August 7, 2012 — The journal Archives of Internal Medicine has published a study that links the long-term use of anti-hypertensive medications (used to lower high blood pressure) to a higher risk of lip cancer in white people. The result is plausible, because the drugs are known to increase sun-sensitivity. The researchers warned that the risk is still small, and people should not stop taking their blood pressure medications. However, it is a warning sign that the drugs could potentially increase the risk of skin cancer, and more research needs to be conducted.
The researchers analyzed medical records on Kaiser Permanente patients from 1994 until 2008. They found that 712 patients developed lip cancer who were also taking a blood pressure drug. The researchers compared these cases to 23,000 patients without lip cancer.
When the researchers found that people with darker-colored skin did not have an increased risk of lip cancer, they limited the study to patients who had lighter-colored skin and had been using a blood pressure drug for at least five years. Then they analyzed the data looking for correlations between lip cancer and specific drugs. The found the following associations:
- Hydrochlorothiazide was associated with a 4-fold increased risk
- Hydrochlorothiazide-triamerene (Dyazide, Maxzide) were associated with a 3-fold increased risk
- Nifedipine (Adalat, Nifediac, Procardia, etc.) were associated with a 2.5-fold increased risk
- Lisinopril was associated with a 1.4-fold increased risk
The researchers cautioned that lip cancer is a relatively rare cancer, so even a 4-fold increased risk translates to relatively few cases numerically. Furthermore, the benefits of using a blood pressure drug likely outweigh the risks. The lead researcher emphasized this point, saying “I do not want to alarm people to the extent they are going to stop staking their medicine for blood pressure.”
Furthermore, he said that lip cancer is “a relatively infrequent form of cancer, it is not surprising that associations with anti-hypertensive drugs have not been observed in large clinical trials.” It is also not surprising given that experts know anti-hypertension drugs make people more sun-sensitive.
In an accompanying editorial, the researchers advised that doctors should “ascertain whether patients are at high risk of lip cancer because of their fair skin and long-term sun exposure and discuss lip protection with them.” They also advised that people can reduce the risk of skin cancer by wearing sunscreen, lip protector, rash guard swimming suits, large-brimmed hats, and avoiding exposure to the sun during peak hours of the day. All people can reduce their risk of skin cancer by taking these steps, but people who are using a blood pressure drug should be reminded.
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