Alpha-blockers show worse CV outcomes compared to 5-Alpha Reductase Inhibitors in BPH patients

The most prescribed class of medications for benign prostatic hyperplasia (BPH) is ABs. However, the cardiovascular safety profile of these medications among patients with BPH is not well understood.

A recent cohort study involving Medicare beneficiaries from 2007 to 2019 has shed light on the comparative cardiovascular safety of medications used for benign prostatic hyperplasia (BPH). The findings highlight potential cardiovascular risks associated with α-blockers in this demographic and imply implications for public health.

The study found that treatment of benign prostatic hyperplasia with α-blockers was associated with worse cardiovascular outcomes compared with 5-α reductase inhibitors.

The study was published in JAMA Network Open by Jiangdong Zhang and colleagues. The study, focusing on males aged 66 to 90, aimed to analyze adverse cardiovascular outcomes associated with α-blockers (ABs) versus 5-α reductase inhibitors (5-ARIs).

The analysis encompassed 189,868 older adult males initiating either ABs or 5-ARIs. Among the AB initiators (mean age 74.6 years), 81.5% were non-Hispanic White, while the 5-ARI initiators (mean age 75.3 years) had a comparable demographic composition. The study evaluated outcomes such as hospitalization for heart failure (HF), major adverse cardiovascular events (MACE), and mortality over a year following treatment initiation.

Results revealed that compared to 5-ARIs, ABs were associated with an increased 1-year risk of MACE (8.95% vs. 8.32%), composite MACE and HF, and death. Notably, the risk of HF hospitalization alone showed no significant difference between the two medications.

If further corroborated with more extensive data, these results could inform clinical decision-making regarding the prescription of medications for managing BPH. This study's scope contributes valuable insights into the safety profile of commonly prescribed BPH medications, emphasizing the necessity for continued research and potentially reevaluating clinical practices surrounding their use.

Reference:

Zhang, J., Latour, C. D., Olawore, O., Pate, V., Friedlander, D. F., Stürmer, T., Jonsson Funk, M., & Jensen, B. C. Cardiovascular outcomes of α-blockers vs 5-α reductase inhibitors for benign prostatic hyperplasia. JAMA Network Open,2023; 6(11):e2343299. https://doi.org/10.1001/jamanetworkopen.2023.43299