Initiation of nonselective alpha1-antagonist therapy and occurrence of hypotension-related adverse events among men with benign prostatic hyperplasia: a retrospective cohort study.
BACKGROUND
Treatment of benign prostatic hyperplasia (BPH) with nonselective alpha1 antagonists such as terazosin, doxazosin, and prazosin results in blood pressure reduction due to vasodilation.


OBJECTIVE
Using claims data from a large Medigap plan, we examined the effect of initiating nonselective alpha1-antagonist therapy on the incidence of hypotension-related adverse events likely to be associated with vascular alpha-adrenoreceptor antagonism in patients with BPH.


METHODS
Medical and prescription claims data were obtained from the MEDSTAT Group for 53,824 men with a diagnosis code for BPH during the study period (January 1995-December 1997). We examined the rate of possible hypotension-related adverse events (diagnosis codes for hypotension, syncope, dizziness, fractures, and other injuries) per 10,000 person-days for men who began therapy with alpha1 antagonists and for a random sample of nonusers, stratified by prior use of other antihypertensive agents.


RESULTS
After adjusting for baseline differences in event rates, those who initiated alpha1-antagonist therapy (n = 1564) had a significantly greater increase in hypotension-related adverse-event rates in the 4 months after initiation (vs the 4 months before initiation) than randomly selected nonusers (n = 8641) (increase of 1.82 vs decrease of 0.02 events per 10,000 person-days among those not taking antihypertensive agents; increase of 0.94 vs 0.69 events per 10,000 person-days among those taking other antihypertensive agents; P < 0.01). This increase began earlier and lasted longer among patients taking other antihypertensive agents. Those who discontinued their alpha1 antagonist had a higher rate of hypotensive events at baseline than those who did not (5.09 vs 3.19 events per 10,000 person-days among those using other antihypertensive agents; 3.62 vs 2.27 events per 10,000 person-days among those not using other antihypertensive agents; P < 0.05).


CONCLUSIONS
Initiation of nonselective alpha1-antagonist therapy for the treatment of BPH increases the risk of a cluster of clinical events consistent with vascular alpha-adrenoreceptor antagonism. This effect is seen during a 4-month period around the initiation date. Prior initiation of other antihypertensive medication increases this effect. Urologists should consult with a patient's primary care physician about use of other antihypertensive agents before initiating nonselective alpha1-antagonist therapy for BPH.
Chrischilles
E
E
Department of Epidemiology, University of Iowa, Iowa City 52242, USA. echrischilles@uiowa.edu
Rubenstein
L
L
Chao
J
J
Kreder
K J
KJ
Gilden
D
D
Shah
H
H
D000058:Accidental Falls; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects*; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects*; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology; D004244:Dizziness / Q000209:etiology; D017292:Doxazosin / Q000009:adverse effects; D004359:Drug Therapy, Combination; D050723:Fractures, Bone / Q000209:etiology; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007022:Hypotension / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D011224:Prazosin / Q000009:adverse effects / Q000031:analogs & derivatives; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D013575:Syncope / Q000209:etiology
D000317:Adrenergic alpha-Antagonists; D000959:Antihypertensive Agents; C041226:Terazosin; D017292:Doxazosin; D011224:Prazosin