Antihypertensive medications associated with eczematous dermatitis in older patients

Key takeaways:

• Patients taking antihypertensive drugs had a higher incidence rate of eczematous dermatitis.
• Diuretic drugs and calcium channel blockers had higher incidence rates than ACE inhibitors or B-blockers.

Due to a small increase in eczematous dermatitis, older adults taking antihypertensive drugs should be monitored and this possibility considered when assessing for eczema, according to a study.

“Rates of physician-diagnosed atopic eczema (also known as atopic dermatitis) have been increasing among older adults,” Morgan Ye, MPH, research data analyst, department of medicine, University of California, San Francisco, and colleagues wrote. “The clinical presentation among older adults can be nonspecific, especially among those with late-onset disease. It has been hypothesized that drug-induced eczematous dermatitis may be a common cause of atopic eczema misdiagnosis among older adults.”

Researchers conducted a longitudinal cohort study using data from the primary care electronic health records of The Health Improvement Network cohort regarding patients aged 60 years and older who did not have a previous eczematous dermatitis diagnosis or antihypertensive drug prescription.

Overall prevalence of eczematous dermatitis during a median period of 6 years was 6.7% of more than 1.5 million subjects.

Among those who received an antihypertensive drug prescription during the study, the incidence of eczematous dermatitis was 11 to 12 per 1,000 patient-years, compared with nine per 1,000 patient years in those who did not receive antihypertensive medications.

An absolute rate, assuming a population of 14.5 million older adults in the U.K., is a difference of three cases per 1,000 patient years, possibly insinuating approximately 43,500 new eczematous dermatitis cases per year associated with these drugs, the study said.

An adjusted Cox proportional hazard model found an increased hazard rate of 29% (HR = 1.29; 95% CI, 1.26-1.31) in these patients.

When stratified by antihypertensive drug classes, those taking diuretic drugs (HR = 1.21; 95% CI, 1.19-1.24) and calcium channel blockers (HR = 1.16; 95% CI, 1.14-1.18) had the highest prevalence of eczematous dermatitis, whereas those taking angiotensin-converting enzyme inhibitors (HR = 1.02; 95% CI, 1-1.04) and B-blockers (HR = 1.04; 95% CI, 1.02-1.06) had the lowest.

“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. “Although additional research is needed to understand the mechanisms underlying the association of antihypertensive drug use and eczematous dermatitis, these data could be helpful to clinicians to guide clinical management when an older patient presents with eczematous dermatitis.”