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UBC Theses and Dissertations

Anti-hypertensive medications and risk of colorectal cancer in British Columbia Qi, Jia


Purpose: Evidence for impacts of antihypertensive medication use on risk of colorectal cancer is mixed. We conducted an epidemiologic study to evaluate associations of five commonly prescribed classes of antihypertensive medications: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and diuretics with colorectal cancer risk. Methods: A systematic review and meta-analysis was conducted to appraise and synthesize previous epidemiologic studies of associations between anti-hypertensive medications and colorectal cancer risk. A systematic search for previously published studies was conducted in MEDLINE, Embase, Web of Science, and the Cochrane library (August 2021). Meta-analytic risk ratios (RRs) and corresponding 95% confidence intervals (95% CIs) were calculated using the inverse variance method. To address methodological limitations of previous studies, a population-based retrospective cohort study (n=1,693,297) was conducted using administrative health data captured for people living in the province of British Columbia (BC). Antihypertensive medication use was parameterized as; ever use, cumulative duration of use, and cumulative dose used. A new-user design was applied to minimize the influence of prevalent use of antihypertensive medications. Multivariate, time-varying cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs for associations between medication use and occurrence of colorectal cancer. Results: No significant associations of ACEIs, ARBs, BBs, CCBs or diuretics with colorectal cancer risk were observed in the meta-analysis. In the cohort, 28,460 incident cases of colorectal cancer were identified during the follow-up period (mean=12.9 years). Diuretic use (ever/never) was associated with increased risk of colorectal cancer (HR 1.08, 95% CI 1.04-1.12). However, no associations were observed when cumulative duration and cumulative dose of diuretic use were assessed. No significant associations between any of the other four classes of medications (ever use, cumulative duration and cumulative dose) and colorectal cancer risk were observed. Conclusion: The findings help to clarify associations between the five commonly prescribed classes of antihypertensive medications and colorectal cancer risk, suggesting that these antihypertensive medications are unlikely to influence colorectal cancer risk.

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