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High Incidence of Ischemic Stroke with Alpha-blocker Therapy in Older Patients

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High Incidence of Ischemic Stroke with Alpha-blocker Therapy in Older Patients

Introduction

Ischemic stroke occurs as a result of reduced blood supply to the brain.

Alpha-blockers also called as alpha-adrenergic-antagonists are the anti-hypertensive agents. Alpha-blockers may cause hypotension and cerebral hypoperfusion during the early start of the therapy.

Cerebral hypoperfusion is a condition caused by the decrease in the blood flow to the brain. Cerebral hypoperfusion is one of the causative factors for ischemic stroke.

Aim of the study

The aim of the study iswas to present a quantitative assessment of the risk of ischemic stroke during the initial course of α-blocker therapy in the older men.

Study methods

All the analysis were performed using SAS, version 9.2.

The study included all the men above 50 years of age who were incident users of alpha blockers. The men who were diagnosed with ischemic stroke during the study period were also included in the study.

The study excluded men who were below 50 years of age. Men with any diagnosis that may predispose ischemic stroke and patients who were using anti-platelet or anti-coagulation medications were also excluded.

Alpha-blockers used

The alpha-blockers used in the study were Terazosin, Doxazosin, Tamsulosin and Alfuzosin.

The day on which the subjects were administered the drug was considered as the incident date. The 60 days prior to the incident date was considered as pre-exposure risk period and the 60 days after the incident date was considered as post exposure risk period. In the unexposed period, the subjects were not administered any drug.

Results

The results obtained through the study provide evidence that the incidence of the ischemic stroke is higher in the post-exposure risk periods and the pre-exposure risk periods. The higher number of the stoke attacks were found in the three months study period around the index date.

Using the conditional Poisson regression model, the incidence rates of ischemic stroke in various risk periods were compared with the rates in the unexposed period and the results are presented as incidence rate ratios (IRRs).

Incidence of the Ischemic Stroke based on the Individual DrugsIschemic1Incidence of the Ischemic Stroke with Concomitant and Non-concomitant use of other Anti-hypertensive Agents

Ischemic2

The incidence of the ischemic stroke was found to be higher in the subjects who were only on alpha-blocker therapy without any other anti-hypertensive agents.

Conclusion

The study concludes that alpha-blockers are associated with an increased risk of ischemic stroke during the early initiation period.

Caution is recommended while prescribing alpha-blockers to older men especially who are not taking any other anti-hypertensive drugs.

Reference

Chao-Lun Lai, MD PhD et al Risk of ischemic stroke during the initiation period of α-blocker therapy among older men. CMAJ. 2016 Mar 1; 188(4): 255–260.

Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771534/#b22-1880255/
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