2010 position paper of the Italian Society of Hypertension (SIIA): Angiotensin receptor blockers and risk of cancer

Antihypertensive therapy has been demonstrated to significantly reduce cardiovascular and non-cardiovascular mortality in randomized controlled clinical trials. In the past, however, doubts have been raised on the safety of one class of blood pressure lowering drugs, namely the angiotensin II type 1 receptor antagonists (angiotensin receptor blockers ARBs), in terms of increased risk of myocardial infarction. Several comprehensive meta-analyses have definitely demonstrated no significant increased risk of myocardial infarction in patients treated with ARBs compared with placebo or any other active treatments. More recently, a partial meta-analysis has suggested a potential link between the use of this drug class and an increased risk of cancer. Although a further comprehensive network meta-analysis demonstrated the lack of any increased risk of cancer development or cancer mortality in patients treated with different antihypertensive drug classes, including ARBs, compared with placebo, this report has generated claims and uncertainties in the medical community and produced a vast echo in the lay press. The biological plausibility, the potential pathophysiological mechanisms, and the clinical evidence that rule out such hypotheses are discussed here. The present article, which represents a position paper of the Italian Society of Hypertension (SIIA), states that the benefits derived from the use of ARBs outweigh the potential risks, and that the use of these drugs should be maintained according to present indications.