Angiotensin-receptor blockers ( also known as sartans ) are a widely used drug class approved for treatment of hypertension, heart failure, diabetic nephropathy, and for cardiovascular risk reduction.
Experimental studies implicate the renin-angiotensin system, particularly angiotensin II type-1 and type-2 receptors, in the regulation of cell proliferation, angiogenesis, and tumour progression.

Researchers at Case Western Reserve University School of Medicine, Cleveland, have evaluated whether sartans affect cancer occurrence, and carried out a meta-analysis of randomised controlled trials of these drugs.

Randomised controlled trials with an Angiotensin-receptor blocker given in at least one group, with a follow-up of at least 1 year, and that enrolled at least 100 patients were included in the analysis.

New-cancer data were available for 61,590 patients from five trials. Data on common types of solid organ cancers were available for 68,402 patients from five trials, and data on cancer deaths were available for 93,515 patients from eight trials.

Telmisartan ( Micardis ) was the study drug in 30,014 ( 85·7% ) patients who received sartans as part of the trials with new cancer data.

Patients randomly assigned to receive Angiotensin-receptor blockers 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; p=0·016 ).
When analysis was limited to trials where cancer was a prespecified endpoint, the RR was 1·11 ( p=0·001 ).

Among specific solid organ cancers examined, only new lung-cancer occurrence was significantly higher in patients randomly assigned to receive sartans than in those assigned to receive control ( 0·9% vs 0·7%, RR 1·25; p=0·01 ).

No statistically significant difference in cancer deaths was observed ( 1·8% vs 1·6%, RR 1·07; p=0·183 ).

This meta-analysis of randomised controlled trials suggests that Angiotensin-receptor blockers are associated with a modestly increased risk of new cancer diagnosis. Given the limited data, it is not possible to draw conclusions about the exact risk of cancer associated with each particular drug.

Source: Lancet Oncology, 2010

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