Association Between Alpha-Blockers for Benign Prostatic Hyperplasia and Acute Angle-Closure Glaucoma

To investigate the association between alpha (α)-blockers use for benign prostatic hyperplasia (BPH) and the incidence of acute angle-closure glaucoma (AACG) in a nationwide population-based cohort.

Retrospective clinical cohort study.

This study analyzed data from the Korean National Health Insurance Sharing Service, encompassing nationwide health records from 2002 to 2022. A 1:5 propensity score-matched cohort was created using baseline covariates, ensuring balance between AACG cases and matched controls.

Alpha-blocker use for BPH was identified by the presence of both a BPH diagnosis (KCD code N40) and a corresponding prescription prior to AACG diagnosis. Patients were categorized into three groups based on cumulative medication duration: Category 1 (≤23 days), Category 2 (24-202 days), and Category 3 (≥203 days).

Incident AACG cases were identified using diagnostic and procedure codes, and hazard ratios (HR) were estimated using Cox proportional hazards models.

The final cohort included 30 450 participants, comprising 5075 AACG cases and 25 375 matched controls. Alpha-blocker use was associated with a significantly increased risk of AACG (adjusted HR, 1.52; 95% CI, 1.40-1.66; P < .001) compared to nonuse. A dose-response relationship was observed, with AACG incidence increasing from 0.15% among users with ≤23 days of exposure to 0.41% among those with ≥203 days.

This study demonstrates a significant, duration-dependent association between α-blocker use for BPH and an increased risk of AACG. These findings underscore the potential value of ophthalmologic evaluation when prescribing α-blockers, particularly for patients who may be anatomically predisposed to angle-closure events.