Summary:
A recent longitudinal cohort study has found that antihypertensive medications are associated with a slight increase in the risk of developing eczematous dermatitis in older adults. The strongest associations were observed with diuretics and calcium channel blockers.
Study Details:
The study, addressing the rise of atopic eczema among older adults, suggests that drug-induced eczematous dermatitis could be a frequent misdiagnosis. Researchers examined records from the THIN cohort, which included 1,561,358 older adults (average age 67; 54% women) in the United Kingdom, spanning from January 1994 to January 2015. Among the participants, 45% had hypertension and 64% used antihypertensive medications. The primary outcome was the incidence of newly diagnosed eczematous dermatitis.
Key Findings:
Over a median follow-up period of six years, 6.7% of participants (105,007 individuals) were diagnosed with eczematous dermatitis. The incidence was higher among those taking antihypertensive drugs (11-12 per 1000 patient-years) compared to those who did not use these medications (9 per 1000 patient-years). The use of any antihypertensive drug was linked to a 29% increased risk of eczematous dermatitis (hazard ratio [HR], 1.29; 95% CI, 1.26-1.31), after adjusting for confounding factors.
Among the drug classes:
- Diuretics presented the highest risk (HR, 1.21; 95% CI, 1.19-1.24).
- Calcium channel blockers followed (HR, 1.16; 95% CI, 1.14-1.18).
- Angiotensin receptor blockers (HR, 1.12; 95% CI, 1.09-1.15).
- Alpha-blockers (HR, 1.08).
The smallest risks were associated with:
- Angiotensin-converting enzyme (ACE) inhibitors (HR, 1.02; 95% CI, 1.00-1.04).
- Beta-blockers (HR, 1.04; 95% CI, 1.02-1.06).
Clinical Implications:
The authors suggest that if a clinical evaluation does not reveal another cause for dermatitis and the condition is persistent and unresponsive to treatment, switching to a different class of antihypertensive medication, such as an ACE inhibitor, might be considered.
Source:
The research was led by Morgan Ye, MPH, from the Department of Dermatology at the University of California, San Francisco, and published online in JAMA Dermatology on May 22, 2024.
Limitations:
The study did not provide detailed information on the severity or resolution of dermatitis. It could not establish causality or assess the effects of discontinuing the medications. Additionally, the majority of the study participants were of European descent, and the lack of comprehensive ethnic data may limit the generalizability of the findings.
Disclosures:
The study received support from the US National Eczema Association and the Wellcome Trust Senior Research Fellowship in Clinical Science. Two authors disclosed financial support outside of this work, while the other authors reported no conflicts of interest.
