Analysis of nearly 100,000 men with benign prostatic hyperplasia found alpha-blockers increased cardiovascular events compared to 5α-reductase inhibitors. Selective α1A-receptor antagonists raised heart failure risk by 48%, heart attack by 41%, and stroke by 36% at one year. Nonselective alpha-blockers showed similar patterns with persistent elevation through five years of follow-up. This finding challenges conventional wisdom about prostate medication safety. Alpha-blockers like tamsulosin and doxazosin are first-line BPH treatments for millions of older men, making cardiovascular implications significant. The study's strength lies in its massive scale across 113 healthcare organizations, though observational design cannot prove causation. Previous ALLHAT trial concerns about nonselective alpha-blockers for hypertension now extend to BPH-specific medications. The persistent risk elevation over five years suggests this isn't merely an acute adjustment phenomenon. However, confounding factors like underlying cardiovascular disease severity between medication groups could influence results. As an unreviewed preprint, these findings require peer validation before clinical practice changes. If confirmed, this could shift BPH treatment algorithms toward 5α-reductase inhibitors for men with cardiovascular risk factors, fundamentally altering care for this common aging-related condition.