Previous studies have shown that ACEI may increase people's risk of cancer, but the results are inconclusive, because most of the existing studies are short or of relatively small sample size.
Recently, scientists from McGill University in Canada began studying whether ACEI increases the risk of cancer, particularly lung cancer. The scientists propose that ACEI may increase the risk of lung cancer by stimulating the accumulation of two specific substances in the lungs: myotensin and substance p.
Myotensin is a kind of peptide which can enlarge blood vessels and reduce blood pressure. Substance p is also a peptide that acts as a neurotransmitter.
Scientists have linked the two compounds to lung cancer: it is thought that myotensin stimulates lung cancer growth directly, while lung cancer tissue expresses substance p, which allows tumors to proliferate.
Blood pressure, drugs and lung cancer
The researchers, led by professor Laurent Azoulay, examined the medical records of nearly a million people in the UK.
All of the patients began taking blood pressure medication between 1995 and 2015.
The participants were 18 years old or older and had no previous cancer incidence.
The team followed them for an average of 6.4 years.
During that time, doctors diagnosed nearly 8,000 cases of lung cancer.
The scientists compared the risk of lung cancer between people who had already started ACEI and those who were taking blood pressure drugs known as angiotensin-receptor blockers (ARBs).
They also considered other factors that could affect lung cancer risk, such as smoking, age, body mass index, alcohol consumption and lung history.
They concluded that taking ACEI increased the risk of lung cancer by 14 percent compared with taking ARBs.
This conclusion would be obvious after five years a person took the drug.
The risk of lung cancer increases as the use of ACEI increases. The risk was particularly pronounced for people who took the drug for a decade or more, an increase of 31 percent.
Although 14 percent of people thought there was a big increase, the authors wanted to look at the issue in the long run. In real terms, the increase for any individual will increase from 1.2 cases per 1,000 people per year to 1.6 cases per 1,000 people per year.
On a population level, however, the effect is even more pronounced because many people take antihypertensive drugs. As the authors wrote, these small relative effects can translate into an absolute number of at-risk patients.
The researchers hope to continue the study, with cause and effect not easily separated and other factors likely to play a role. However, as the current study uses a large number of participants, the conclusions deserve further study.
For patients who are taking these drugs, the long-term risk of developing lung cancer should be balanced by an increase in life expectancy associated with the use of ACEI.
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