Abstract C090: Association between hypertension and prostate cancer risk in black and white men in the Atherosclerosis Risk in Communities (ARIC) study
Authors: Wang Wanmei , Bhanat Eldrin , Butler Kenneth R. , Joshu Corinne E. , Mosley Thomas H. , Platz Elizabeth A. , Gomez Christian R. 
Published: August 2020

Abstract
Background: A diagnosis of hypertension (HTN) has been reported to be associated with an increased risk of total and aggressive prostate cancer (PCa) in some studies. In this study, we evaluated the association between HTN and total and lethal PCa in African-American (AA) and Caucasian-American (CA) men. Given that AA men are disproportionately burdened by both HTN and PCa, especially aggressive disease, we hypothesized that the positive association between HTN and total and lethal PCa is stronger in AA than CA men. We alternatively hypothesized that the positive association between HTN and PCa is the same in AA and CA men, but the higher HTN prevalence in AA men results in a greater PCa burden in AA men.
Methods: We studied 1,590 AA men and 5,094 CA men from the Atherosclerosis Risk in Communities (ARIC) study without a history of cancer at the first study visit (1987-1989) and who were followed through 2012. HTN was defined based on clinic-measured systolic and diastolic blood pressure and self-reported use of antihypertensive drugs at Visit 1. First primary total PCa (N=266 in AA men, 565 in CA men) and lethal PCa (metastatic at baseline or progressed to death from prostate cancer, N=39 in AA men, 59 in CA men) were ascertained by cancer registry linkage, medical records, and death certificates. We used Cox proportional hazards regression to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of total and lethal PCa comparing CA men with HTN, AA men without HTN, and AA men with HTN to CA men without HTN. We adjusted for age, education, and purported risk factors including body mass index, waist to hip ratio, smoking, physical activity, diabetes, cholesterol-lowering medication use, and aspirin use.
Results: AA men had a higher prevalence of HTN (54.6%) than CA men (28.6%) at baseline. Compared with CA men without HTN, CA men with HTN had a higher risk of total PCa (HR=1.23, 95% CI=1.01-1.49, p=0.040), and as expected, AA men without HTN had an elevated PCa risk (HR=2.41, 95% CI=1.94-3.01, p&lt;0.001), but AA men with HTN had a similarly elevated PCa risk (HR=2.41, 95% CI=1.93-3.01, p&lt;0.001). Patterns were similar for lethal PCa (versus CA men without HTN, CA men with HTN - HR=1.48, 95% CI=0.83-2.63, p=0.183, AA men without HTN - HR=3.27, 95% CI=1.79-5.95, p&lt;0.001, AA men with HTN - HR=2.49, 95% CI=1.31-4.73, p=0.005).
Conclusions: Our prospective findings support some prior studies that HTN is associated with an increased risk of total and possibly lethal PCa in CA men. Counter to our hypothesis, HTN was not associated with total or lethal PCa in AA men.
Support: NHLBI, NCI, NPCR, UMMC Office of Research.
Citation Format: Wanmei Wang, Eldrin Bhanat, Kenneth R. Butler, Corinne E. Joshu, Thomas H. Mosley, Elizabeth A. Platz, Christian R. Gomez. Association between hypertension and prostate cancer risk in black and white men in the Atherosclerosis Risk in Communities (ARIC) study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C090.