Elsevier

Annals of Epidemiology

Volume 11, Issue 8, November 2001, Pages 534-542
Annals of Epidemiology

Original report
Hypertension, Heart Rate, Use of Antihypertensives, and Incident Prostate Cancer

https://doi.org/10.1016/S1047-2797(01)00246-0Get rights and content

Abstract

PURPOSE: Recent studies have reported conflicting results on a possible relationship between hypertension, heart rate, and prostate cancer. A model has been developed suggesting that high blood pressure and high heart rate may both be markers for increased central sympathetic nervous activity, which may result in androgen-mediated stimulation of prostate cancer growth.

METHODS: In this study we examined the associations between hypertension, heart rate, use of antihypertensive medications, and incident prostate cancer in a cohort of 2442 men. Data from the Cardiovascular Health Study (CHS), an NHLBI-sponsored observational study of adults age 65 or older in four U.S. communities, were analyzed using Cox proportional hazards regression. Seated systolic and diastolic blood pressures were measured using a standardized protocol at the initial clinical examination and annually at follow-up visits. Medications data were transcribed by trained interviewers from prescription medication containers brought into the clinic by participants.

RESULTS: A total of 209 cases of incident prostate cancer were identified from either an ICD-9 code of 185 in hospital medical records (n = 130) or by self-report from annual surveillance interviews (n = 79). An average of 5.6 years of follow-up was available for analyses. No associations between blood pressure measures at entry into the study and prostate cancer were found, although these results may have been affected by subsequent treatment of hypertension. An association between resting heart rate (HR) equal to or greater than 80 beats per minute and incident prostate cancer was found compared to men with a rate of less than 60 beats per minute (HR: 1.6, 95% confidence interval [CI]: 1.03–2.5). An inverse association was found between risk of incident prostate cancer and use of any antihypertensive medication (HR: 0.7, 95% CI: 0.5–0.9). A test of heterogeneity found no difference between use of the specific classes of antihypertensive medication and the association with prostate cancer risk.

CONCLUSIONS: These data tend to support the hypothesized causal pathway between vascular disease markers and prostate cancer.

Section snippets

Selected Abbreviations and Acronyms

CHS = Cardiovascular Health Study HR = hazard ratio CI = confidence interval BMI = body mass index

The Cohort

The Cardiovascular Health Study (CHS) is a cohort of 5201 adults over age 65 recruited from a random selection of HCFA records in 1989/90 from four U.S. communities (Forsyth County, NC; Sacramento County, CA; Washington County, MD; and Pittsburgh, PA) (15). In 1992/93 an additional 687 individuals of black race were added to the cohort. Recruitment criteria into the CHS included being age 65 at time of initial examination, non-institutionalized, and able to give informed consent; those who were

Incident Prostate Cancer

A total of 209 cases of incident prostate cancer were assessed between June 1, 1989 and June 31, 1996. One hundred thirty of these cases were ascertained using ICD-9 codes from the hospital abstraction data. An additional 79 cases were identified from self-report of prostate cancer from the medical history form completed at each clinic visit. A total of 13,009 person years of follow-up accrued, resulting in an incident prostate cancer rate of 16.1 per 1000 person-years at risk.

Hypertension Status

At entry into the

Cancer and Hypertension

In this article, we present data from a cohort that included 2442 men age 65 and older suggesting that, after controlling for other known risk factors (age, race, and obesity), an increased risk of incident prostate cancer may be associated with increased heart rate and that a decreased risk may be found with use of antihypertensives. Evidence was lacking on an association with hypertension at entry into the study and subsequent prostate cancer. The literature contains very few studies focusing

Acknowledgements

Supported in part by contracts N01-HC-85079 through N01-HC-85086 from the National Heart, Lung, and Blood Institute.

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