• Aaron M Drucker, Loes Hollestein, Yingbo Na, Martin A Weinstock, Wen-Qing Li, Husam Abdel-Qadir, and An-Wen Chan.
• Divisions of Dermatology (Drucker, Chan) and Cardiology (Abdel-Qadir), Department of Medicine, University of Toronto; Department of Medicine and Women's College Research Institute (Drucker, Abdel-Qadir, Chan), Women's College Hospital, Toronto, Ont.; Department of Dermatology (Drucker, Weinstock, Li), Brown University, Providence, RI; Erasmus MC Cancer Institute (Hollestein), Rotterdam, The Netherlands; Department of Research (Hollestein), Netherlands Comprehensive Cancer Center (IKNL), Utrecht, The Netherlands; ICES Central (Drucker, Abdel-Qadir) and ICES University of Toronto (Na, Chan), Toronto, Ont.; Department of Cancer Epidemiology (Li), Peking University Cancer Hospital & Institute, China.
• CMAJ. 2021 Apr 12; 193 (15): E508-E516.

BackgroundThe risk of skin cancer associated with antihypertensive medication use is unclear, although thiazides have been implicated in regulatory safety warnings. We aimed to assess whether use of thiazides and other antihypertensives is associated with increased rates of keratinocyte carcinoma and melanoma.MethodsWe conducted a population-based inception cohort study using linked administrative health data from Ontario, 1998-2017. We matched adults aged ≥ 66 years with a first prescription for an antihypertensive medication (thiazides, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, β-blockers) by age and sex to 2 unexposed adults who were prescribed a non-antihypertensive medication within 30 days of the index date. We evaluated each antihypertensive class in a separate cohort study. Our primary exposure was the cumulative dose within each class, standardized according to the World Health Organization's Defined Daily Dose. Outcomes were time to first keratinocyte carcinoma, advanced keratinocyte carcinoma and melanoma.ResultsThe inception cohorts included a total of 302 634 adults prescribed an antihypertensive medication and 605 268 unexposed adults. Increasing thiazide exposure was associated with an increased rate of incident keratinocyte carcinoma (adjusted hazard ratios [HRs] per 1 Defined Annual Dose unit 1.08, 95% confidence interval [CI] 1.03-1.14), advanced keratinocyte carcinoma (adjusted HR 1.07, 95% CI 0.93-1.23) and melanoma (adjusted HR 1.34, 95% CI 1.01-1.78). We found no consistent evidence of association between other antihypertensive classes and keratinocyte carcinoma or melanoma.InterpretationHigher cumulative exposure to thiazides was associated with increased rates of incident skin cancer in people aged 66 years and older. Consideration of other antihypertensive treatments in patients at high risk of skin cancer may be warranted.© 2021 Joule Inc. or its licensors.

29 keywords...

hide…