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Open Access

Consider patient risk factors for melanoma when prescribing antihypertensives

Martin Dawes
CMAJ June 21, 2021 193 (25) E996; DOI: https://doi.org/10.1503/cmaj.78786
Martin Dawes
Family physician, University of British Columbia, Vancouver, BC
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Drucker and colleagues provide a great paper1 that raises questions about antihypertensive medications and adverse effects. The adjusted hazard ratio for melanoma with thiazide exposure is quite high at 1.34 (95% confidence interval 1.01–1.78).1

In comparison, the baseline incidence rate for melanoma among men 40–44 years old is 23.50 per 100 000.2 Therefore, a very rough translation of hazard ratios (with apologies to all biomedical statisticians) shows that prescribing thiazides increases the risk of melanoma by about 34%, increasing the incidence rate from 23.5 to 31.49 per 100 000 people.

That means if 100 000 people were prescribed hydrochlorothiazide, then about 8 more people (plus or minus the confidence interval) would get melanoma — a number needed to harm of about 12 500 people per year. If the patient had a tenfold greater risk of melanoma, based on skin colour, family history and so on, the number needed to harm becomes 1250 people. For some patients, that may cross the decision threshold of whether or not to take thiazide.

I would appreciate someone checking my “back of the envelope” numbers, but if they are correct, this paper shows that providers should be considering melanoma risk in our review of drug options for patients with hypertension.

Footnotes

  • Competing interests: None declared.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    1. Drucker AM,
    2. Hollestein L,
    3. Na Y,
    4. et al
    . Association between antihypertensive medications and risk of skin cancer in people older than 65 years: a population-based study. CMAJ 2021;193:E508–16.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Fears TR,
    2. Guerry D,
    3. Pfeiffer RM,
    4. et al
    . Identifying individuals at high risk of melanoma: a practical predictor of absolute risk. J Clin Oncol 2006;24: 3590–6.
    OpenUrlAbstract/FREE Full Text
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Canadian Medical Association Journal: 193 (25)
CMAJ
Vol. 193, Issue 25
21 Jun 2021
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Consider patient risk factors for melanoma when prescribing antihypertensives
Martin Dawes
CMAJ Jun 2021, 193 (25) E996; DOI: 10.1503/cmaj.78786

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Consider patient risk factors for melanoma when prescribing antihypertensives
Martin Dawes
CMAJ Jun 2021, 193 (25) E996; DOI: 10.1503/cmaj.78786
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