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Impact of alpha 1-adrenergic antagonist use for benign prostatic hypertrophy on outcomes in patients with heart failure.
Am J Cardiol. 2009 Jul 15; 104(2):270-5.AJ

Abstract

Previous clinical trials have shown that alpha(1)-adrenergic antagonists are not effective in subjects with heart failure (HF) and might increase HF rates when used for hypertension. However, alpha(1)-adrenergic antagonists may be prescribed to subjects with HF who have symptomatic benign prostatic hyperplasia. We sought to determine any association between alpha(1)-adrenergic antagonist use, commonly prescribed for benign prostatic hyperplasia, and the clinical outcomes of subjects with HF receiving contemporary therapy. An existing database of 388 subjects with decompensated HF admissions from 2002 to 2004 at the Veterans Affairs Hospital was analyzed according to the use of alpha(1)-adrenergic antagonists at discharge. Covariate-adjusted Cox proportional hazard models were used to examine any association with future admissions for decompensated HF and total mortality. Alpha-1-adrenergic antagonist therapy was prescribed in 25% of our HF population, predominantly for benign prostatic hyperplasia, and was not associated with significant increases in the combined risk of all-cause mortality and rehospitalization for HF (hazard ratio 1.24, 95% confidence interval 0.93 to 1.65, p = 0.14), HF hospitalization (hazard ratio 1.20, 95% confidence interval 0.85 to 1.70, p = 0.31), or all-cause mortality (hazard ratio 1.10, 95% confidence interval 0.78 to 1.56, p = 0.57). In patients not receiving beta-blocker therapy, alpha(1)-adrenergic antagonist therapy was significantly associated with increased HF hospitalizations (hazard ratio 1.94, 95% confidence interval 1.14 to 3.32, p = 0.015). In conclusion, in patients with chronic HF, the use of alpha(1)-adrenergic antagonists was significantly associated with more HF hospitalizations when prescribed without concomitant beta blockade. Thus, background beta-blocker therapy appears to be protective against the potential harmful effects of alpha(1)-adrenergic antagonist therapy in patients with HF.

Authors+Show Affiliations

Section of Cardiology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19576359

Citation

Dhaliwal, Amandeep S., et al. "Impact of Alpha 1-adrenergic Antagonist Use for Benign Prostatic Hypertrophy On Outcomes in Patients With Heart Failure." The American Journal of Cardiology, vol. 104, no. 2, 2009, pp. 270-5.
Dhaliwal AS, Habib G, Deswal A, et al. Impact of alpha 1-adrenergic antagonist use for benign prostatic hypertrophy on outcomes in patients with heart failure. Am J Cardiol. 2009;104(2):270-5.
Dhaliwal, A. S., Habib, G., Deswal, A., Verduzco, M., Souchek, J., Ramasubbu, K., Aguilar, D., Ma, T. S., Jneid, H. M., Bolos, M., & Bozkurt, B. (2009). Impact of alpha 1-adrenergic antagonist use for benign prostatic hypertrophy on outcomes in patients with heart failure. The American Journal of Cardiology, 104(2), 270-5. https://doi.org/10.1016/j.amjcard.2009.03.030
Dhaliwal AS, et al. Impact of Alpha 1-adrenergic Antagonist Use for Benign Prostatic Hypertrophy On Outcomes in Patients With Heart Failure. Am J Cardiol. 2009 Jul 15;104(2):270-5. PubMed PMID: 19576359.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of alpha 1-adrenergic antagonist use for benign prostatic hypertrophy on outcomes in patients with heart failure. AU - Dhaliwal,Amandeep S, AU - Habib,Gabriel, AU - Deswal,Anita, AU - Verduzco,Melinda, AU - Souchek,Julianne, AU - Ramasubbu,Kumudha, AU - Aguilar,David, AU - Ma,Tony S, AU - Jneid,Hani M, AU - Bolos,Mariana, AU - Bozkurt,Biykem, PY - 2009/02/14/received PY - 2009/03/13/revised PY - 2009/03/13/accepted PY - 2009/7/7/entrez PY - 2009/7/7/pubmed PY - 2009/7/22/medline SP - 270 EP - 5 JF - The American journal of cardiology JO - Am J Cardiol VL - 104 IS - 2 N2 - Previous clinical trials have shown that alpha(1)-adrenergic antagonists are not effective in subjects with heart failure (HF) and might increase HF rates when used for hypertension. However, alpha(1)-adrenergic antagonists may be prescribed to subjects with HF who have symptomatic benign prostatic hyperplasia. We sought to determine any association between alpha(1)-adrenergic antagonist use, commonly prescribed for benign prostatic hyperplasia, and the clinical outcomes of subjects with HF receiving contemporary therapy. An existing database of 388 subjects with decompensated HF admissions from 2002 to 2004 at the Veterans Affairs Hospital was analyzed according to the use of alpha(1)-adrenergic antagonists at discharge. Covariate-adjusted Cox proportional hazard models were used to examine any association with future admissions for decompensated HF and total mortality. Alpha-1-adrenergic antagonist therapy was prescribed in 25% of our HF population, predominantly for benign prostatic hyperplasia, and was not associated with significant increases in the combined risk of all-cause mortality and rehospitalization for HF (hazard ratio 1.24, 95% confidence interval 0.93 to 1.65, p = 0.14), HF hospitalization (hazard ratio 1.20, 95% confidence interval 0.85 to 1.70, p = 0.31), or all-cause mortality (hazard ratio 1.10, 95% confidence interval 0.78 to 1.56, p = 0.57). In patients not receiving beta-blocker therapy, alpha(1)-adrenergic antagonist therapy was significantly associated with increased HF hospitalizations (hazard ratio 1.94, 95% confidence interval 1.14 to 3.32, p = 0.015). In conclusion, in patients with chronic HF, the use of alpha(1)-adrenergic antagonists was significantly associated with more HF hospitalizations when prescribed without concomitant beta blockade. Thus, background beta-blocker therapy appears to be protective against the potential harmful effects of alpha(1)-adrenergic antagonist therapy in patients with HF. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/19576359/Impact_of_alpha_1_adrenergic_antagonist_use_for_benign_prostatic_hypertrophy_on_outcomes_in_patients_with_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(09)00770-X DB - PRIME DP - Unbound Medicine ER -