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Is there any information about a link between lisinopril (Zestril, generics) and breast cancer recurrence? —Capt. Brandy R. Perry, PA-C, USAF

Multiple studies have examined the relationship between lisinopril, other angiotensin-converting enzyme (ACE) inhibitors, and cancer risk, progression, and survival.1 These studies used different trial designs (eg, randomized controlled trials, observational studies, epidemiological studies) and reported conflicting results. In vitro data with the ACE inhibitor captopril (Capoten, generics) and the angiotensin receptor blocker (ARB) losartan (Cozaar, generics) suggest that these medications may decrease tissue factor and other regulators of cancer proliferation, growth, and metastases.2 In short, further study is needed. The data are not yet conclusive regarding ACE inhibitors and cancer recurrence risk, and the decision to use an ACE inhibitor over another type of antihypertensive should be made after evaluation of the multiple risks and benefits associated with these medications. ONA

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Lisa Thompson is assistant professor, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.


1. McMenamin UC, Murray LJ, Cantwell MM, Hughes CM. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in cancer progression and survival: a systematic review. Cancer Causes Control. 2012;23(2):221-230.

2. Napoleone E, Cutrone A, Cugino D, et al. Inhibition of the renin-angiotensin system downregulates tissue factors and vascular endothelial growth factor in human breast carcinoma cells. Thrombosis Res. 2012;129(6):736-742.