Cardiac Failure Associated With Medical Therapy Of Benign Prostatic Hyperplasia: A Population Based Study

Purpose: Increased risk of cardiac failure with alpha-blockers in hypertension studies and 5-alpha reductase inhibitors in prostate studies have raised safety concerns for long term management of benign prostatic hyperplasia. The objective of this study was to determine if these medications are associated with an increased risk of cardiac failure in routine care.Materials and Methods: This population based study used administrative databases including all men over 66 with a diagnosis of benign prostatic hyperplasia between 2005 and 2015. Men were categorized based on 5-alpha reductase inhibitor exposure and/or alpha-blocker exposure with a primary outcome of new cardiac failure utilizing competing risk models. Explanatory variables examined included exposure thresholds, formulations, age, and comorbidities associated with cardiac disease.Results: The data set included 175,201 men with a benign prostatic hyperplasia diagnosis with 8,339, 55,383, and 41,491 exposed to 5-alpha reductase inhibitor, alpha-blocker and combination therapy, respectively. Men treated with 5-alpha reductase inhibitor and alpha-blocker, alone or in combination, had a statistically increased risk of being diagnosed with cardiac failure compared to no medication use. Cardiac failure risk was highest for alpha-blockers alone (HR 1.22; 95% CI 1.18-1.26), intermediate for combination alpha-blockers/5-alpha reductase inhibitors (HR 1.16; 95% CI 1.12-1.21) and lowest for 5-alpha reductase inhibitors alone (HR 1.09; 95% CI 1.02-1.17). Nonselective alpha-blocker had a higher risk of cardiac failure than selective alpha-blockers (HR 1.08; 95% CI 1.00-1.17).Conclusions: In routine care, men with a benign prostatic hyperplasia diagnosis and exposed to both 5-alpha reductase inhibitor and alpha-blocker therapy had an increased association with cardiac failure, with the highest risk for men exposed to nonselective alpha-blockers.