+
Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Hypertension and risk of cancer recurrence in adult survivors: A systematic review and meta-analysis

Hypertension Research (2025)Cite this article

Abstract

As cancer treatments improve, hypertension has become a frequent comorbidity among cancer survivors. While it may result from the cancer itself or its treatment, the impact of hypertension on cancer recurrence remains poorly understood. We conducted a systematic review and meta-analysis to evaluate the association between hypertension and the risk of recurrence of solid cancers in adult survivors. We searched four major databases including PubMed, Embase, Web of Science and the Cochrane Library for relevant studies involving adult cancer survivors who had completed initial treatment for solid tumors. The primary outcome was recurrence risk in hypertensive versus normotensive individuals, assessed using hazard ratios (HRs) pooled through a random-effects model. Heterogeneity across studies was assessed using the I² statistic. Of 1337 records screened, 13 observational studies including 15 cohorts comprising 50,549 participants met the inclusion criteria. In the overall analysis, hypertension was not significantly associated with an increased risk of solid tumor recurrence (HR: 1.09; 95% CI: 0.97–1.22; I² = 49%). Subgroup analyses showed a significant association in colorectal cancer (HR: 1.18; 95% CI: 1.02–1.36; I² = 27%), but not in breast (HR: 1.09; 95% CI: 0.86–1.40; I² = 40%) or prostate cancer (HR: 1.12; 95% CI: 0.91–1.38; I² = 53%). However, no significant difference was found across subgroups (P = 0.18). These findings suggest a potential link between hypertension and recurrence in specific cancers, particularly colorectal cancer. Comprehensive blood pressure control may play a key role in the long-term management of cancer survivors.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Data availability

The authors declare that all supporting data are available within the article and its Supplemental Material.

References

  1. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398:957–80.

    Article  Google Scholar 

  2. Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Böhm M, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022;43:4229–361.

    Article  PubMed  Google Scholar 

  3. Kidoguchi S, Sugano N, Tokudome G, Yokoo T, Yano Y, Hatake K, et al. New concept of onco-hypertension and future perspectives. Hypertension. 2021;77:16–27.

    Article  CAS  PubMed  Google Scholar 

  4. Minegishi S, Nishiyama A, Yano Y, Node K. JSH Working Group Onco-Hypertension. Future prospects of onco-hypertension. Hypertension. 2023;80:e123–e4.

    Article  CAS  PubMed  Google Scholar 

  5. Stocks T, Van Hemelrijck M, Manjer J, Bjorge T, Ulmer H, Hallmans G, et al. Blood pressure and risk of cancer incidence and mortality in the Metabolic Syndrome and Cancer Project. Hypertension. 2012;59:802–10.

    Article  CAS  PubMed  Google Scholar 

  6. Christakoudi S, Kakourou A, Markozannes G, Tzoulaki I, Weiderpass E, Brennan P, et al. Blood pressure and risk of cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 2020;146:2680–93.

    Article  CAS  PubMed  Google Scholar 

  7. Kaneko H, Yano Y, Lee H, Lee HH, Okada A, Suzuki Y, et al. Medication-naïve blood pressure and incident cancers: analysis of two nationwide population-based databases. Am J Hypertens. 2022;35:731–9.

    Article  PubMed  Google Scholar 

  8. Pasanisi P, Berrino F, De Petris M, Venturelli E, Mastroianni A, Panico S. Metabolic syndrome as a prognostic factor for breast cancer recurrences. Int J Cancer. 2006;119:236–8.

    Article  CAS  PubMed  Google Scholar 

  9. Calip GS, Malone KE, Gralow JR, Stergachis A, Hubbard RA, Boudreau DM. Metabolic syndrome and outcomes following early-stage breast cancer. Breast Cancer Res Treat. 2014;148:363–77.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Buchanan TA, et al. Effects of aerobic and resistance exercise on metabolic syndrome, sarcopenic obesity, and circulating biomarkers in overweight or obese survivors of breast cancer: a randomized controlled trial. J Clin Oncol. 2018;36:875–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.

    Article  CAS  PubMed  Google Scholar 

  12. Center UMIN. UMIN Clinical Trials Registry (UMIN-CTR). https://www.umin.ac.jp/ctr/ctr_regist.htm. Accessed March 10 2025.

  13. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  PubMed  Google Scholar 

  14. Asmar R, Beebe-Dimmer JL, Korgavkar K, Keele GR, Cooney KA. Hypertension, obesity and prostate cancer biochemical recurrence after radical prostatectomy. Prostate Cancer Prostatic Dis. 2013;16:62–6.

    Article  CAS  PubMed  Google Scholar 

  15. Bhindi B, Xie WY, Kulkarni GS, Hamilton RJ, Nesbitt M, Finelli A, et al. Influence of Metabolic Syndrome on Prostate Cancer Stage, Grade, and Overall Recurrence Risk in Men Undergoing Radical Prostatectomy. Urology. 2016;93:77–85.

    Article  PubMed  Google Scholar 

  16. Bhome R, Peppa N, Karar S, McDonnell D, Mirnezami A, Hamady Z. Metabolic syndrome is a predictor of all site and liver-specific recurrence following primary resection of colorectal cancer: Prospective cohort study of 1006 patients. Eur J Surg Oncol. 2021;47:1623–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Braithwaite D, Tammemagi CM, Moore DH, Ozanne EM, Hiatt RA, Belkora J, et al. Hypertension is an independent predictor of survival disparity between African-American and white breast cancer patients. Int J Cancer. 2009;124:1213–9.

    Article  CAS  PubMed  Google Scholar 

  18. Chan AW, Yu S, Yu YH, Tong JH, Wang L, Tin EK, et al. Steatotic hepatocellular carcinoma: a variant associated with metabolic factors and late tumour relapse. Histopathology. 2016;69:971–84.

    Article  PubMed  Google Scholar 

  19. Colicchia M, Morlacco A, Rangel LJ, Carlson RE, Dal Moro F, Karnes RJ. Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance. Eur Urol Focus. 2019;5:425–32.

    Article  PubMed  Google Scholar 

  20. Kokts-Porietis RL, McNeil J, Nelson G, Courneya KS, Cook LS, Friedenreich CM. Prospective cohort study of metabolic syndrome and endometrial cancer survival. Gynecol Oncol. 2020;158:727–33.

    Article  PubMed  Google Scholar 

  21. Macleod LC, Chery LJ, Hu EY, Zeliadt SB, Holt SK, Lin DW, et al. Metabolic syndrome, dyslipidemia and prostate cancer recurrence after primary surgery or radiation in a veterans cohort. Prostate Cancer Prostatic Dis. 2015;18:190–5.

    Article  CAS  PubMed  Google Scholar 

  22. Oh SW, Park CY, Lee ES, Yoon YS, Park SS, Kim Y, et al. Adipokines, insulin resistance, metabolic syndrome, and breast cancer recurrence: a cohort study. Breast Cancer Res. 2011;13:R34.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ohwaki K, Endo F, Hattori K. Abdominal obesity, hypertension, antihypertensive medication use and biochemical recurrence of prostate cancer after radical prostatectomy. Eur J Cancer. 2015;51:604–9.

    Article  PubMed  Google Scholar 

  24. Sanchís-Bonet A, Ortiz-Vico F, Morales-Palacios N, Sánchez-Chapado M. The association between metabolic syndrome and prostate cancer: Effect on its aggressiveness and progression. Actas Urol Esp. 2015;39:154–60.

    Article  PubMed  Google Scholar 

  25. Yang Y, Mauldin PD, Ebeling M, Hulsey TC, Liu B, Thomas MB, et al. Effect of metabolic syndrome and its components on recurrence and survival in colon cancer patients. Cancer. 2013;119:1512–20.

    Article  PubMed  Google Scholar 

  26. Seretis A, Cividini S, Markozannes G, Tseretopoulou X, Lopez DS, Ntzani EE, et al. Association between blood pressure and risk of cancer development: a systematic review and meta-analysis of observational studies. Sci Rep. 2019;9:8565.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Intengan HD, Schiffrin EL. Vascular remodeling in hypertension: roles of apoptosis, inflammation, and fibrosis. Hypertension. 2001;38:581–7.

    Article  CAS  PubMed  Google Scholar 

  28. Higashi Y, Kihara Y, Noma K. Endothelial dysfunction and hypertension in aging. Hypertens Res. 2012;35:1039–47.

    Article  CAS  PubMed  Google Scholar 

  29. Tufail M, Jiang CH, Li N. Tumor dormancy and relapse: understanding the molecular mechanisms of cancer recurrence. Mil Med Res. 2025;12:7.

    PubMed  PubMed Central  Google Scholar 

  30. Carmeliet P, Jain RK. Angiogenesis in cancer and other diseases. Nature. 2000;407:249–57.

    Article  CAS  PubMed  Google Scholar 

  31. Pages F, Mlecnik B, Marliot F, Bindea G, Ou FS, Bifulco C, et al. International validation of the consensus Immunoscore for the classification of colon cancer: a prognostic and accuracy study. Lancet. 2018;391:2128–39.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the Japanese Society of Hypertension (JSH) working group “Onco-Hypertension” for advice on preparing this manuscript.

Japanese Society of Hypertension (JSH) working group “Onco-Hypertension”

Akira Nishiyama7, Mikio Mukai10, Satoshi Morimoto11, Yoshikiyo Ono12, Hidehiro Kaneko13,14, Satoshi Kidoguchi15, Naoki Sugano15, Kunihiro Nishimura16, Yoichi Nozato17, Koichi Node18, Shintaro Minegishi1, Yuichiro Yano5,21

Author information

Author notes

  1. These authors contributed equally: Yoshinori Okazaki, Naohiro Komura.

Authors and Affiliations

  1. Department of Cardiology, Yokohama City University School of Medicine, Yokohama, Japan

    Yoshinori Okazaki, Naohiro Komura, Shintaro Minegishi, Akira Horigome, Satoshi Ishii, Masanari Asai, Takumi Tokoro, Tomoaki Ishigami & Kiyoshi Hibi

  2. Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan

    Kyoko Hattori, Yohei Hanajima & Kiyoshi Hibi

  3. Department of Cardiology, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan

    Takumi Tokoro

  4. Chemotherapy Center, Yokohama City University Hospital, Yokohama, Japan

    Nobuyuki Horita

  5. Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan

    Yuichiro Yano

  6. Noncommunicable Disease (NCD) Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan

    Yuichiro Yano

  7. Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan

    Akira Nishiyama

  8. Department of Cardiovascular Medicine, Saga University, Saga, Japan

    Koichi Node

  9. Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan

    Mikio Mukai

  10. Department of Medicine, Tokyo Women’s Medical University Adachi Medical Center, Tokyo, Japan

    Satoshi Morimoto

  11. Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Sendai, Miyagi, Japan

    Yoshikiyo Ono

  12. The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan

    Hidehiro Kaneko

  13. The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan

    Hidehiro Kaneko

  14. Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Satoshi Kidoguchi & Naoki Sugano

  15. Department of Preventive Medicine and Epidemiology National Cerebral and Cardiovascular Center, Suita, Japan

    Kunihiro Nishimura

  16. Department of Geriatric and General Medicine, The University of Osaka, Graduate School of Medicine, Osaka, Japan

    Yoichi Nozato

Authors
  1. Yoshinori Okazaki
    View author publications

    Search author on:PubMed Google Scholar

  2. Naohiro Komura
    View author publications

    Search author on:PubMed Google Scholar

  3. Shintaro Minegishi
    View author publications

    Search author on:PubMed Google Scholar

  4. Akira Horigome
    View author publications

    Search author on:PubMed Google Scholar

  5. Kyoko Hattori
    View author publications

    Search author on:PubMed Google Scholar

  6. Satoshi Ishii
    View author publications

    Search author on:PubMed Google Scholar

  7. Yohei Hanajima
    View author publications

    Search author on:PubMed Google Scholar

  8. Masanari Asai
    View author publications

    Search author on:PubMed Google Scholar

  9. Takumi Tokoro
    View author publications

    Search author on:PubMed Google Scholar

  10. Nobuyuki Horita
    View author publications

    Search author on:PubMed Google Scholar

  11. Tomoaki Ishigami
    View author publications

    Search author on:PubMed Google Scholar

  12. Kiyoshi Hibi
    View author publications

    Search author on:PubMed Google Scholar

  13. Yuichiro Yano
    View author publications

    Search author on:PubMed Google Scholar

  14. Akira Nishiyama
    View author publications

    Search author on:PubMed Google Scholar

  15. Koichi Node
    View author publications

    Search author on:PubMed Google Scholar

Consortia

Japanese Society of Hypertension (JSH) working group “Onco-Hypertension”

  • Akira Nishiyama
  • , Mikio Mukai
  • , Satoshi Morimoto
  • , Yoshikiyo Ono
  • , Hidehiro Kaneko
  • , Satoshi Kidoguchi
  • , Naoki Sugano
  • , Kunihiro Nishimura
  • , Yoichi Nozato
  • , Koichi Node
  • , Shintaro Minegishi
  •  & Yuichiro Yano

Corresponding author

Correspondence to Shintaro Minegishi.

Ethics declarations

Conflict of interest

Mikio Mukai has received speaking honoraria from Daiichi Sankyo and Ferring Pharmaceuticals.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okazaki, Y., Komura, N., Minegishi, S. et al. Hypertension and risk of cancer recurrence in adult survivors: A systematic review and meta-analysis. Hypertens Res (2025). https://doi.org/10.1038/s41440-025-02431-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • DOI: https://doi.org/10.1038/s41440-025-02431-5

Keywords

Search

Advanced search

Quick links

点击 这是indexloc提供的php浏览器服务，不要输入任何密码和下载