NEW YORK (Reuters Health) – The use of certain antihypertensives may worsen lower urinary tract symptoms (LUTS), but there are significant differences between medications and genders, researchers from a report in the September 27th online BJU International.

“Although an excess of voiding, storage, and nocturia symptoms was not observed for users of most common antihypertensives after risk factor adjustment, our results are consistent with the hypothesis that certain types may contribute to LUTS, although further studies must be conducted before concluding cause and effect,” Dr. Susan A. Hall from New England Research Institutes, Watertown, Massachusetts told Reuters Health in an email.

Dr. Hall and colleagues used data from the Boston Area Community Health (BACH) Survey to compare the presence of urological symptoms among male and female users of a wide variety of common antihypertensive drugs. The analysis sample included 1865 subjects (1204 using antihypertensives).

Among women, calcium channel blockers were the only drugs associated with a urological symptom (nocturia) in monotherapy. Calcium channel blockers and loop diuretics, when used with other antihypertensives, were significantly and consistently associated with voiding and nocturia symptoms.

The associations of calcium channel blockers with LUTS were confined to women under 55 years of age, and the associations of loop diuretics with LUTS were attenuated when calcium channel blocker users were removed from the analysis, “suggesting that at least part of the association of loop diuretics when used with other antihypertensives was attributable to exposure to calcium channel blockers.”

Among men, monotherapy with thiazide diuretics was significantly associated with voiding symptoms, and use of loop diuretics with or without other antihypertensives was associated significantly with nocturia symptoms.

“Users of most other commonly used antihypertensives did not have more symptoms than non-users with hypertension,” the researchers note. “This may indicate that the potential for urological symptoms from hypertension treatment may be less of a problem than is commonly believed.”

“The presence of new, or worsening LUTS, with hypertension treatment with calcium channel blockers among women should prompt a review of medications and consideration of a change in class of antihypertensive agent,” the investigators conclude.

“Our findings, although they are an association and not cause and effect, may suggest that it is important to consider these relationships by gender and age, since the association was only observed among younger women for voiding and nocturia symptoms,” Dr. Hall said. “Given diuretics are commonly implicated as a cause of LUTS, it was also surprising to see that thiazide diuretics were not significantly associated with LUTS among women, suggesting that it is also important to look at subclasses of diuretics (associations only observed for loop diuretics among women).”

“We plan to consider use of antihypertensives and incident urologic symptoms in our new longitudinal data (again by gender), where we have data collected at two time points, on average 5 years apart,” Dr. Hall added. “This will allow us to look at symptom progression and remission among new, continuing, and former users of different antihypertensive groups.”

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BJU Intl 27 September 2011.