Alpha blockers lower mortality in Heart Failure: JACC
The use of alpha-blocker (AB) following an admission for heart failure (HF) is associated with a lower rate of HF readmission and death, according to a new study published in the journal JACC: Heart Failure. Higher doses and nonselective ABs were also associated with lower mortality, regardless of the use of beta-blocker (BB).
Alpha-blockers, found to increase the risk of HF in the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) trial, are commonly used for prostatic hypertrophy, including in those with or at risk for HF.
This study evaluated whether AB use following an admission for heart failure (HF) was associated with an increased risk of HF readmission or death.
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This propensity score-matched cohort study included patients discharged from a Veterans Affairs hospital between January 2002 and September 2015 with a primary diagnosis of HF and ascertained AB use at discharge. Cox proportional hazards models were constructed to compare time to first HF readmission and death at 2 years between groups. Secondary analyses assessed effects by AB dose and type and by beta-blocker (BB) use.
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- Of 169,911 HF patients, 47,638 (28%) were prescribed an AB. Propensity score matching resulted in 35,713 matched pairs.
- In the propensity score-matched cohort, AB use was associated with fewer HF readmissions (39.8% vs. 41.7% at 2 years; hazard ratio: 0.95; 95% confidence interval [CI]: 0.92 to 0.97; p < 0.0001) and death (42.8% vs. 46.5%, hazard ratio: 0.93; 95% CI: 0.91 to 0.94; p < 0.0001).
- Nonselective ABs had fewer deaths and HF readmissions (p < 0.0001), while higher AB doses reduced mortality.
- AB treatment was associated with reduced deaths in both BB-treated and untreated patients, with no increase in HF.
These data should lay to rest the misinterpretation of ALLHAT that alpha-blockers have an adverse effect on outcome in hypertension. What ALLHAT demonstrated is that the cardiovascular protective effect of an alpha-blocker is less than that for alternative treatments for hypertension.
"ABs may be used safely in HF patients where clinically indicated. The finding of improved outcomes with ABs may warrant further study," concluded the authors.
For further reference log on to 10.1016/j.jchf.2018.06.015