Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietySeptember 2024
Observational data suggest an association, particularly among patients initiating calcium-channel blockers or diuretics.
More than a decade ago, two small case-control studies suggested an association between some antihypertensive drugs and chronic eczematous dermatitis in older adults. Both studies showed excess risk for eczema in patients taking calcium-channel blockers; one study also showed an association with thiazide diuretics (NEJM JW Dermatol Jan 2008 and J Invest Dermatol 2007; 127: 2766-2771; NEJM JW Gen Med Jun 15 2013 and JAMA 2013; 149: 814-818). To explore this association further, researchers analysed electronic health records of about 1.5 million older patients (age, 60 years and older) from primary care practices across the UK.
After adjustment for confounders, new diagnoses of eczema were 29% more common in patients who initiated antihypertensive drugs. Diuretics and calcium-channel blockers had the strongest associations with eczematous dermatitis (adjusted hazard ratios [HRs], about 1.2 for each). ACE inhibitors and beta blockers were associated only weakly with eczema (adjusted HRs, 1.02 and 1.04, respectively). Associations between these extremes were noted for angiotensin receptor blockers and alpha blockers.
Comment: This study bolsters prior evidence showing that some antihypertensive drugs are associated with eczematous dermatitis in older adults. Although these data are observational, I find them convincing: the authors analysed a large population-based cohort, they controlled for many relevant confounders and their results concur with those of earlier reports. Going forward, when I see an older adult who develops eczematous dermatitis after initiating an antihypertensive drug (especially a calcium-channel blocker or a diuretic), I will consider discontinuing the drug – unless the patient has a compelling need for the specific drug and the eczema is mild and easily controlled with standard measures.
Molly S. Brett, MD, Assistant Professor of Medicine, University of Colorado, Boulder, USA.
Ye M, et al. Antihypertensive medications and eczematous dermatitis in older adults. JAMA Dermatol 2024; 160: 710-716.
This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.