Italian Society of Hypertension (SIIA). High Blood Press Cardiovasc Prev 18, 37–40 (2011). https://doi.org/10.2165/11588060-000000000-00000

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  • DOI: https://doi.org/10.2165/11588060-000000000-00000

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