Alpha blockers tied to less favourable cardiovascular profile than 5-ARIs in BPH

In the treatment of men with benign prostatic hyperplasia (BPH), alpha blockers appear to be associated with worse cardiovascular outcomes compared with 5-alpha reductase inhibitors (5-ARIs), as shown in a study.

For the study, researchers used insurance claims data from a random sample of Medicare beneficiaries to evaluate the 1-year risk of adverse cardiovascular outcomes among men between 66 and 90 years of age who were initiated on an alpha blocker or a 5-ARI for BPH.

The primary endpoints were hospitalization for heart failure (HF), composite major adverse cardiovascular events (MACE: hospitalization for stroke, myocardial infarction, or death), composite MACE or hospitalization for HF, and death. Inverse probability of treatment and censoring-weighted 1-year risks were used in the analysis.

Of the 189,868 older adult males included in the study, 163,829 initiated alpha blockers (mean age 74.6 years, 81.5 percent non-Hispanic) and 26,039 initiated 5-ARIs (mean age 75.3 years, 83.0 percent non-Hispanic White).

Compared with 5-ARIs, alpha blockers were associated with a greater 1-year risk of MACE (8.95 percent, 95 percent confidence interval [CI], 8.81–9.09 vs 8.32 percent, 95 percent CI, 7.92–8.72; risk ratio [RR], 1.08, 95 percent CI, 1.02–1.13; risk difference [RD], 6.26 per 1,000 individuals, 95 percent CI, 2.15–10.37), composite MACE and HF (RR, 1.07, 95 percent CI, 1.03–1.12; RD, 7.40 per 1,000 individuals, 95 percent CI, 2.88–11.93), and death (RR, 1.07, 95 percent CI, 1.01–1.14; RD, 3.85 per 1,000 individuals, 95 percent CI, 0.40–7.29).

The findings, if replicated with more detailed confounder data, may have important public health implications given the medications’ widespread use.