Correspondence

Obesity, Hypertension, and Renal Cancer

N Engl J Med 2001; 344:531-532February 15, 2001

Article

To the Editor:

We disagree with Dr. Chow and colleagues, who stated in their recent article (Nov. 2 issue)1 that “epidemiologic studies have not been able to distinguish the effects of hypertension from those of diuretics or other antihypertensive drugs on the risk of renal-cell cancer. . . . In addition, although our results provide strong evidence of a dose–response relation with body-mass index and blood pressure in men, they may not apply to the same extent in women.”

Three years ago, we reported the findings of a large, population-based, case–control study designed specifically to examine the association of renal-cell carcinoma with the use of diuretics and antihypertensive agents and its association with the conditions (hypertension and obesity) that call for the use of these drugs.2 The study involved 1204 patients with histologically confirmed, newly diagnosed renal-cell carcinoma (781 men and 423 women) and an equal number of age-, sex-, and race-matched controls from the same neighborhood. Self-reported use of all prescription diuretics and antihypertensives was validated, whenever possible, against physicians' records for both the patients with renal-cell carcinoma and the controls. We noted that obesity and a history of hypertension were strong and independent risk factors for renal-cell carcinoma in both men and women. There was little evidence that the use of diuretics was directly related to the development of renal-cell carcinoma. The use of diuretics for reasons other than hypertension (primarily weight control) was unrelated to risk among subjects who described themselves as having normal blood pressure; among subjects with hypertension, subjects with a high cumulative lifetime dose of diuretics had a risk similar to that in subjects with a low cumulative lifetime dose. Similarly, subjects with normal blood pressure who regularly took nondiuretic antihypertensive agents were not at increased risk for renal-cell carcinoma, and among hypertensive subjects, intake did not further increase the risk.

Mimi C. Yu, Ph.D.
Ronald K. Ross, M.D.
University of Southern California, Los Angeles, CA 90033

2 References

1. 1

   Chow W-H, Gridley G, Fraumeni JF, Jarvholm B. Obesity, hypertension, and the risk of kidney cancer in men. N Engl J Med 2000;343:1305-1311
   Full Text | Web of Science | Medline

2. 2

   Yuan J-M, Castelao JE, Gago-Dominguez M, Ross RK, Yu MC. Hypertension, obesity and their medications in relation to renal cell carcinoma. Br J Cancer 1998;77:1508-1513
   CrossRef | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: We appreciate the comments of Drs. Yu and Ross on our recent cohort study. In earlier case–control studies of renal-cell cancer based on interview data, it was difficult to disentangle the risks associated with hypertension, use of antihypertensive medications, or both. The challenge of obtaining accurate and complete histories of hypertension, fluctuations in blood pressure, and use of antihypertensive medications over long periods would, at least in part, explain the inconsistent findings reported in the literature.

In their large and well-designed case–control study of renal-cell cancer, Yu and Ross and their colleagues were able to limit the potential for bias by contacting physicians to verify the use of prescription medications. However, the rates of response from physicians ranged from 35 percent to 40 percent, and it seems likely that only recent prescriptions could have been verified and that the severity and control of hypertension were difficult to evaluate.

We agree from the sum of the epidemiologic evidence that hypertension and obesity are important risk factors in both sexes. Since our study population consisted of male construction workers who had periodic measurements of height, weight, and blood pressure, we could not claim that the observed levels of risk associated with variations in weight and blood pressure would be similar in women.

Wong-Ho Chow, Ph.D.
Joseph F. Fraumeni, Jr., M.D.
National Cancer Institute, Bethesda, MD 20892-7240

Citing Articles (3)

Citing Articles

1. 1

   Themistocles L. Assimes, Eleanor Elstein, Adrian Langleben, Samy Suissa. (2008) Long-term use of antihypertensive drugs and risk of cancer. Pharmacoepidemiology and Drug Safety 17:11, 1039-1049
   CrossRef

2. 2

   Akio Horiguchi, Makoto Sumitomo, Junichi Asakuma, Takako Asano, Rong Zheng, Tomohiko Asano, David M. Nanus, Masamichi Hayakawa. (2006) Increased Serum Leptin Levels and Over Expression of Leptin Receptors are Associated With the Invasion and Progression of Renal Cell Carcinoma. The Journal of Urology 176:4, 1631-1635
   CrossRef

3. 3

   Akio Horiguchi, Makoto Sumitomo, Junichi Asakuma, Takako Asano, Rong Zheng, Tomohiko Asano, David M. Nanus, Masamichi Hayakawa. (2006) Leptin Promotes Invasiveness of Murine Renal Cancer Cells Via Extracellular Signal-Regulated Kinases and Rho Dependent Pathway. The Journal of Urology 176:4, 1636-1641
   CrossRef