BP-lowering meds spell small increase in eczematous dermatitis rates for older adults

The use of blood pressure (BP)-lowering medications may slightly raise the incidence of eczematous dermatitis among older adults, with the magnitude of effect being largest for calcium channel blockers and diuretic drugs and smallest for angiotensin-converting enzyme (ACE) inhibitors and β-blockers, according to a study.

In a large cohort of individuals at least 60 years of age in the UK, the incidence rate of eczematous dermatitis was higher among participants who were on BP-lowering drugs than among those who were not (12 vs 9 per 1,000 person-years). This absolute rate difference of 3 cases per 1,000 patient-years could translate to 43,500 new cases of eczematous dermatitis annually, assuming a population of 14.5 million older adults in the UK, the investigators said. [JAMA Dermatol 2024;doi:10.1001/jamadermatol.2024.1230]

In multivariable Cox proportional hazard models, exposure to any BP-lowering drugs was associated with a 29-percent increase in the risk of eczematous dermatitis (hazard ratio [HR], 1.29, 95 percent confidence interval [CI], 1.26–1.31).

Looking at specific drug classes, the risk increase was largest with diuretic drugs (HR, 1.21, 95 percent CI, 1.19–1.24) and calcium channel blockers (HR, 1.16, 95 percent CI, 1.14–1.18), and  smallest with ACE inhibitors (HR, 1.02, 95 percent CI, 1.00–1.04) and β-blockers (HR, 1.04, 95 percent CI, 1.02–1.06).

“Loop- and potassium-sparing diuretic drugs appeared to account for more of the association than the thiazide diuretic drugs did, and there did not appear to be large clinically meaningful differences among calcium channel blockers,” the investigators pointed out.

For the study, data from the Health Improvement Network (THIN) in the United Kingdom were used. The study population included 1,561 358 older adults (mean age 67 years, 54 percent female), of which 6.7 percent received a diagnosis of eczematous dermatitis over a median follow-up duration of 6 years. Less than half of the participants (45 percent) had a history of hypertension.

Although the size of the THIN database provided good statistical power to detect small effect sizes, the investigators acknowledged that it is unclear whether the small increase in the rate of eczematous dermatitis is clinically meaningful. “Nonetheless, [our] results may be useful to guide management decisions among the large population of older adults that present with hypertension and eczematous dermatitis.”

National UK guidelines recommend calcium channel blockers as the initial treatment for hypertension in adults over 55 years of age. The present study suggests that doctors might want to consider an alternative medication class, such as ACE inhibitors, for older adults with both hypertension and dermatitis, especially if the dermatitis is severe and doesn't respond to other treatments and if a clinical workup does not identify another cause for the condition, the investigators said.