A dark side of calcium channel blockers: Increased risk of stasis dermatitis

Summary: Abstract Body: Stasis dermatitis (SD) is an eczematous condition often linked with chronic venous insufficiency. Given the increasing use of calcium channel blockers (CCBs) for hypertension, concerns have emerged regarding their role in exacerbating or inducing SD through the development of peripheral edema. This study investigates the association between CCBs use and the development of lower extremity SD in patients with essential hypertension. A retrospective cohort design was employed using the TriNetX database, comparing SD outcomes between CCBs users (ATC: C08) and non-users with essential hypertension (ICD-10: I10). Patients were 1:1 matched by propensity score, adjusting for age, sex, and race/ethnicity. SD was identified via ICD-10-CM codes for chronic venous hypertension with inflammation (I87.321, I87.322, I87.323). CCBs users demonstrated a significantly higher risk of lower extremity SD compared to non-users: right lower extremity (RR: 1.535, 95% CI: 1.213–1.944, p < 0.0001), left lower extremity (RR: 1.330, 95% CI: 1.093–1.617, p = 0.004), and bilateral lower extremity (RR: 1.340, 95% CI: 1.123–1.598, p = 0.001). This association suggests that CCBs use increases the risk of lower extremity SD in patients with essential hypertension. One potential mechanism is that CCBs induce edema through preferential arteriolar dilation without corresponding venous dilation, leading to venous stasis, inflammation, and subsequent skin changes. Therefore, discontinuing CCBs should be considered upon diagnosis of SD. Limitations include potential ICD-10 misclassification of SD and residual confounding despite propensity score matching. Future research should explore whether mitigating venous hypertension in CCBs users could reduce the risk of SD and clarify the dose-dependent relationship between CCBs and skin pathology. Racha Cherradi², Iman Bouchelkia¹, Safiya Haque³, Jennifer Ezuruike¹, O Pacha⁴ 1. University of Houston Tilman J Fertitta Family College of Medicine, Houston, TX, United States. 2. College of Medicine, Texas A&M University, College Station, TX, United States. 3. The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, United States. 4. Department of Dermatology, MD Anderson Cancer Center, Houston, TX, United States. Clinical Research: Epidemiology and Observational Research