Hypertension Medication Side Effects: Weighing Cancer Risk vs. Stroke Prevention

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• Common Side Effects of Blood Pressure Drugs
• Metabolic Risks from Diuretics and Beta-Blockers
• The Hypertension and Cancer Link
• Medication and Cancer Risk Controversy
• Risk-Benefit Analysis of Treatment
• Full Transcript

Common Side Effects of Blood Pressure Drugs

Dr. Ehud Grossman, MD, explains that all hypertension medications carry potential side effects. These adverse effects range from minor inconveniences to more serious metabolic changes. Common issues include leg edema from calcium channel blockers and abdominal pain. Many side effects are immediately noticeable to the patient. This allows for a discussion with their doctor about continuing or changing the medication.

Metabolic Risks from Diuretics and Beta-Blockers

Dr. Ehud Grossman, MD, highlights specific metabolic risks associated with certain drug classes. He notes that diuretics and beta-blockers can increase the risk of developing diabetes. Beta-blockers negatively impact cholesterol levels by lowering HDL (good cholesterol) and raising LDL and triglycerides. Diuretics also carry a risk of causing hyponatremia, or dangerously low blood sodium. Dr. Grossman points out this often occurs when patients drink excessive water. Clear instructions to limit fluid intake can help prevent this serious complication.

The Hypertension and Cancer Link

A more complex issue is the observed epidemiological link between hypertension and cancer. Dr. Ehud Grossman, MD, references his own research showing this association. He states that hypertensive patients, particularly those with diabetes, have a higher risk of developing cancer. The exact mechanism is not proven but is philosophically complicated. Dr. Anton Titov, MD, suggests a connection to obesity and metabolic syndrome. Dr. Grossman agrees, noting it is difficult to isolate high blood pressure from other co-existing risk factors.

Medication and Cancer Risk Controversy

Whether antihypertensive drugs themselves cause cancer is a major controversy. Dr. Grossman mentions a specific association found between thiazide diuretics and kidney tumors. However, he presents a critical counterpoint: living longer inherently increases cancer risk. The central question becomes whether a drug causes cancer or if the extended lifespan it provides allows time for cancer to develop. Dr. Ehud Grossman, MD, states there is not very strong evidence that the medications are a direct cause.

Risk-Benefit Analysis of Treatment

Dr. Ehud Grossman, MD, concludes with a powerful risk-benefit analysis for patients. He frames the choice starkly: treat hypertension and potentially live to 80, or avoid treatment and risk dying from a stroke at 60. The data shows treatment decreases stroke risk by 40-50%. This benefit massively outweighs a potential 1% increase in cancer risk. The ultimate decision is to take the medication to prevent immediate, life-threatening heart disease. Dr. Anton Titov, MD, facilitates this crucial discussion on balancing long-term risks.

Full Transcript

Dr. Ehud Grossman, MD: Hypertension is a problem for millions of people around the world. Millions of people have been treated with various antihypertensive drugs. Of course, every medication has side effects, and every drug has risks. Some of the antihypertensive drugs have increased or relatively increased risks of certain cancers. There are also some other side effects of anti-hypertensive medications.

Could you discuss potential side effects of hypertension treatments? There are some side effects that we know of. Patients who are treated with diuretics are at risk to develop diabetes; the same is true with beta blockers, because they lower the HDL (the good cholesterol) and increase the LDL and triglycerides. So you have some imbalance of metabolic parameters.

Calcium antagonists can cause leg edema, gingival hypertrophy, and some abdominal pain. Hypertension drugs have a lot of side effects. Most of the side effects you feel, and when you feel them, you can decide if you should stop the hypertension medication.

Diuretics also can cause hyponatremia (low blood sodium), which is very dangerous. This is mainly because patients who are getting diuretics—I don't know why—they drink a lot of water, and when they drink a lot, they develop hyponatremia. Now we give instructions to patients who are on a diuretic: "Don't drink too much!" If they keep our suggestion, they don't develop side effects.

There are some side effects that you cannot really appreciate—this is a risk of cancer. Now we believe—this is one of the studies that we did many years ago—we found a correlation, or association, between hypertension itself and cancer. So we believe that hypertensive patients, especially if they are diabetic, have a higher risk to develop cancer.

Whether the medications are the cause of cancer or not is a big discussion; it's a controversy. But we also believe that if someone lives longer, they will finally develop cancer. So the question is not if hypertension medications cause cancer—if you live 80 years instead of 60 years, in the last 20 years you may develop cancer.

So that's the question: whether this is because of the drug or because you live longer. I mean, it's not very strong evidence that anti-hypertensive medications cause cancer. We found an association between thiazide diuretic and kidney tumors.

Again, when you weigh the benefit—advantage vs. disadvantage—you increase the risk to develop cancer by 1% and you decrease the risk of stroke by 40–50%. What would you do? Take the medications or not? The answer is you would take hypertension treatment drugs, even though there is a possibility that anti-hypertension medications increase a little bit the risk of cancer.

Of course, hypertension by itself increases the risk of cancer, but we still want to lower the blood pressure and to prevent heart disease.

Dr. Anton Titov, MD: Is there anything known about how hypertension might increase the risks of cancers?

Dr. Ehud Grossman, MD: It's a philosophy; it's a very complicated mechanism that has been suggested. It's not proven, but it is an epidemiological observation that there is more cancer among hypertensive patients.

Dr. Anton Titov, MD: Probably could be connected to the relatively higher rates of obesity and metabolic syndrome?

Dr. Ehud Grossman, MD: That's it! It's very difficult to isolate high blood pressure from other risk factors!