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However, it remains unknown whether continuous use of hydralazine\u2014an antihypertensive agent (AHA) with notable anti-neoplastic activity\u2014is associated with a lower risk of hematologic neoplasms compared to other AHAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method and findings<\/jats:title>\n                    <jats:p>\n                      Utilizing Taiwan\u2019s National Health Insurance Research Database, we conducted a 16-year follow-up study (2000\u20132015) involving 375,107 patients with hypertension treated with an AHA for \u2265180 days. The patients with hypertension were divided into two groups based on hydralazine prescription duration: an exposure group (hydralazine \u2265180 days;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200959,786) and a reference group (hydralazine &lt;180 days;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009239,144) after 1:4 matching for sex, age, and index date with the exposure group. Both groups were well-matched, with a mean age of approximately 60.8 years and 52.19% male. We assess the association between hydralazine use and the risk of hematologic neoplasms using Kaplan\u2013Meier analysis and multivariable Cox proportional hazards regression, with models adjusted for concomitant medications possessing potential anti-neoplastic properties. The 16-year cumulative incidence of hematologic neoplasms was lower in the exposure group (105.58 per 100,000 person-years) than in the reference group (160.33). Accounting for death as competing risk, the exposure group exhibited an adjusted subdistribution hazard ratio (adjusted sHR) of 0.789 (95% confidence interval [0.667,0.913];\n                      <jats:italic>P\u2009<\/jats:italic>\n                      &lt;\u2009.001) for hematologic neoplasms compared to the reference group. Subgroup analyses demonstrated that the association with a lower risk was strongest in the longest prescription duration category. For example, for patients with prescription durations of \u2265668 days, the adjusted sHR was 0.448 (95% CI [0.366,0.555];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001) for other malignant neoplasms of lymphoid and histiocytic tissue, 0.552 (95% CI [0.453,0.683];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001) for multiple myeloma and immunoproliferative neoplasms, and 0.555 (95% CI [0.457,0.689];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.001) for myeloid leukemia. The main limitation was the potential for residual confounding due to the unavailability of lifestyle and laboratory data in the administrative database.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this study, we observed that long-term hydralazine use in patients with hypertension was associated with a lower, duration-dependent risk of hematologic neoplasms. These findings warrant prospective studies to confirm this association and its potential clinical implications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004646","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:35:09Z","timestamp":1764873309000},"page":"e1004646","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of hydralazine use with risk of hematologic neoplasms in patients with hypertension: A nationwide population-based cohort study in Taiwan"],"prefix":"10.1371","volume":"22","author":[{"given":"Li-Tzu","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3286-0780","authenticated-orcid":true,"given":"Wu-Chien","family":"Chien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin Sheng-Kai","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4576-9900","authenticated-orcid":true,"given":"Chi-Hsiang","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeu-Chin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8293-9964","authenticated-orcid":true,"given":"Wei-Che","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2902-632X","authenticated-orcid":true,"given":"Bing-Heng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"issue":"5","key":"pmed.1004646.ref001","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1200\/JCO.22.01875","article-title":"Onco-hypertension: 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