Antihypertensive Drug Use and the Risk of Ovarian Cancer Death among Finnish Ovarian Cancer Patients—A Nationwide Cohort Study

Abstract

Ovarian cancer (OC) has a poor prognosis. Hypertension may be a prognostic factor for OC, but it is unclear whether antihypertensive (anti-HT) drug use of modifies OC prognosis. We performed a population-based analysis assessing the effect of anti-HT drug use on OC mortality. A cohort of 12,122 women identified from the Finnish Cancer Registry with OC in 1995–2013 was combined with information on their anti-HT drug use during the same time period. Use of each anti-HT drug was analysed as a time-dependent variable. Analyses were run for five, ten and full follow-up (19-year) mortality with cardiovascular morbidity risk evaluated in competing risk analysis. No anti-HT drug group was associated with OC survival within five years after OC diagnosis. At ten years, a dose-dependent association was observed between pre-diagnostic ACE-inhibitor use and improved OC survival. With full follow-up, post-diagnostic high-intensity use associated with reduced OC death risk for multiple anti-HT drug groups. In competing risk analysis, only the post-diagnostic use of ACE-inhibitors associated with increased OC survival. Anti-HT drugs were not associated with survival benefits within five years after OC diagnosis. ACE-inhibitors may confer survival benefits in women with OC, but further confirmatory studies are needed.

Evaluation of antihypertensive medications use and survival in patients with ovarian cancer: a population-based retrospective cohort study

“…Our result that ACE inhibitors use after ovarian cancer diagnosis is associated with reduced cancer-specific mortality risk is in agreement with results of previous studies [ 6 – 8 ]. Huang et al (2021), observed a reduced mortality for post-diagnostic therapy involving ACE inhibitors (HR 0.53, 95% CI: 0.31– 0.91), but no association for post-diagnostic use of other antihypertensive medication [ 7 ].…”

“…Huang et al (2021), observed a reduced mortality for post-diagnostic therapy involving ACE inhibitors (HR 0.53, 95% CI: 0.31– 0.91), but no association for post-diagnostic use of other antihypertensive medication [ 7 ]. Similarly, Santala et al reported, that only ACE inhibitors are associated with improved long term ovarian cancer survival when the effect of cardiovascular mortality is taken into account (HR 0.73 95% CI: 0.58–0.91) [ 6 ]. In a study by Harding et al, ovarian cancer-specific mortality was found to be lower among women who used ACE inhibitors (HR 0.76, 95% CI: 0.63–0.92) [ 8 ].…”

“…Hypertension is a common comorbidity in patients with cancer. A number of large cohort studies on the association between the antihypertensive medication use and ovarian cancer death risk showed a significant beneficial effect of post-diagnostic angiotensin-converting enzyme inhibitors (ACE inhibitors) use on cancer-specific survival compared to not users [ 6 , 7 ]. Moreover, in a study of women 66 + years of age with ovarian cancer, lower cancer-specific mortality was shown in patients who received ACE inhibitors or diuretics during the year following a cancer diagnosis [ 8 ].…”

“…Moreover, in a study of women 66 + years of age with ovarian cancer, lower cancer-specific mortality was shown in patients who received ACE inhibitors or diuretics during the year following a cancer diagnosis [ 8 ]. A protective effect of angiotensin-receptor blockers (ARBs) has been observed among epithelial ovarian cancer patients by Cho et al [ 9 ]; however, no clear associations between post-diagnostic ARBs or beta-blockers (BBs) use and ovarian cancer mortality were found in cohort studies by Santala et al or Huang et al [ 6 , 7 ]. The results of several recent studies suggested survival benefits for BBs users, particularly for nonselective BBs users [ 8 , 10 , 11 ].…”

“…In recent meta-analyses it was concluded, that there is insufficient evidence regarding the association between ACE inhibitors or BBs and ovarian cancer survival [ 12 , 16 ]. Consumption of other antihypertensive drug groups (calcium channel blockers (CCBs) or diuretics) was not associated with a decreased ovarian cancer death risk, except the elevated risk observed with furosemide use [ 6 , 7 , 9 ]. We found no studies aiming to examine the role of centrally and peripherally acting antiadrenergic agents (SNS-AH) in ovarian cancer survival.…”