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31.03.2015, admin  
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After reports of a link between common blood pressure drugs and increased cancer risk, researchers caution patients not to get their heart rates up. Treatment starts with a healthful habit makeover: a low-fat diet, a moderate exercise program, quitting smoking, managing stress and the like. Physicians tend to call upon well-established diuretics and calcium channel blockers for simple cases. This summer ARBs caused a stir in the medical community and in the national news when researchers at Case Western Reserve University and University Hospitals Case Medical Center reported their apparent connection to cancer, leading already-high blood pressures to skyrocket in panic.
Persuading patients to continue taking blood pressure drugs is one of the biggest hurdles to treating the condition. This July, researchers at Case Western Reserve reported the gravity of a danger they say was suggested years before, though it was largely ignored at the time. The positive track record of ARBs, it seemed, had made the world turn a blind eye to the drugs' potential risk. A 2003 study of heart failure patients treated with one ARB showed the drug was linked to a significantly higher risk of developing fatal cancers.
To better understand the data, cardiology experts Ilke Sipahi, MD, Daniel Simon, MD, and James Fang, MD, of Case Western Reserve's School of Medicine and University Hospitals Case Medical Center; and Sara M. Those taking ARBs, the researchers say, were 8 percent to 11 percent more likely to develop a new cancer over a four-year period than those in the control groups. The researchers published their findings in the journal The Lancet Oncology, describing the risk of cancer as "modest but significant." The lung cancer statistic stands out, but the overall increase in new cancers cannot be overlooked, they say. The results were widely reported by ABC News, Reuters, The New York Times, The Wall Street Journal and other national outlets. As for the course of action for those who currently take the drugs, Sipahi says he's happy to see most media outlets have effectively communicated his message that patients should not discontinue the drugs on their own, but rather should consult their physician to determine the appropriate course of action.

Nissen counters saying, "Meta-analysis is not a perfect tool, but it is a very useful tool.
All you can ask of independent investigators is that they provide a careful, ethical and appropriate discussion of both the values and limitations of their studies. Sipahi concedes the team would have preferred to review individual-level data, but he calls on government agencies to help out.
In the end, some will continue to wonder: Why cause a scare about ARBs when patients are already bad about taking their medicine-especially when the results are small and the study not definitive?
About 70 percent of patients, however, require medication to lower their blood pressure, and drug options abound. Though their results are noteworthy and clearly distressing, the scientists are quick to calm the nerves of those who rely on the popular drugs.
In an effort to keep patients taking their medications faithfully, ACE inhibitors, with their tendency to cause a persistent cough for some patients, are being replaced by ARBs. They've been proved effective at treating high blood pressure and reducing the risk of stroke and death after a heart attack.
This finding was largely ignored because it was just a single study and wasn't primarily looking at cancer outcomes. This is especially important, he says, because abandoning the medications can leave patients at a higher risk for cardiovascular and renal complications. In 2001, he linked COX-2 inhibitors, such as Vioxx, with an increased risk of heart attack and stroke.
These drugs are often over-prescribed, as a result of aggressive marketing, and in the absence of evidence that they are better than ACE inhibitors.
The European Medicines Agency and the FDA each announced they would begin investigations regarding the risk of cancer in patients taking ARBs.

They called the study "a very bad example of science," "irresponsible," "skewed" and "noise and rubbish," among other unflattering remarks. White, MD, president-elect of the American Society of Hypertension, argue that the meta-analysis is limited because the majority of the trials were not designated to look at cancer risk, that some large trial results were not available for inclusion and that study participants had other risk factors. But amid the compliments and the controversies, what's the course of action for the 10 million U.S.
Left untreated, however, it can lead to heart disease, heart failure, stroke, kidney failure and more. They slow the progression of chronic kidney disease and improve heart failure outcomes-all with fewer chances of side effects. Later, two trials by the manufacturer of another ARB showed their medication also caused an increased risk of cancer. Rowland, PhD, of the School of Medicine, conducted a meta-analysis of all publicly available data from randomized controlled trials of ARBs published before November 2009. Other criticisms are that the study follow-up was too short to detect cancer and that there was no biological explanation for how the drugs could cause cancer.
In 2007, his meta-analysis on the diabetes drug Avandia revealed high cardiovascular risks, resulting in an FDA warning-and a sales loss of about 75 percent for the drug.

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