Antihypertensive drugs like calcium channel blockers and diuretics may increase risk of eczematous dermatitis: JAMA

Rates of physician-diagnosed eczema have been increasing among older adults, but little is known about the underlying mechanisms and optimal treatments for this subgroup. Preliminary data suggested a potential link between antihypertensive medications and eczematous dermatitis, prompting further investigation into this association.

The study analyzed a population-based sample of individuals aged 60 years and older without a prior diagnosis of eczematous dermatitis. Conducted from January 1, 1994, to January 1, 2015, the study utilized data from The Health Improvement Network in the UK. Data analyses were performed from January 6, 2020, to February 6, 2024. The primary exposure was the first prescription of an antihypertensive drug, categorized by drug class.

• The study included 1,561,358 older adults with a mean age of 67 years (SD 9), and 54% were female.

• The overall prevalence of eczematous dermatitis was 6.7% during a median follow-up of 6 years (IQR 3-11). Incidence was higher among those receiving antihypertensive drugs (12 vs. 9 per 1000 person-years).

• Adjusted Cox proportional hazard models indicated a 29% increased hazard rate for eczematous dermatitis among those using any antihypertensive drugs (HR 1.29; 95% CI 1.26-1.31).

•Diuretic drugs showed the largest effect size (HR 1.21; 95% CI 1.19-1.24).

• Calcium channel blockers also had a significant effect (HR 1.16; 95% CI 1.14-1.18).

• Angiotensin-converting enzyme inhibitors had a smaller effect (HR 1.02; 95% CI 1.00-1.04).

• β-blockers showed a similar smaller effect (HR 1.04; 95% CI 1.02-1.06).

The findings indicate a small but significant increased risk of eczematous dermatitis associated with antihypertensive drugs, particularly with diuretics and calcium channel blockers. While the exact mechanisms remain unclear, the data suggest that clinicians should consider these potential side effects when prescribing antihypertensive medications to older adults.

These results could guide clinicians in managing patients who develop eczema later in life. Awareness of the potential link between antihypertensive medications and eczematous dermatitis may prompt more careful selection of antihypertensive therapy, possibly opting for drugs with a lower associated risk when appropriate.

Researchers have found that the use of antihypertensive drugs in older adults is associated with a higher rate of eczematous dermatitis. The effect size varies by drug class, being largest for diuretic drugs and calcium channel blockers. These findings underscore the importance of considering medication history in the management of eczema in older adults.

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