The relation between blood pressure and kidney cancer risk is well established but complex and different study designs have reported discrepant findings on the relative importance of diastolic blood pressure (DBP) and systolic blood pressure (SBP). In this study, we sought to describe the temporal relation between diastolic and SBP with renal cell carcinoma (RCC) risk in detail.
Our study involved two prospective cohorts: the European Prospective Investigation into Cancer and Nutrition study and UK Biobank, including >700 000 participants and 1692 incident RCC cases. Risk analyses were conducted using flexible parametric survival models for DBP and SBP both separately as well as with mutuality adjustment and then adjustment for extended risk factors. We also carried out univariable and multivariable Mendelian randomization (MR) analyses (DBP: ninstruments = 251, SBP: ninstruments = 213) to complement the analyses of measured DBP and SBP.
In the univariable analysis, we observed clear positive associations with RCC risk for both diastolic and SBP when measured ≥5 years before diagnosis and suggestive evidence for a stronger risk association in the year leading up to diagnosis. In mutually adjusted analysis, the long-term risk association of DBP remained, with a hazard ratio (HR) per standard deviation increment 10 years before diagnosis (HR10y) of 1.20 (95% CI: 1.10-1.30), whereas the association of SBP was attenuated (HR10y: 1.00, 95% CI: 0.91-1.10). In the complementary multivariable MR analysis, we observed an odds ratio for a 1-SD increment (ORsd) of 1.34 (95% CI: 1.08-1.67) for genetically predicted DBP and 0.70 (95% CI: 0.56-0.88) for genetically predicted SBP.
The results of this observational and MR study are consistent with an important role of DBP in RCC aetiology. The relation between SBP and RCC risk was less clear but does not appear to be independent of DBP.
International journal of epidemiology. 2022 Mar 21 [Epub ahead of print]
Karine Alcala, Daniela Mariosa, Karl Smith-Byrne, Dariush Nasrollahzadeh Nesheli, Robert Carreras-Torres, Eva Ardanaz Aicua, Nicola P Bondonno, Catalina Bonet, Mattias Brunström, Bas Bueno-de-Mesquita, María-Dolores Chirlaque, Sofia Christakoudi, Alicia K Heath, Rudolf Kaaks, Verena Katzke, Vittorio Krogh, Börje Ljungberg, Richard M Martin, Anne May, Olle Melander, Domenico Palli, Miguel Rodriguez-Barranco, Carlotta Sacerdote, Tanja Stocks, Anne Tjønneland, Ruth C Travis, Roel Vermeulen, Stephen Chanock, Mark Purdue, Elisabete Weiderpass, David Muller, Paul Brennan, Mattias Johansson
International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France., Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK., Group of Digestive Diseases and Microbiota, Institut d'Investigació Biomèdica de Girona-IDIBGI, Salt, Spain., Navarra Public Health Institute, Pamplona, Spain., Danish Cancer Society Research Center, Copenhagen, Denmark., Unit of Nutrition and Cancer, Catalan Institute of Oncology, ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute -(IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain., Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden., Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands., CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain., Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, St Mary's Campus, London, UK., Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK., Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany., Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy., Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden., Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK., Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy., Escuela Andaluza de Salud Pública (EASP), Granada, Spain., Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy., Department of Clinical Sciences Lund, Lund University, Lund, Sweden., Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK., Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands., Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA., International Agency for Research on Cancer (IARC/WHO), Lyon, France., Imperial College London, London, UK.