HYPERTENSION (P HAMET, SECTION EDITOR) Association of Hypertension and Anti-Hypertensive Therapy with Cancers Abhishek Deshmukh & Sadip Pant & Parloop Bhatt & Jawahar L. Mehta Published online: 15 June 2012 # Springer Science+Business Media, LLC 2012 Abstract Hypertension and cancer impose a huge burden on health care systems. Optimal treatment of hypertension have shown to improve mortality and morbidity. However, there are reports of potential occurrence of cancer on these life saving medications. In this review, we summarize the findings of the recent literature on hypertension, antihypertensive medications, and cancer and suggest recommendations for our patients. Keywords Hypertension . Cancer . Angiotensin receptor blockers . Diuretics Hypertension is a very common condition, affecting approx- imately 65 million subjects in the United States. It is the most important modifiable risk factor for cardiovascular disease. According to the World Health Organization, it is the leading cause of death in all societies, irrespective of level of income. Each 20-mm Hg increment in systolic blood pressure or 10-mm Hg increment in diastolic blood pressure doubles the risk of cardiovascular events, indepen- dent of other factors [1••]. The number of hypertensive emergencies is also on the rise [2]. The American Heart Association estimates that hypertension in the general pop- ulation costs the United States economy approximately $73 billion in direct and indirect expenditures in 2009, up from $69 billion in 2008, and $66 billion in 2007. Most studies have shown that antihypertensive treatment decreases cardiovascular morbidity and mortality, but not all studies have shown a decrease in all-cause mortality. This discrepancy could be due to a relative increase in noncardio- vascular mortality in some treated hypertensive patients [3•]. Cancer is also a very common disease world-wide. There is much interest in developing pharmacologic agents that de- crease the burden associated with hypertension and cancer. However, hypertension and cancer are not perceived by the general population the same way, as the negative image of cancer far outweighs that of hypertension and heart disease [4]. Patients treated with hypertension may be more likely to die of cancer than are untreated patients who may die earlier. There are several reports of carcinogenic potential of several antihypertensive drugs over the last 3 decades, ever since reports of an increased risk of breast cancer with rauwolfia derivatives in women older than 50 years appeared in litera- ture. Β-adrenergic blockers, calcium-channel blockers (CCBs), and diuretic drugs have all been variably reported to be associated with increased cancer risk [5]. The association of cancer development from anti-hypertensive drug use, how- ever, is far from conclusive [3•]. Early reports zeroed in on dihydropyridine type CCBs, while more recent reports have focused on angiotensin II receptor blockers (ARBs) [6, 7••]. The issue of heightened incidences of cancer or deaths from cancers with anti-hypertensive therapy warrants close atten- tion given that over 500 million people worldwide are being treated with anti-hypertensive drugs. The objectives of this review are to: (1) review literature regarding association of cancer and hypertension, and (2) discuss data in the association (or lack thereof) between anti- hypertensive therapy and cancer occurrence and mortality. Blood Pressure and Risk of Cancer Dyer et al in 1975 first pointed to the potential of hyperten- sion as a risk factor for cancer development (relative risk A. Deshmukh (*) : S. Pant : P. Bhatt : J. L. Mehta University of Arkansas for Medical Sciences, 4301 W.Markham Street, Little Rock, AR 72205, USA e-mail: AJDeshmukh@uams.edu Curr Cardiovasc Risk Rep (2012) 6:261–266 DOI 10.1007/s12170-012-0250-4