Evidence map›Paper›PMID 33794209›Full record

ArticleThe Lancet. Oncology2021

Antihypertensive treatment and risk of cancer: an individual participant data meta-analysis.

Emma Copland, Dexter Canoy, Milad Nazarzadeh, Zeinab Bidel, Rema Ramakrishnan, Mark Woodward, John Chalmers, Koon K Teo, Carl J Pepine, Barry R Davis and 4 more

Open access · hybridAbstract readNetwork Meta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
56citing papers in PubMed, 6 pooled it
11.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

56 citing papers in PubMed, 6 syntheses or guidelines pooled it, 101 citations in OpenAlex.

  1. Pooled it
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  7. Article
  8. Recent updates and perspectives in "Onco-hypertension".Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Review
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  16. Mitochondrial CaJournal of cellular physiology · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 10 institutions in 6 countries.

Emma CoplandDeep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Dexter CanoyDeep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Milad NazarzadehDeep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
Zeinab BidelDeep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Rema RamakrishnanDeep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
Mark WoodwardThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Epidemiology and Biostatistics, The George Institute for Global Health, Imperial College London, London, UK; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
John ChalmersThe George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Koon K TeoPopulation Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
Carl J PepineCollege of Medicine, University of Florida, Gainesville, FL, USA.
Barry R DavisSchool of Public Health, University of Texas, Houston, TX, USA.
Sverre KjeldsenDepartment of Cardiology, University of Oslo, Ullevaal Hospital, Oslo, Norway.
Johan SundströmDepartment of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
Kazem RahimiDeep Medicine, Oxford Martin School, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address: kazem.rahimi@wrh.ox.ac.uk.
Blood Pressure Lowering Treatment Trialists' Collaboration
University of Oxford · GBUppsala University · SENational Institute for Health Research · GBThe University of Texas Health Science Center at Houston · USOslo University Hospital · NOThe George Institute for Global Health · AUUniversity of Florida · USHamilton Health Sciences · CAImperial College London · GBUniversity of Oslo · NO

Funding

British Heart Foundation CH/1996001/9454British Heart Foundation FS/19/36/34346British Heart Foundation PG/18/65/33872Cancer Research UK 16896Department of HealthMedical Research Council MC_U137686849Medical Research Council MC_UU_00017/4Medical Research Council MC_UU_12026/6
6 · The paper itself

Abstract

backgroundSome studies have suggested a link between antihypertensive medication and cancer, but the evidence is so far inconclusive. Thus, we aimed to investigate this association in a large individual patient data meta-analysis of randomised clinical trials.

methodsWe searched PubMed, MEDLINE, The Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from Jan 1, 1966, to Sept 1, 2019, to identify potentially eligible randomised controlled trials. Eligible studies were randomised controlled trials comparing one blood pressure lowering drug class with a placebo, inactive control, or other blood pressure lowering drug. We also required that trials had at least 1000 participant years of follow-up in each treatment group. Trials without cancer event information were excluded. We requested individual participant data from the authors of eligible trials. We pooled individual participant-level data from eligible trials and assessed the effects of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), β blockers, calcium channel blockers, and thiazide diuretics on cancer risk in one-stage individual participant data and network meta-analyses. Cause-specific fixed-effects Cox regression models, stratified by trial, were used to calculate hazard ratios (HRs). The primary outcome was any cancer event, defined as the first occurrence of any cancer diagnosed after randomisation. This study is registered with PROSPERO (CRD42018099283).

findings33 trials met the inclusion criteria, and included 260 447 participants with 15 012 cancer events. Median follow-up of included participants was 4·2 years (IQR 3·0-5·0). In the individual participant data meta-analysis comparing each drug class with all other comparators, no associations were identified between any antihypertensive drug class and risk of any cancer (HR 0·99 [95% CI 0·95-1·04] for ACEIs; 0·96 [0·92-1·01] for ARBs; 0·98 [0·89-1·07] for β blockers; 1·01 [0·95-1·07] for thiazides), with the exception of calcium channel blockers (1·06 [1·01-1·11]). In the network meta-analysis comparing drug classes against placebo, we found no excess cancer risk with any drug class (HR 1·00 [95% CI 0·93-1·09] for ACEIs; 0·99 [0·92-1·06] for ARBs; 0·99 [0·89-1·11] for β blockers; 1·04 [0·96-1·13] for calcium channel blockers; 1·00 [0·90-1·10] for thiazides).

interpretationWe found no consistent evidence that antihypertensive medication use had any effect on cancer risk. Although such findings are reassuring, evidence for some comparisons was insufficient to entirely rule out excess risk, in particular for calcium channel blockers.

fundingBritish Heart Foundation, National Institute for Health Research, Oxford Martin School.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsBlood PressureCalcium Channel BlockersHumansHypertensionNeoplasmsRandomized Controlled Trials as TopicRisk FactorsAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAntihypertensive AgentsCalcium Channel Blockers

Identifiers

PMID33794209
PMCPMC8024901
OpenAlexW3145416765

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.