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Risk of congestive heart failure in an elderly population treated with peripheral alpha-1 antagonists

Chris L Bryson1, Nicholas L Smith, Lewis H Kuller

  • 1VA Puget Sound Health Services Research and Development, VAMC, Seattle, Washington 98108, USA. cbryson@u.washington.edu

Journal of the American Geriatrics Society
|September 29, 2004
PubMed

Insights

Elderly individuals taking alpha-1 antagonists for hypertension face a higher risk of congestive heart failure (CHF). This increased risk, particularly for women without prior cardiovascular disease, was partly explained by blood pressure control.

Area of Science:

  • Cardiology
  • Geriatrics
  • Pharmacology

Background:

  • Hypertension management in the elderly is crucial for preventing cardiovascular events like congestive heart failure (CHF).
  • Peripheral alpha-1 antagonists are used for hypertension, but their comparative safety regarding CHF risk requires investigation.
  • Thiazide diuretics are a common first-line treatment for hypertension in older adults.

Purpose of the Study:

  • To compare the risk of congestive heart failure (CHF) in elderly individuals treated with peripheral alpha-1 antagonists versus thiazide diuretics for hypertension.
  • To determine if the CHF risk associated with alpha-1 antagonists persists in individuals without pre-existing cardiovascular disease (CVD).
  • To examine CHF risk in normotensive men with prostatism treated with alpha antagonists.

Main Methods:

  • Prospective cohort study involving 5,888 community-dwelling subjects aged 65 and older across four U.S. sites.
  • Adjudicated incident congestive heart failure (CHF) was the primary outcome measure.
  • Analysis compared CHF risk between alpha-1 antagonist monotherapy and thiazide monotherapy, with adjustments for baseline characteristics and blood pressure control.

Main Results:

  • Elderly individuals receiving alpha-1 antagonist monotherapy for hypertension had a 1.90-fold increased age-adjusted risk of CHF compared to those on thiazides.
  • In subjects without baseline CVD, women on alpha antagonist monotherapy showed a 3.6-fold greater age-adjusted CHF risk, while men showed no significant difference.
  • Adjusting for systolic blood pressure partially attenuated the observed differences in CHF risk. No increased CHF risk was noted in normotensive men with prostatism using alpha antagonists.

Conclusions:

  • Alpha-1 antagonist monotherapy for hypertension is associated with a two to three times greater risk of incident congestive heart failure (CHF) in the elderly.
  • This elevated CHF risk was observed even in lower-risk subjects and was partly attributable to differences in blood pressure control.
  • Findings suggest careful consideration of alpha-1 antagonists in elderly hypertensive patients, particularly women without prior CVD, due to potential CHF risks.
Abstract

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