Background: Studies have reported improved survival among cancer patients associated with some common hypertension medications, i.e. beta-blockers, and the renin-angiotensin system (RAS) antagonist medications.
Methods: We investigated the association between regular use of beta-blockers and RAS antagonists, including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) and survival in women with epithelial ovarian cancer. We used data from the Ovarian cancer Prognosis and Lifestyle (OPAL) study, a prospective study of Australian women aged 18-79, diagnosed from 2012-2015 (follow-up=5-8 years). We defined exposure based on pre-diagnosis use, as most women used RAS antagonists continuously (pre-diagnosis and post-diagnosis), and few started to use them post-diagnosis. We measured overall (OS), cancer-specific (OVS) and progression-free survival (PFS) from date of starting primary cancer treatment (surgery or neoadjuvant chemotherapy) until the earliest of date of death/last follow-up. We used Cox regression to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI). We also applied inverse probability of treatment weighting (IPTW) to reduce bias due to confounding by indication.
Findings: We had pre-diagnosis data for 950 women. We observed an association between use of ARB or ACEI and improved survival (OVS=0.73, 95%CI=0.58-0.92, OS=0.76, 95%CI=0.60-0.96 and PFS=0.77, 95%CI=0.62-0.94). IPTW models weighted to all women with ovarian cancer only suggested a possible reduction in mortality associated with ARB use (OVS=0.82, 95%CI=0.57‐1.19). In IPTW models weighted to ACEI or ARB users, the HRs were very similar to unweighted models, suggesting possible survival benefit associated with the use. As many BB users had also used ARB/ACEI, the observed association between BB and survival might be affected by these medications.
Interpretation: Our findings suggest that ARB/ACEI use might improve survival in women with ovarian cancer. Further studies, in larger cohorts or, preferably, a randomised controlled trial, could clarify these findings.