Commonly used antihypertensives and lower urinary tract symptoms: results from the Boston Area Community Health (BACH) Survey

Abstract

Study Type – Prevalence (inception cohort) Level of Evidence 1b What's known on the subject? and What does the study add? Certain antihypertensives, particularly diuretics and calcium channel blockers, are known to be associated with increased risk of LUTS including nocturia, but little is known about gender-specific effects. This is the first epidemiological study, to our knowledge, to compare the prevalence of several urological symptoms (storage, voiding and nocturia) among male and female users of a wide variety of common antihypertensives using a community-based sample. OBJECTIVE • To examine differences in the prevalence of lower urinary tract symptom (LUTS) among users of five common AHT classes compared with non-users, adjusted for LUTS risk factors in a large, representative sample. SUBJECTS AND METHODS • Data were from the Boston Area Community Health Survey, a population-based study of community-dwelling male and female (30–79 years) residents of Boston, MA, USA for whom prescription drug information was collected between 2002 and 2005. • The urological symptoms of storage, voiding, and nocturia were assessed using interviewer-administered questionnaires and the American Urological Association Symptom Index. This analysis was conducted among 1865 participants with an AHT indication. • Associations of angiotensin-converting enzyme inhibitors, beta blockers, calcium channel blockers (CCBs) and loop and thiazide diuretics with the three groups of LUTS were estimated using odds ratios (ORs) and 95% confidence intervals (CIs) from multivariate logistic regression (referent group: untreated hypertension). Overlap in use was accounted for using monotherapy and combination therapy exposure categories. RESULTS • Among women, monotherapy with CCBs was associated with increased prevalence of nocturia (OR = 2.65, 95% CI: 1.04–6.74) and voiding symptoms (OR = 3.84, 95% CI: 1.24–11.87); these results were confined to women aged <55 years. • Among men of all ages, positive associations were observed for thiazides and voiding symptoms (monotherapy OR = 2.90, 95% CI: 1.17–7.19), and loop diuretics and nocturia (combination therapy OR = 2.55, 95% CI: 1.26–5.14). CONCLUSION • Results are consistent with the hypothesis that certain AHTs may aggravate LUTS. The presence of new or worsening LUTS among AHT users suggests medications should be reviewed and a change in AHT class considered.