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TOPLINE:

Antihypertensive drugs are associated with a small increased risk for eczematous dermatitis in older adults, with the highest association seen for diuretics and calcium channel blockers, in a longitudinal cohort study.

METHODOLOGY:

• Atopic eczema has been increasing among older adults, and drug-induced eczematous dermatitis may be a common reason for a misdiagnosis of atopic eczema in this population.
• To evaluate the association of eczematous dermatitis with antihypertensives, researchers analyzed records of 1,561,358 older adults (mean age, 67 years; 54% women) from the THIN cohort, a sample of patients in the United Kingdom, from January 1994 to January 2015.
• A total of 45% of patients had hypertension, and 64% used antihypertensive drugs.
• The primary outcome was the diagnosis of newly active eczematous dermatitis.

TAKEAWAY:

• Overall, 105,007 participants (6.7%) were diagnosed with eczematous dermatitis over a median follow-up of 6 years.
• The incidence of eczematous dermatitis was higher among adults who received antihypertensive drugs than among those who did not (11-12 per 1000 patient-years vs 9 per 1000 patient-years, respectively). Any antihypertensive drug use was associated with a 29% higher risk for eczematous dermatitis (hazard ratio [HR], 1.29; 95% CI, 1.26-1.31), after adjusting for potential confounders.
• Diuretics were associated with the highest risk (HR, 1.21; 95% CI, 1.19-1.24), followed by calcium channel blockers (HR, 1.16; 95% CI, 1.14-1.18), angiotensin receptor blockers (HR, 1.12; 95% CI, 1.09-1.15), and alpha-blockers (HR, 1.08).
• The smallest effects were with angiotensin-converting enzyme (ACE) inhibitors (HR, 1.02; 95% CI, 1.00-1.04) and beta-blockers (HR, 1.04; 95% CI, 1.02-1.06).

IN PRACTICE:

"Based on the currently available evidence, if a clinical workup does not identify another cause for the dermatitis and it is bothersome and does not respond to treatment, clinicians could consider switching treatment to a different class of antihypertensive, such as an ACE inhibitor," the authors wrote.

SOURCE:

The study, led by Morgan Ye, MPH, of the Department of Dermatology, University of California San Francisco, was published online in JAMA Dermatology on May 22, 2024.

LIMITATIONS:

Detailed information on the severity and resolution of dermatitis was not available. The study could not establish causality or assess the effect of discontinuation on dermatitis. Inclusion of participants of mostly European descent and lack of comprehensive ethnic data could limit generalizability.

DISCLOSURES:

The study was supported by the US National Eczema Association and, indirectly, by the Wellcome Trust Senior Research Fellowship in Clinical Science. Two authors declared receiving financial support outside this work; the other authors reported no conflicts of interest.