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May 30, 2026Journal of Clinical Oncology

ACEi/ARB initiation was associated with lower all-cause mortality compared to beta-blockers or calcium channel blockers in patients with gastrointestinal malignancy (HR 0.83; 95% CI 0.77-0.90; p<0.001).

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Why the study?

Does ACEi/ARB initiation reduce all-cause mortality compared to beta-blockers or calcium channel blockers in adults with incident gastrointestinal malignancy and new-onset hypertension?

Population

16,880 adults with incident gastrointestinal malignancy who developed new-onset hypertension requiring…

Comparison

ACE inhibitors or angiotensin receptor blockers… vs Beta-blocker or calcium channel blocker initiation

Design

Cohort

Key result

ACEi/ARB initiation was associated with lower all-cause mortality compared to beta-blockers or calcium channel blockers in patients with gastrointestinal malignancy (HR 0.83; 95% CI 0.77-0.90; p<0.001).

Authors

KDKartik DapkeMKManaswini KrishnakumarAMArankesh Mahadevan

Discussion

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Overview

Initiation of ACEi/ARB for incident hypertension in patients with gastrointestinal malignancy is associated with improved survival and reduced acute kidney injury compared to beta-blockers or calcium channel blockers.

Key Points

  • To evaluate the effectiveness of RAS inhibitors versus non-RAS antihypertensives in patients with gastrointestinal malignancy and incident hypertension.
  • Conducted a retrospective cohort study using the TriNetX Research Network (2017-2025) with propensity score matching.
  • Included adults diagnosed with gastrointestinal malignancy who developed new-onset hypertension within 90 days of diagnosis.
  • Compared ACEi/ARB initiators to beta-blocker or calcium channel blocker initiators, evaluating outcomes using Cox regression.
  • ACEi/ARB initiation was associated with lower all-cause mortality (HR 0.83, 95% CI 0.77-0.90; p < 0.001).
  • ACEi/ARB associated with reduced acute kidney injury (HR 0.81, 95% CI 0.70-0.92; p = 0.002).
  • ARB use showed consistent mortality reductions compared to ACEi, BB, and CCB with significant HRs (HR 0.85, 0.74, and 0.76 respectively).

Study Design

Type

Cohort (n=16,880)

Multicenter

Yes

Structured PICO

Does ACEi/ARB initiation reduce all-cause mortality compared to beta-blockers or calcium channel blockers in adults with incident gastrointestinal malignancy and new-onset hypertension?

P
Population
16,880 adults (8,440 patient pairs) with incident gastrointestinal malignancy (ICD-10 C15-C25) who developed new-onset hypertension requiring antihypertensive initiation within 90 days of cancer diagnosis.
I
Intervention
ACE inhibitors (ACEi) or angiotensin receptor blockers (ARB) initiation
C
Comparator
Beta-blocker (BB) or calcium channel blocker (CCB) initiation
O
Outcome
All-cause mortalityhard clinical

Main Result

Effect estimate: HR 0.83 (95% CI 0.77-0.90)

p-value: p=<0.001

Initiation of ACEi/ARB for incident hypertension in patients with gastrointestinal malignancy is associated with improved survival and reduced acute kidney injury compared to beta-blockers or calcium channel blockers.

Cite This Study

Dapke et al. (2026) conducted a cohort in Gastrointestinal malignancy and incident hypertension (n=16,880). ACE inhibitors or angiotensin receptor blockers (ACEi/ARB) vs. Beta-blockers or calcium channel blockers (BB/CCB) was evaluated on All-cause mortality (HR 0.83, 95% CI 0.77-0.90, p=<0.001). ACEi/ARB initiation was associated with lower all-cause mortality compared to beta-blockers or calcium channel blockers in patients with gastrointestinal malignancy (HR 0.83; 95% CI 0.77-0.90; p<0.001).

synapsesocial.com/papers/6a1a82640307b78509433f86https://doi.org/10.1200/jco.2026.44.16_suppl.e16359
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A comparative analysis of ACE Inhibitors and ARBs as cancer risk factors2026
  2. 2Angiotensin receptor blocker and angiotensin-converting enzyme inhibitor use and survival in gastric cancer patients: a Finnish nationwide cohort study2025 · 1 citations
  3. 3Comparative cardiovascular outcomes of renin–angiotensin system inhibitors in patients receiving maintenance hemodialysis: a large real-world cohort study2026 · 1 citations
  4. 4Impact of angiotensin converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARB) on tumor lysis syndrome, acute kidney injury, and rasburicase use in patients undergoing chemotherapy for hematologic malignancies2025
  5. 5Comparative Effectiveness of Angiotensin-Converting Enzyme Inhibitors Versus Angiotensin Receptor Blockers: Multidatabase Target Trial Emulation Studies2025 · 10 citations