Impact of hypertension on lower urinary tract symptoms in men with benign prostatic hyperplasia

BACKGROUND: Impaired blood supply to the bladder is considered a risk factor for urinary dysfunction, including in patients with benign prostatic hyperplasia. One of the possible causes of pelvic hemodynamic disturbances is hypertension.

AIM: This study aimed to evaluate the impact of hypertension on the severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia.

METHODS: This retrospective and prospective observational study included 6117 men aged 48 to 83 years (mean age: 59.57 ± 10.1 years) who underwent surgical treatment for benign prostatic hyperplasia; 5960 patients were included in the final analysis. Medical records were reviewed with assessment of International Prostate Symptom Score, ultrasonographic findings of the prostate and bladder, and the presence and characteristics of comorbid conditions.

RESULTS: Hypertension was identified in 3052 (51.2%) patients, of whom only 1385 (45.4%) were aware of the diagnosis. Patients with benign prostatic hyperplasia and concomitant hypertension demonstrated greater severity of lower urinary tract symptoms, with significant differences observed not only in overall International Prostate Symptom Score but also separately for storage and voiding symptoms. The severity of urinary dysfunction, primarily storage symptoms, depended on the stage and duration of hypertension, as well as on pharmacological blood pressure control. The presence of hypertension influenced the likelihood of persistent urinary dysfunction after surgical treatment of benign prostatic hyperplasia. In the postoperative period, lower urinary tract symptoms were observed in 2078 (68.1%) of 3052 patients with hypertension, compared with only 577 (19.8%) of 2908 patients without hypertension.

CONCLUSION: Hypertension is associated with increased severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia; the duration and stage of hypertension, as well as antihypertensive therapy, are of significance. Hypertension may be considered a risk factor for persistent lower urinary tract symptoms in the long-term postoperative period. Prior to deciding on surgical intervention for benign prostatic hyperplasia in patients with hypertension, adequate blood pressure control followed by reassessment of lower urinary tract symptom severity appears to be necessary.