Blánaid Hicks, PhD, BSc, on BP Medications and Lung Cancer Risk
Angiotensin converting enzyme inhibitors (ACEIs) are widely prescribed, effective treatments for hypertension. However, these medications are likely not without risk.
A study published in the BMJ found that ACEI use, especially for long periods of time, may be tied to an increased risk of lung cancer compared with the use of angiotensin receptor blockers for blood pressure control.
We spoke with the study’s first author, Blánaid Hicks, PhD, BSc, Vice-Chancellor’s Fellow at Queen’s University Belfast in Northern Ireland, UK, about how clinicians should interpret these findings in practice.
Consultant360: How did your study come about? What led you to hypothesize that ACEI use in the treatment of hypertension could be associated with an increased risk of lung cancer?
Blánaid Hicks: ACEIs are known to be associated with an accumulation of peptides such as bradykinin and substance P in the lung. A number of pre-clinical studies have demonstrated that these peptides may promote lung cancer growth. Despite this, while a number of other observational studies have investigated the risk of all cancers associated with ACEIs, none had been designed specifically to investigate lung cancer risk with these drugs.
C360: How does the risk of lung cancer observed in your study compare with the benefits of ACEIs? Does this risk necessarily outweigh the benefits of ACEIs?
BH: Overall, we found a 14% increased risk of lung cancer among ACEI users. Increases in risk were only observed for those using ACEIs for more than 5 years, with the highest risks observed for those using ACEIs for over 10 years. While the risks are small, these could translate to large absolute risks worldwide, given the widespread use of ACEIs.
However, the silver lining here is that the risk at the individual patient level is likely low, even after 10 years of use. Therefore, this potential increase in lung cancer risk needs to be weighed against the well-documented benefits of ACEI therapy.
C360: How can clinicians prescribing ACEIs interpret your findings? Should the findings affect prescribing practices going forward, or is more research still needed in this area?
BH: Given that the risks are likely small at an individual level, we would not deter patients from taking these drugs, if their physicians deem them appropriate.
It is certainly premature to suggest that this study should affect prescribing practices going forward. While it is important that clinicians are aware of this potential association, further research is needed to corroborate these findings.
C360: What are the key takeaways from your study?
BH: The key findings of this study are that ACEIs appear to increase the risk of lung cancer among those patients who use ACEIs for over 5 years, suggesting a latent effect of exposure on this cancer risk. However, further research in this area is imperative to fully elucidate this potential safety issue.
C360: What are the next steps in your research?
BH: As outlined above, it is important that this study is replicated in other settings, particularly with sufficient follow-up, given the associations observed with long-term use in our study. Detailed confounding information for smoking and related factors is also needed.
Hicks BM, Filion KB, Yin H, Sakr L, Udell JA, Azoulay L. Angiotensin converting enzyme inhibitors and risk of lung cancer: population based cohort study [Published online October 24, 2018]. BMJ. https://doi.org/10.1136/bmj.k4209.