Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Cancer pattern among hypertensive patients in North Karelia, Finland

Abstract

The objective of this study was to determine the site-specific cancer incidence of hypertensive patients and examine the effect of blood pressure-related variables on the risk of cancers with elevated incidence among the hypertensive patients. A record linkage study of Hypertension Register of the North Karelia Project and the Finnish Cancer Registry was conducted. The mean follow-up time was 16 years. A total of 20 529 hypertensive patients were studied. Main outcome measures were standardised incidence ratios and hazard ratios. The overall cancer incidence was close to that of the general population for both men and women. The incidence rate for the kidney cancer was significantly increased in hypertensive patients (standardised incidence ratio 1.34, 95% confidence interval (CI) 1.11–1.60), as well as incidence rates for cancers of pancreas (1.26, 1.02–1.54), and endometrium (1.22, 1.01–1.44) in hypertensive women. The incidence of lung cancer was significantly decreased (0.86, 0.77–0.95). The incidence of liver cancer was elevated with borderline significance (1.36, 0.99–1.82). In Cox regression models, the use of antihypertensive drugs at baseline was a significant predictor of kidney (hazard ratio for use of antihypertensive drugs 1.89, 95% CI 0.96–3.75) and pancreatic cancer (1.78, 0.99–3.22) in women but not in men. The incidence of endometrial cancer or liver cancer was not related to blood pressure levels or the use of antihypertensive drugs. In women, obesity was a significant predictor of cancers of the endometrium, kidney and liver. In conclusion, increased occurrence of some cancer types among hypertensive patients seem to be partly explained by obesity and the use of antihypertensive drugs.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Dyer AR et al. High blood-pressure: a risk factor for cancer mortality? Lancet 1975; 1: 1051–1056.

    Article  CAS  PubMed  Google Scholar 

  2. Svardsudd K, Tibblin G . Mortality and morbidity during 13.5 years’ follow-up in relation to blood pressure. The study of men born in 1913. Acta Med Scand 1979; 205: 483–492.

    Article  CAS  PubMed  Google Scholar 

  3. Raynor Jr WJ et al. High blood pressure and 17-year cancer mortality in the Western Electric Health Study. Am J Epidemiol 1981; 113: 371–377.

    Article  PubMed  Google Scholar 

  4. Khaw KT, Barrett-Connor E . Systolic blood pressure and cancer mortality in an elderly population. Am J Epidemiol 1984; 120: 550–558.

    Article  CAS  PubMed  Google Scholar 

  5. Goldbourt U et al. Elevated systolic blood pressure as a predictor of long-term cancer mortality: analysis by site and histologic subtype in 10,000 middle-aged and elderly men. J Natl Cancer Inst 1986; 77: 63–70.

    CAS  PubMed  Google Scholar 

  6. Filipovsky J et al. Abdominal body mass distribution and elevated blood pressure are associated with increased risk of death from cardiovascular diseases and cancer in middle-aged men. The results of a 15- to 20-year follow-up in the Paris prospective study I. Int J Obes Relat Metab Disord 1993; 17: 197–203.

    CAS  PubMed  Google Scholar 

  7. Rosengren A et al. Hypertension and long-term cancer incidence and mortality among Swedish men. J Hypertens 1998; 16: 933–940.

    Article  CAS  PubMed  Google Scholar 

  8. Wannamethee G, Shaper AG . Blood pressure and cancer in middle-aged British men. Int J Epidemiol 1996; 25: 22–31.

    Article  CAS  PubMed  Google Scholar 

  9. Peeters P et al. Hypertension, antihypertensive drugs, and mortality from cancer among women. J Hypertens 1998; 16: 941–947.

    Article  CAS  PubMed  Google Scholar 

  10. Taylor JO et al. Blood pressure and mortality risk in the elderly. Am J Epidemiol 1991; 134: 489–501.

    Article  CAS  PubMed  Google Scholar 

  11. Clausen J, Jensen G . Blood pressure and mortality: an epidemiological survey with 10 years follow-up. J Hum Hypertens 1992; 6: 53–59.

    CAS  PubMed  Google Scholar 

  12. Grove JS et al. The association of blood pressure with cancer incidence in a prospective study. Am J Epidemiol 1991; 134: 942–947.

    Article  CAS  PubMed  Google Scholar 

  13. Batty GD, Shipley MJ, Marmot MG, Davey SG, Whitehall Study. Blood pressure and site-specific cancer mortality: evidence from the original Whitehall study. Br J Cancer 2003; 89: 1243–1247.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Shapiro JA et al. Hypertension, antihypertensive medication use, and risk of renal cell carcinoma. Am J Epidemiol 1999; 149: 521–530.

    Article  CAS  PubMed  Google Scholar 

  15. Chow WH et al. Obesity, hypertension, and the risk of kidney cancer in men. N Engl J Med 2000; 343: 1305–1311.

    Article  CAS  PubMed  Google Scholar 

  16. Parazzini F et al. Population attributable risk for endometrial cancer in northern Italy. Eur J Cancer Clin Oncol 1989; 25: 1451–1456.

    Article  CAS  PubMed  Google Scholar 

  17. Soler M et al. Hypertension and hormone-related neoplasms in women. Hypertension 1999; 34: 320–325.

    Article  CAS  PubMed  Google Scholar 

  18. Zhang ZF et al. Adenocarcinomas of the esophagus and gastric cardia: medical conditions, tobacco, alcohol, and socioeconomic factors. Cancer Epidemiol Biomarkers Prev 1996; 5: 761–768.

    CAS  PubMed  Google Scholar 

  19. Grossman E, Messerli FH, Goldbourt U . Does diuretic therapy increase the risk of renal cell carcinoma? Am J Cardiol 1999; 83: 1090–1093.

    Article  CAS  PubMed  Google Scholar 

  20. Lindblad P et al. Risk of kidney cancer among patients using analgesics and diuretics: a population-based cohort study. Int J Cancer 1993; 55: 5–9.

    Article  CAS  PubMed  Google Scholar 

  21. Pahor M et al. Do calcium channel blockers increase the risk of cancer? Am J Hypertens 1996; 9: 695–699.

    Article  CAS  PubMed  Google Scholar 

  22. Lever AF et al. Do inhibitors of angiotensin-I-converting enzyme protect against risk of cancer? Lancet 1998; 352: 179–184.

    Article  CAS  PubMed  Google Scholar 

  23. Nissinen A, Tuomilehto J, Puska P . The hypertension register of the North Karelia project. Clin Sci Mol Med Suppl 1978; 4: 355s–358s.

    CAS  PubMed  Google Scholar 

  24. Puska P et al. The North Karelia Project: 20 Years’ Results and Experience. Helsinki, Finland: National Public Health Institute, 1995.

    Google Scholar 

  25. Lindgren A, et al. Cancer incidence in hypertensive patients in North Karelia, Finland. Hypertension 2001; 37: 1251–1255.

    Article  CAS  PubMed  Google Scholar 

  26. Lindgren A et al. Blood pressure, smoking and the incidence of lung cancer in hypertensive men in North Karelia, Finland. Am J Epidemiol 2003; 158: 442–447.

    Article  PubMed  Google Scholar 

  27. World Health Organization. Arterial Hypertension: Report of a WHO Expert Committee. Geneva, Switzerland: World Health Organization, Technical Report Series 628, 1998.

  28. Lindholm LH et al. Relation between drug treatment and cancer in hypertensives in the Swedish Trial in Old Patients with Hypertension 2: a 5-year, prospective, randomised, controlled trial. Lancet 2001; 358: 539–544.

    Article  CAS  PubMed  Google Scholar 

  29. Dyer AR, Elliott P . The INTERSALT study: relations of body mass index to blood pressure. INTERSALT Co-operative Research Group. J Hum Hypertens 1989; 3: 299–308.

    CAS  PubMed  Google Scholar 

  30. Jalkanen L et al. Changes in body mass index in a Finnish population between 1972 and 1982. J Int Med 1989; 226: 163–170.

    Article  CAS  Google Scholar 

  31. Yuan JM et al. Hypertension, obesity and their medications in relation to renal cell carcinoma. Br J Cancer 1998; 77: 1508–1513.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. McLaughlin JK et al. International renal-cell cancer study. VIII. Role of diuretics, other anti-hypertensive medications and hypertension. Int J Cancer 1995; 63: 216–221.

    Article  CAS  PubMed  Google Scholar 

  33. Mellemgaard A et al. Risk factors for renal cell carcinoma in Denmark: role of medication and medical history. Int J Epidemiol 1994; 23: 923–930.

    Article  CAS  PubMed  Google Scholar 

  34. Muscat JE, Hoffmann D, Wynder EL . The epidemiology of renal cell carcinoma. A second look. Cancer 1995; 75: 2552–2557.

    Article  CAS  PubMed  Google Scholar 

  35. Mellemgaard A, Moller H, Olsen JH . Diuretics may increase risk of renal cell carcinoma. Cancer Causes Control 1992; 3: 309–312.

    Article  CAS  PubMed  Google Scholar 

  36. Gago-Dominguez M et al. Lipid peroxidation: a novel and unifying concept of the etiology of renal cell carcinoma (United States). Cancer Causes Control 2002; 13: 287–293.

    Article  PubMed  Google Scholar 

  37. Nissinen A et al. Drug treatment of high blood pressure in the community—experience in eastern Finland. J Hum Hypertens 1989; 3: 165–171.

    CAS  PubMed  Google Scholar 

  38. Wallenius S, Peura S, Klaukka T, Enlund H . Who is using antihypertensive drugs? A prescription analysis from Finland. Scand J Prim Health Care 1996; 14: 54–61.

    Article  CAS  PubMed  Google Scholar 

  39. Calle EE et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 2003; 348: 1625–1638.

    Article  PubMed  Google Scholar 

  40. Berrington de Gonzalez A, Sweetland S, Spencer E . A meta-analysis of obesity and the risk of pancreatic cancer. Br J Cancer 2003; 89: 519–523.

    Article  CAS  PubMed  Google Scholar 

  41. Friedman GD, van den Eeden SK . Risk factors for pancreatic cancer: an exploratory study. Int J Epidemiol 1993; 22: 30–37.

    Article  CAS  PubMed  Google Scholar 

  42. Stolzenber-Solomon RZ et al. A prospective study of medical conditions, anthropometry, physical activity, and pancreatic cancer in male smokers (Finland). Cancer Causes Control 2002; 13: 417–426.

    Article  Google Scholar 

  43. Weiderpass E et al. Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Cancer Causes Control 2000; 11: 185–192.

    Article  CAS  PubMed  Google Scholar 

  44. Brinton LA et al. Ethnicity and variation in breast cancer incidence. Int J Cancer 1997; 73: 349–355.

    Article  CAS  PubMed  Google Scholar 

  45. Inoue M et al. A case–control study on risk factors for uterine endometrial cancer in Japan. Jpn J Cancer Res 1994; 85: 346–350.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Parazzini F et al. The epidemiology of endometrial cancer. Gynecol Oncol 1991; 41: 1–16.

    Article  CAS  PubMed  Google Scholar 

  47. Furberg AS, Thune I . Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer 2003; 104: 669–676.

    Article  CAS  PubMed  Google Scholar 

  48. Moller H, Mellemgaard A, Lindvig K, Olsen JH . Obesity and cancer risk: a Danish record-linkage study. Eur J Cancer 1994; 30A: 344–350.

    Article  CAS  PubMed  Google Scholar 

  49. Caldwell SH, Crespo DM, Kang HS, Al-Osaimi AM . Obesity and hepatocellular carcinoma. Gastroenterology 2004; 127 (5 Suppl 1): S97–S103.

    Article  CAS  PubMed  Google Scholar 

  50. Teppo L, Pukkala E, Lehtonen M . Data quality and quality control of a population-based cancer registry. Experience in Finland. Acta Oncol 1996; 33: 365–369.

    Article  Google Scholar 

Download references

Acknowledgements

The research was funded with a grant from the Finnish Cultural Foundation and the Finnish Cancer Foundation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A M Lindgren.

Additional information

This work has not been published elsewhere in whole or in part. There are no potential conflicts of interest. The research was funded with a grant from the Finnish Cultural Foundation.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lindgren, A., Nissinen, A., Tuomilehto, J. et al. Cancer pattern among hypertensive patients in North Karelia, Finland. J Hum Hypertens 19, 373–379 (2005). https://doi.org/10.1038/sj.jhh.1001834

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001834

Keywords

This article is cited by

Search

Quick links