Heart failure risk is increased among men taking an alpha blocker (AB) or 5-alpha reductase inhibitor (5ARI) for benign prostatic hyperplasia (BPH), with greater risks among AB users, investigators reported in The Journal of Urology.

Among 175,201 patients older than 66 years diagnosed with BPH, 69,988 (39.9%), 8339 (4.8%), 55,383 (31.6%), and 41,491 (23.7%) men received no medication, 5ARI alone (finasteride or dutasteride), AB alone, or a combination of 5ARI and AB, respectively. No patient had a previous history of heart failure. Of the cohort, 22% were non-White.

The risk for developing new heart failure was highest among users of ABs alone (22%), followed by combination therapy (16%), and 5ARIs alone (9%), J. Curtis Nickel, MD, and colleagues from Queen’s University in Kingston, Ontario, Canada, reported.  Nonselective ABs (terazosin, doxazosin, and alfuzosin) were significantly associated with an 8% higher risk for heart failure compared with selective ABs (silodosin and tamsulosin), even after controlling for hypertension, diabetes, and previous myocardial infarction. Drug exposure longer than 420 days was significantly associated with a 16% and 14% increased risk for heart failure among users of ABs alone and selective ABs, respectively.

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The investigators noted that previous studies have suggested that men take BPH medications for several years, with primary care physicians prescribing a longer course of treatment than urologists. “It is important that urologists and primary care physicians be aware of this potential link,” Dr Nickel’s team stated. They advocated for more informed conversations with patients about the choices for contemporary management of BPH/male lower urinary tract symptoms.

As part of these conversations, it may be time to start advocating for early surgical therapy, Naeem Bhojani, MD, of the Centre Hospitalier de l’Universite de Montreal, in Ontario, Canada, and colleagues added in an accompanying editorial.


Lusty A, Siemens DR, Tohidi M, Whitehead M, Tranmer J, and Curtis Nickel J. Cardiac failure associated with medical therapy of benign prostatic hyperplasia: a population-based study. J Urol. doi:10.1097/JU.0000000000001561

Akhtar OS, Bhojani N, Zorn KC, Elterman D. Editorial comments. J Urol.