| Background:Antihypertensive medications are widely used with the increasing incidence of hypertension worldwide,and usually use more than one for a long time to maintain the stability of blood pressure so as to reduce the incidence and mortality of cardiovascular and cerebrovascular diseases.The association between antihypertensive medications and the risk of cancer has been widely concerned.In recent years,research on the association between the use of antihypertensive drugs and the risk of prostate cancer has been emerging.Prostate cancer(PCa)is one of the most common cancers affecting men worldwide.It was found that 59%of men aged more than 79years had prostate cancer upon autopsy studies.The global incidence of PCa has been increasing in most countries,and such increases were most notable in Asia,Northern and Western Europe.Known risk factors for PCa include age,race,and family history.Several studies suggest that hypertension may be risk factor of PCa.Hypertension prevalence increased with age and was more prevalent among men than women.Previously,only one meta-analysis searched the literature published before May 2015 to study the association between the use of antihypertensive drugs and the risk of PCa and concluded that CCBs may well increase PCa risk,while other antihypertensive drugs had no significant relationship with the risk of PCa.However,later published studies assessing this association are still inconsistent.Therefore,in order to systematically evaluate the association between several common antihypertensive drugs including ACEIs,ARBs,BBs,CCBs and diuretics and the risk of PCa,we conducted a meta-analysis of relevant observational studies.Objective:Several studies have reported inconsistent findings regarding the association between use of antihypertensive medications and the risk of prostate cancer.We performed a meta-analysis of observational studies to assess the association.Methods:We comprehensively searched Pub Med,Embase,Web of Science,and Cochrane Library databases and included observational studies published until July 2020.We calculated the pooled risk ratio(RR)and 95%confidence interval(CI)through random effect models to estimate the risk of prostate cancer(PCa)among users of the following classes of antihypertensive medications:angiotensin converting enzyme inhibitors(ACEIs),angiotensin receptor blockers(ARBs),calcium channel blockers(CCBs),β-blockers(BBs)and diuretics.We conducted subgroup and sensitivity analysis to evaluate the stability of results,and assessed publication bias using a funnel plot.Results:Twenty-eight studies with 5237576 participants were identified for inclusion in the meta-analysis.No association was found between the use of antihypertensive medications and the risk of PCa(RR:0.98,95%CI 0.92-1.04),but a beneficial effect was shown in sensitivity analyses that included the studies with long-term follow-up(RR:0.84,95%CI 0.71–0.99).However,the analyses by class of antihypertensive medication indicated that the risk of PCa is related to CCBs(RR:1.08,95%CI 1.03-1.13),with acceptable between-studies heterogeneity(I~2=47%).There was no association between use of ACEIs,ARBs,BBs,or diuretics and the risk of PCa.Additionally,we found spironolactone usage appeared to be associated with reduced risk of PCa(RR:0.81,95%CI 0.72-0.91),while use of thiazide diuretics were not associated with the risk of PCa(RR:1.07,95%CI 0.97-1.18).Conclusions:Our results indicate that use of CCBs may be associated with an increased risk of PCa,and no association was found between ACEIs,ARBs,BBs or diuretics and the risk of PCa.Additionally,we found spironolactone usage appeared to be associated with reduced risk of PCa. |
