Blood pressure drug linked to increased cancer risk in older Aussies

Drug’s properties makes skin more sensitive to the sun, scientists say.

Old man reading leaflet with instructions for medication

One of the most prescribed high blood pressure drugs in Australia increases older people’s risk of developing skin cancer, according to a University of NSW study.

But researchers warn that it may still be dangerous to suddenly stop taking the medicine. 

Hydrochlorothiazide contains photosynthesising properties, which can make your skin more sensitive to the sun, the scientists say.

The findings are based on analysis of skin cancer rates in a case-control study involving older Australians. The results, published in Basic & Clinical Pharmacology & Toxicology, support similar findings from previous international studies.

“We found increased risk for developing malignant melanoma and squamous cell cancer of the lip (lip cancer) with hydrochlorothiazide use,” says pharmacoepidemiologist Dr Benjamin Daniels, lead author of the study and research fellow at UNSW Medicine’s Centre for Big Data Research in Health (CBDRH). Dr Daniels studies the use and effects of drugs in specific population groups.

“For lip cancer, the risk also appears to be cumulative – that is, the longer that hydrochlorothiazide is used, the higher the risk of developing lip cancer,” he says.

High blood pressure – or hypertension – is a chronic illness affecting more than a third of Australians over the age of 18. It is usually defined by blood pressure levels above 140/90. If left untreated, hypertension can lead to serious health conditions including stroke and heart disease.

Sufferers are generally prescribed medicine, such as hydrochlorothiazide, and urged to make healthy lifestyle changes to their diet and exercise regimes.

“Hypertension is a condition that needs to be carefully managed,” says Dr Daniels.

“We don’t want anyone to suddenly stop taking hydrochlorothiazide out of fear of developing skin cancer.

“The skin cancer risk is something for prescribers to be aware of. Doctors may want to consider conducting more skin checks for their patients or reinforcing advice around sun-smart behaviours that everyone should be aware of, like adequate protection when UV is higher than three and avoiding sun exposure during peak UV times.”

He says the study has resulted in an update to the product information.

A spokesperson from the Therapeutic Goods Administration (TGA) said: “This [update] will help prescribers and patients make informed choices about the benefits and risks of hydrochlorothiazide-containing medicines.”

The TGA encourages anyone with concerns to speak with their healthcare professional.

Australia has one of the highest rates of skin cancer in the world, according to the Cancer Council, which reports that about two in three Australians will be diagnosed with a skin cancer by the time they are 70.

In other melanoma research, Centenary Institute scientists have discovered that genes on the X chromosome may be key to improved survival rates of females with melanoma – as compared to their male counterparts. 

Dr Abdullah Al Emran, researcher in the Melanoma Oncology and Immunology Program at the Centenary Institute and lead author of the study, says: “We know that survival from melanoma is strongly related to gender, with females having a survival rate almost twice that of males.

“Many explanations such as behavioural differences in sun exposure and other factors have been previously proposed for this gender difference, but none had withstood critical scrutiny.”

The researchers explored a number of genes on the X chromosome and, more specifically, those genes that had been found to escape a cellular process called ‘X-inactivation’.

A normal regulatory process in the body, X-inactivation is where one of a female’s two X chromosomes is inactivated or silenced during embryonic development. Only one functional copy of the X chromosome is required in each body cell.

However, this ‘silencing’ process is not perfect, says Dr Emran, with between 10 and 20 per cent of the genes on the silenced X chromosome still able to be expressed. As a result, females have a double expression of many genes involved in immune responses when compared to males.

“Our study found that two of these genes on the X chromosome that manage to escape inactivation – the genes KDM6A and ATRX – were both associated with improved survival rates for women with melanoma. We believe that their high expression levels aid the body’s immune system in helping to fight cancer,” says Dr Emran.

Professor Peter Hersey, head of the Melanoma Oncology and Immunology Program at the Centenary Institute, believes the research findings are significant in pointing to KDM6A as a major regulator of immune responses. The focus will now be on how KDM6A is regulated, he says.

Do you take the blood pressure drug Hydrochlorothiazide? Were you aware that it increased the risk of skin cancer?

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    COMMENTS

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    On the Ball
    14th Aug 2020
    11:04am
    "Do you take the blood pressure drug Hydrochlorothiazide?"
    How the hell would I know? How about doing some homework for all of us and tell us the common name of this drug?
    Winston Smith
    14th Aug 2020
    11:39am
    Yes, tell us the brand names that use the drug.
    Marlin
    14th Aug 2020
    12:03pm
    On the Ball... You'd need to look at the packet and see what the 'active ingredient' is, in the tablets. But I do agree that giving the Brand Names that contain this drug would have been helpful.
    Jennie
    14th Aug 2020
    12:41pm
    Does this help? Brand names:
    "Apo-Hydro, Aquazide, BPZide, Dichlotride, Esidrex, Hydrochlorot, Hydrodiuril, HydroSaluric, Hypothiazid, Microzide, Oretic and many others" Don't know what the many others are...
    Julian
    14th Aug 2020
    11:15am
    Usually, it's used as an add on to another class of drug. Most anti hypertensives are available with this in 6.25 or 12.5mg doses. It's an inexpensive diuretic and is abbreviated to hctz.
    Marlin
    14th Aug 2020
    11:16am
    On the Ball... You'd need to look at the packet and see what the 'active ingredient' is, in the tablets. But I do agree that giving the Brand Names that contain this drug would have been helpful.
    casey
    14th Aug 2020
    11:34am
    Marlin, I take Apo-candesartan for high blood pressure. I checked the packet and it does not list the ' active ingredients'
    Marlin
    14th Aug 2020
    11:51am
    Casey, The active ingredient in your medication is candesartan cilexetil.
    Julian
    14th Aug 2020
    11:52am
    Casey, Candesartan is the active ingredient. It is the molecular name of the drug which binds on to the A2 receptor (and therefore known as an A2A or ARB) in the blood vessels.
    Winston Smith
    14th Aug 2020
    11:41am
    Not a terribly helpful article. It needs to tell readers what the commercial names are of the products that contain this drug.
    Koro
    14th Aug 2020
    12:03pm
    What cures one thing can kill you once again ? Heaven knows which way do we go with health situations
    Libby
    14th Aug 2020
    12:14pm
    We all need to know the brand names of this drug as I take two heart tablets and don't know the chemical composition of either!
    Farside
    14th Aug 2020
    6:18pm
    put the name of your medication and "active ingredients" in your favourite search engine and then search the page for Hydrochlorothiazide
    MarLin
    14th Aug 2020
    12:28pm
    Not that it should matter because he/she sounds sensible enough, but "for the avoidance of doubt" as the lawyers would say, the Marlin who has posted on this thread with flowers as an avatar is not me! :))
    Jennie
    14th Aug 2020
    12:42pm
    Not only is Hydrochlorothiazide a carcinogeni but also statin drugs.
    Jennie
    14th Aug 2020
    12:43pm
    Sorry for typo...
    MarLin
    14th Aug 2020
    12:48pm
    Something wrong with 'statins', Jennie? I take Rosuvastatin (20mg), brand name Crestor, for marginally high cholesterol - prescribed by a cardiologist.
    Jennie
    14th Aug 2020
    1:07pm
    Seriously wrong. I have done in depth research on the dangerous adverse drug reactions to statin drugs. It would take me ages to explain here. In a nutshell: cholesterol does NOT cause heart disease, it is an essential brain and body chemical. This has been known for more than 20 years. Unfortunately doctors and patients have been brainwashed by the pharmaceutical companies who make $29 bn from the sale of statins and these companies are the ones that do the "research" and fiddle the stats and hide the serious side effects which include: memory loss, muscle pain and weakness, depression, fatigue, and irritability due to damage to the mitochondria by interfering with the production of CoEnzyme Q10 and dolichols. You can't raise your cholesterol by eating food s containing cholesterol. This vital chemical is made in the liver and brain as required by the body's need for it.
    Some of these effects are explained by doctors as aging. THIS IS NOT TRUE.
    Pharmaceutical companies want everyone to take these drugs in order to boost their profits.
    Jennie
    14th Aug 2020
    1:09pm
    As we age we need more cholesterol not less. The level of cholesterol considered to be "high" has been brought down and down over the years - WRONG, unethical and dangerous.
    Artificially lowering cholesterol with drugs is WRONG.
    MarLin
    14th Aug 2020
    1:32pm
    Thanks Jennie. Call me old fashioned if you like, but I prefer to listen to qualified specialists than someone replying to an online chat site. Sorry, you may be right and everyone else wrong, but your comments above sound too much like conspiracy theory to me!
    Jennie
    14th Aug 2020
    2:39pm
    Read the research for yourself. And be aware of the side effects you may experience. There is no conspiracy theory in this.
    Louisa
    14th Aug 2020
    3:49pm
    Hi Marlin,

    Just ignore Jennie she is an ancient nutter from way back and has a conspiracy theory about everything, but particularly this. She (if she is a she) says she has researched but that amounts to Dr. Google not credible, highly ranked peer reviewed journals. I have postgraduate degrees in the area and know she is talking mostly nonsense with the odd grain of truth about some things ( e.g. yes the liver does make "endogeneous" cholesterol, but blood levels are also influenced by dietary cholesterol, and cholesterol and fatty acids are used in cell walls and some neurotransmitters etc, but in excess it does have deleterious effects on the cardiovascular system). She gives a list of serious side effects , (some which are not true) but fails to explain why me, the majority of people I know, and many patient studies show the majority of people suffer no side effects at all. Yes I have taken statins for many years without the slightest hint of any side effects and will continue to so so without fear.
    Maggie
    14th Aug 2020
    4:10pm
    I just wish that there were no articles on medicines in YLC.

    They just provoke responses from the "medical experts" (quacks?)amongst us, who suggest sometimes quite harmful cures for whatever.

    If you are a doctor or other qualified medical practitioner , please tell us that and talk some sense.
    Jennie
    14th Aug 2020
    4:33pm
    I am sorry Mitzy that you are so rude. I think you have the wrong Jennie. I never use Google for research, nor do I have a conspiracy theory about everything. Do the up to date research yourself from peer reviewed journals avoiding that "research" which has conflict of interest.
    Maggie, unfortunately some people lie about their qualifications.
    Nowhere did I say don't take statins. Just keep a close watch for adverse drug reactions as they can take a short time or years to manifest.
    Julian
    14th Aug 2020
    4:45pm
    It is a requirement of drug companies to document in their PI, all adverse reactions reported to doctors via their patients. These reactions are not investigated or tied to other possible causes unless serious or life threatening. For example, if you start a new medication and experience headache which may or may not be coincidental, and report this to your dr, this information eventually finds its way to the PI. The point is, just because you experienced a side effect, does not necessarily mean the drug caused it.
    Louisa
    14th Aug 2020
    4:56pm
    Thanks Jenny I have done the research myself and continue to do so, as you mention, from peer reviewed credible , well respected reviewed journals , but it appears you haven't . Or perhaps that is indelicate of me, let's just say I have reached a different reasoned conclusion. And no I don't think I have the wrong Jennie. Thank you for more than adequately proving my point about you. And to Julian many thanks for expressing yourself and your point so very well. You are absolutely right, any adverse effect must be reported whether it is causally related to the medications or not. The list of side effects for vitamin tablets are just as extensive particularly nausea, constipation, diarrhoea, headache, flushing , depression, anxiety which are included in the list of possible for side effects for any medications including all supplements.
    MarLin
    14th Aug 2020
    5:35pm
    Thanks Jennie et al. I'm afraid I must agree with Maggie - not because I'm trying to be rude, but because it stands to common sense that we can only ever hope to get 'opinions' on a forum like YLC. The real research essays and reports done by qualified people don't appear in this type of forum - so I'll keep listening to my doctor and the various specialists who I'm sure get new golf carts every year from my medical fees alone!
    Eddy
    15th Aug 2020
    10:05am
    To all, just a thought, would it be reasonable to say that most of the published side effects of any drug is more likely to be the result of lawyers trying to mitigate possible legal proceedings than medical researchers trying to mitigate any possible adverse reactions.
    For myself, I know that sooner or later I am going to die of something, maybe all these life enhancing drugs just make to journey to that final end more enjoyable or less traumatic.
    ChannelingOrwell
    14th Aug 2020
    1:24pm
    I'm far too scared to take any possibly dangerous, laboratory produced drugs, which usually come with a huge list of side effects, for high blood pressure.
    What I do is take a daily heaped teaspoon of relatively cheap flaxseed meal in a glass of orange juice and this seems to keep my blood pressure within normal bounds.
    Before I started this, my blood pressure was much higher and a cause for concern until I heard about the beneficial effects of flaxseed and decided to try it.
    I dare not take any drugs for anything, but I do take daily doses of multivitamins, fish oil, a mega dose of vitamin C (1.5gm), as well as other supplements which significantly help with my prostate.
    I'm also highly skeptical of so-called studies trying to convince us that taking supplements is useless.
    MarLin
    14th Aug 2020
    1:35pm
    Each to his or her own, CO - but couldn't help noticing that you say you 'dare not take any drugs' but then list a whole range of drugs from multivitamins to 'other supplements'! :))
    ChannelingOrwell
    14th Aug 2020
    1:50pm
    Hi MarLin,
    You say ... "a whole range of drugs from multivitamins to 'other supplements"

    Do you have a list of side effects for these?

    Would you care to list the possible side effects of all the vitamins from A to Z please.

    I'm not aware of any, but maybe you could help me out.

    The l-o-o-o-o-o-ng lists of side effects for those lab-produced drugs has scared me off, but apparently you're happy with the risks.
    MarLin
    14th Aug 2020
    2:14pm
    Sorry, CO - I rarely bother reading the side effects if I've been prescribed something by a specialist (well OK, maybe I glance at them to make sure nothing jumps off the page, but I've never found anything worse than, "possible headaches, nausea, etc").
    All I was saying above was that you said you don't take drugs but then listed a whole bunch of drugs (like multivitamins, etc), which sounded like an immediate contradiction!
    All that aside, my wife is Vietnamese and swears by traditional herbal medicine - which has just helped (with acupuncture) to cure the pain she's had for years from 'basketballer's knee'. And the degenerative arthritis I suffered for years was also cured by acupuncture. Maybe that's something for you to consider? Good luck!
    ChannelingOrwell
    14th Aug 2020
    2:33pm
    Hi MarLin,

    You wrote ... "the degenerative arthritis I suffered for years was also cured by acupuncture"

    I've heard of research, sounds implausible I know, that a diet high in fibre will offset the onset of arthritis. I was, and still am, getting lots of fibre in my diet for its other benefits.

    I've also found that keeping yourself hydrated, (i.e. drinking lots of water), can help the joints out.

    Some time ago I had arthritis-like pain in several hand joints.

    I then began to drink several large glasses (at least 4) of water a day and the pain shortly disappeared.

    So now I make sure I get a plentiful daily dose of water, and so far no more pain.

    This could have been gout, but I'm not sure coz I never consult quacks.

    Anyway, plenty of water has numerous other benfits as well.

    And it's far cheaper than those deadly lab-produced drugs!
    Louisa
    14th Aug 2020
    3:56pm
    I wonder what your definition of a drug is ChannellingOrwell, as everything you mention is a drug including flaxseed if it's purpose is to supposedly reduce blood pressure. And where oh where do you think your supplements are produced. Yes that is right in laboratories although there standards are a lot less than government regulated ones and there you have much less of a guarantee that the supplement capsules actually have the chemicals in them, they say they do, and i the doses they say they do.
    ChannelingOrwell
    14th Aug 2020
    4:07pm
    MarLin wrote ...

    "I wonder what your definition of a drug is"

    Of course a drug is a chemical compound ...

    BUT, BUT, BUT ... some "drugs" such as vitamins are naturally derived and are free of side effects.

    Vitamin labs just replicate these known safe drugs.

    Other drugs, which you seem to be a fan of, are newly synthesised in labs and can have deadly side effects,
    many of which don't become evident until people get sick or die from them.

    It's the latter I'm dead scerd of ingesting.
    MarLin
    14th Aug 2020
    5:43pm
    Thanks CO - and yes, my nephrologist reminds me to stay hydrated every time I see him, despite our living in Vietnam most of each year so have little choice because the average 'winter' temperature is low 30s and average summer is mid-high 30s. Wearing a face mask and carrying a bottle of water whenever you venture outside is not only sensible but almost mandatory!
    Btw, it was Mitzy who wondered about your definition of a drug, not me - although the thought did also enter my mind with your references to 'supplements' (arguably the most useless health products in any marketplace imo, especially if you follow a reasonable diet and exercise routine).
    Elizzy
    14th Aug 2020
    4:20pm
    Hydrochlorothiazide lowers your blood pressure by diuretic action. I took it for two weeks and had to stop as it was incompatible with traveling on public transport and doing a full time job - you get the gist... My doc then prescribed a different med which I have taken for the last 20 years with no noticeable side effects. Hydrochlorothiazide is very cheap so the govt likes it, but it is a b.....d of a drug to live with.
    MarLin
    14th Aug 2020
    5:46pm
    Thanks Elizzy - now THAT kind of user opinion makes forums such as YLC worth reading! I'm on diuretics already, so wouldn't need anymore and will remember your words if anyone ever suggests I change to 'Hydro-alphabet'!
    Farside
    14th Aug 2020
    6:33pm
    a medication containing hydrochlorothiazide has been a game changer with managing my HT. Still I would rather know of the potential issues than not.
    MarLin
    14th Aug 2020
    8:24pm
    That's for sure - "forewarned is forearmed"! :))
    Mary
    14th Aug 2020
    5:07pm
    Jennie, don't let the rude members bother you. My cardiologist would agree with everything you said. He wouldn't let me go onto statins. MarLin asked if anything is wrong with statins. Yes, everything. My cardiologist said that only in extreme circumstances should patients go on statins. He put me on to particular vitamins which come from Italy and my cholesterol is perfect. I would guess that the rude comments come from people who are on statins. You've probably scared them.
    MarLin
    14th Aug 2020
    6:00pm
    Thanks Mary, that's v.interesting. We're in Vietnam at the moment - and have been since we arrived on 2 Feb with intentions of staying just 6 months. Then Covid and associated travel bans came along so I was required to shop around for more medication when my 6-months worth were close to running out. I couldn't find the exact hypertension medication but managed to find some that my nephrologist in Sydney said should be ok as substitutes (but in fact they're not because they were made in Europe so disintegrate in the heat so I now have another substitute, but made in India and obviously more heat-resistant than the German tablets, thank goodness). But when I shopped around for cholesterol medication, I found Crestor (rosuvastatin) was readily available everywhere - even in the smallest pharmacies - but no other cholesterol medication whatsoever.
    So if you and Jennie are correct about statins, I have to wonder why cholesterol is not a problem in Vietnam? (the top three killers here are diabetes, hepatitis and hypertension, according to the specialist I saw in an international hospital in Saigon).
    Jennie
    14th Aug 2020
    6:02pm
    Thank you so much Mary. At last a knowledgeable voice of reason. And a cardiologist who is excellent and who hasn't been brainwashed by the pharmaceutical companies.
    Ritza
    28th Aug 2020
    7:30am
    Face the truth people ... living causes death .... how do we avoid that ?


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