Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
To the Editor.—In their thorough study, Dr Rosenberg and colleagues1 did not find that calcium antagonists increased the risk of malignancy, apart from renal cell carcinoma. By looking at all prospective randomized studies in which calcium antagonists were compared with another drug or with a placebo, we recently have confirmed their findings.2 However, the authors also reported an increased risk of renal cell carcinoma in patients taking a calcium antagonist and in those taking an angiotensin-converting enzyme inhibitor or a β-blocker and suggest, therefore, that hypertension, in and of itself, may be a risk for renal cell carcinoma.
Although we cannot exclude this possibility, it seems more likely that this risk of renal cell carcinoma was due to concomitant diuretic use. No fewer than 9 case-control studies and 3 cohort studies suggest that long-term diuretic therapy confers a risk for renal cell carcinoma (other references available from author on request).3 - 6 In some of the studies, this risk was independent of the presence of hypertension and was related to the cumulative dose of diuretic use. The fact that renal cell carcinoma arises from the renal tubular cell, which is also the main target site for the pharmacologic effect of diuretics, lends credence to this hypothesis. Conceivably, the chemical bombardment of this cell over decades ultimately may turn out to be carcinogenic. In most studies, women seem to have a higher risk of diuretic-related renal cell carcinoma than men. Whether these findings cast a shadow on the bright picture of diuretic use for reducing cardiovascular morbidity and mortality in hypertension remains to be determined.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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