Qi Jia, An Ruona, Bhatti Parveen, Spinelli John J, Murphy Rachel A
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
Office of Ethics, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Cancer Causes Control. 2022 Jun;33(6):801-812. doi: 10.1007/s10552-022-01570-1. Epub 2022 Mar 21.
Antihypertensive medications may impact colorectal cancer risk. We conducted a systematic review and meta-analysis of associations, with colorectal cancer risk, of five classes of antihypertensive medications: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs), and diuretics.
A systematic search was conducted in MEDLINE, Embase, Web of Science, and the Cochrane library to identify relevant studies evaluating associations of ACEIs, ARBs, BBs, CCBs, and diuretics with colorectal cancer risk. Meta-analytic risk ratios (RRs) and corresponding 95% confidence intervals (95% CIs) were calculated using the inverse variance method.
No overall significant associations with colorectal cancer risk were observed; ACEIs (5 studies) RR 1.05, 95% CI 0.91-1.23, ARBs (5 studies) RR 0.94, 95% CI 0.80-1.11, BBs (4 studies) RR 1.00, 95% CI 0.92-1.08, CCBs (4 studies) RR 1.02, 95% CI 0.88-1.18, and diuretics (6 studies) RR 1.02, 95% CI 0.90-1.17. There was considerable heterogeneity across studies, partly explained by differences in study design and location. When stratified by study location, there was significantly reduced colorectal cancer risk for ARB use in Asian populations (2 studies, RR 0.69, 95% CI 0.58-0.83).
No significant colorectal cancer risk with ACEIs, BBs, CCBs, or diuretics was observed. ARB use may be associated with decreased risk of colorectal cancer in Asian populations, although additional studies in diverse populations are needed to confirm associations and help understand possible reasons for geographical differences.
抗高血压药物可能会影响结直肠癌风险。我们对五类抗高血压药物（血管紧张素转换酶抑制剂（ACEI）、血管紧张素II受体阻滞剂（ARB）、β受体阻滞剂（BB）、钙通道阻滞剂（CCB）和利尿剂）与结直肠癌风险的关联进行了系统评价和荟萃分析。
在MEDLINE、Embase、Web of Science和Cochrane图书馆进行系统检索，以确定评估ACEI、ARB、BB、CCB和利尿剂与结直肠癌风险关联的相关研究。采用逆方差法计算荟萃分析风险比（RR）和相应的95%置信区间（95%CI）。
未观察到与结直肠癌风险存在总体显著关联；ACEI（5项研究）RR为1.05，95%CI为0.91 - 1.23；ARB（5项研究）RR为0.94，95%CI为0.80 - 1.11；BB（4项研究）RR为1.00，95%CI为0.92 - 1.08；CCB（4项研究）RR为1.02，95%CI为0.88 - 1.18；利尿剂（6项研究）RR为1.02，95%CI为0.90 - 1.17。各研究之间存在相当大的异质性，部分原因可由研究设计和地点的差异来解释。按研究地点分层时，亚洲人群使用ARB可显著降低结直肠癌风险（2项研究，RR为0.69，95%CI为0.58 - 0.83）。
未观察到ACEI、BB、CCB或利尿剂会带来显著的结直肠癌风险。亚洲人群使用ARB可能与结直肠癌风险降低有关，不过需要在不同人群中开展更多研究以确认这种关联，并有助于了解地域差异的可能原因。
