Do alpha-1 receptor blockers help prevent COVID-19 hospitalization?

Frequent use of alpha-1 receptor blockers is neither harmful nor protective against the risk of uncomplicated or severe COVID-19 hospitalization, a study has shown.

This observational case-control study was conducted in male Medicare beneficiaries aged ≥65 years, with or without benign prostatic hyperplasia (BPH), and treated with alpha-1 receptor blockers or 5-alpha reductase inhibitors.

The authors estimated adjusted odds ratios (aOR) and 95 percent confidence intervals (CIs) for the outcomes of uncomplicated and severe COVID-19 hospitalization (ie, intensive care unit admission, invasive mechanical ventilation, or death).

A total of 20,963 hospitalized COVID-19 patients were matched to 101,161 controls on calendar date and neighbourhood of residence.

The primary analysis on males with BPH revealed no significant difference in the risk of uncomplicated COVID-19 hospitalization (aOR, 1.08, 95 percent CI, 0.996‒1.17) or hospitalization with severe complications (aOR, 0.97, 95 percent CI, 0.88‒1.08).

In the secondary analysis involving males with or without BPH, the corresponding aORs for uncomplicated and complicated COVID-19 hospitalizations were 1.02 (95 percent CI, 0.96‒1.09) and 0.99 (95 percent CI, 0.91‒1.07). Results were consistent in subgroup and sensitivity analyses.

Notably, no difference was seen in the risk of severe COVID-19 hospitalization between nonselective and selective alpha-1 blocker use (aOR, 0.98, 95 percent CI, 0.86‒1.10), between higher- and lower-dose alpha-1 blocker use (aOR, 0.96, 95 percent CI, 0.86‒1.08), or between current and remote alpha-1 blocker use (aOR, 1.04, 95 percent CI, 0.91‒1.18).

“Alpha-1 adrenergic receptor antagonists prevent cytokine storm in mouse sepsis models,” the authors said. “This led to the hypothesis that alpha-1 blockers may prevent severe COVID-19, which is characterized by hypercytokinaemia and progressive respiratory failure.”