There is little evidence of an association between antihypertensive drug use and risk for pancreatic cancer in patients with chronic pancreatitis, according to a study published in the British Journal of Cancer.
Pancreatic carcinogenesis in chronic pancreatitis patients may be inhibited by antihypertensive drugs. In this population-based study, researchers identified a cohort of all patients with a first-time diagnosis of chronic pancreatitis between 1996 and 2012 from the Danish National Patient Registry (N=8311). Information was obtained on pancreatic cancers, comorbidities, prescription drug use, and vital signs. Patients were followed from 1 year after diagnosis with chronic pancreatitis until pancreatic cancer, death, emigration, or December 31, 2015, whichever came first. Researchers assessed the use of antihypertensive drugs, requiring ≥2 filled prescriptions of the same drug class.
During 60,365 person-years of follow-up, there were 153 diagnoses of pancreatic cancer. The overall distribution of risk estimates for drug classes appeared to be centered around the null; use of aldosterone receptor antagonists may carry a lower risk for pancreatic cancers, whereas the use of calcium channel blockers may carry elevated risk. There was no measurable impact on these estimates after adjusting for alcohol- and smoking-related diseases.
This study is limited by confounding by indication, which may have affected estimates, because people who use antihypertensive drugs have more comorbidities and a potentially higher baseline risk for pancreatic cancer. Some of the confidence intervals were wide because pancreatic cancer was a rare event. There was limited information on alcohol consumption and exposure to tobacco smoking because such diagnoses were under-recorded in the registry, so there may be residual confounding from these substances.
“We did not observe any clinically relevant association between use of antihypertensive drugs and pancreatic cancer risk in patients with chronic pancreatitis,” the researchers concluded. “Chronic pancreatitis patients have a particularly high risk [for] pancreatic cancer, possibly due to sustained pancreatic inflammation. These patients generally exhibit poor lifestyle choices with a high frequency of tobacco smoking and high alcohol consumption. As these substances are closely associated with pancreatic cancer, they may mitigate a potential anticancer effect of antihypertensive drugs.”
Kirkegård J, Mortensen FV, Cronin-Fenton D. Antihypertensive drugs and pancreatic cancer risk in patients with chronic pancreatitis: a Danish nationwide population-based cohort study [published online September 2, 2019]. Br J Cancer. doi: 10.1038/s41416-019-0562-y