Impact of Angiotensin Receptor Blockers, Beta Blockers, Calcium Channel Blockers and Thiazide Diuretics on Survival of Ovarian Cancer Patients

Abstract

PurposeWe investigated the impact of four types of antihypertensive medications, angiotensin receptor blockers (ARBs), beta blockers (BBs; both selective and non-selective), calcium channel blockers (CCBs), and thiazide diuretics (TDs) on survival outcomes in epithelial ovarian cancer (EOC).Materials and MethodsA single-institutional retrospective chart review of 878 patients with EOC was performed. Survival was compared according to use of the four antihypertensive medications during primary treatment. Propensity score matching (ratio 1:3) was performed to control possible associated covariates, such as age, International Federation of Gynecology and Obstetrics stage, residual status after primary debulking surgery, and co-morbidity.ResultsAmong 878 patients, 56 patients (6.4%) were ARB users, 62 (7.1%) were BB users, 107 (12.2%) were CCBs users and 32 (3.6%) used TDs. Median progression-free survival (PFS) for ARB, BB, and CCB users was 37.8, 27.2, and 23.6 months compared with 33.6 months for non-users. ARB was associated with 35% decreased risk of disease progression (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.42 to 0.99; p=0.046) in multivariate analysis. After propensity score matching, median PFS for ARB users was 37.8 months and ARB use remained to be associated with lower recurrence rate in univariate (p=0.035) and multivariate analysis (HR, 0.60; 95% CI, 0.39 to 0.93; p=0.022).ConclusionIn this study, ARBs use during primary treatment is associated with lower recurrence in EOC patients. However, CCBs, BBs, and TDs did not show beneficial impact.

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

“…According to one report, angiotensin-converting enzyme (ACE)-inhibitors, another anti-HT drug group with a different mechanism of action, might improve OC survival [ 16 ]. Angiotensin-receptor (ATR)-blockers, but not other anti-HT drugs, have also been associated with a longer recurrence-free time in patients with epithelial OC [ 17 ]. In vitro telmisartan, an angiotensin-receptor blocker, was demonstrated to inhibit cell proliferation and induce apoptosis in ovarian cancer cells [ 18 ].…”

Post-Diagnostic Beta Blocker Use and Prognosis of Ovarian Cancer: A Systematic Review and Meta-Analysis of 11 Cohort Studies With 20,274 Patients

“…During the last 2 years, many of high-quality studies with additional potential confounder adjustments have been published (22)(23)(24)(25). Several studies have indicated that post-diagnostic beta blocker use increased OC mortality (22,25), while other studies did not show an association (23,24). In 2020, a large prognostic cohort study with 6,197 OC patients showed that post-diagnostic beta blocker use increased mortality (25).…”

Does sympathetic nervous system modulate tumor progression? A narrative review of the literature

“…Furthermore, a study showed that perioperative treatment with propranolol and a COX-2 inhibitor caused a decrease in biomarkers related to breast cancer recurrence and metastasis [ 66 ]. Similarly, studies in patients with ovarian cancer have shown a positive effect [ 67 ], no significant effect [ 68 , 69 ], or even negative effects [ 70 , 71 ]. In the same manner, evidence has shown that β-blockers may have a role in the treatment of melanoma [ 72 ] yet the data are inconclusive and the efficacy not always apparent [ 73 ].…”