HWN Suggests

Alpha-Blocker Use and the Risk of Hypotension and Hypotension-Related Clinical Events in Women of Advanced Age

Previously considered as possible first-line agents for the treatment of hypertension, enthusiasm has waned post publication of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial), which reported an increase in adverse cardiac events with the AB doxazosin. In addition to potential cardiovascular concerns, AB initiation is associated with symptomatic orthostatic hypotension and tachycardia... These risks are potentially heightened in those with advanced age or on multiple antihypertensive agents. Hence, they have been appropriately relegated to fourth or fifth line agents, following renin-angiotensin system blockade, calcium channel blockers, and diuretics…

read full article

Featured

  Should alpha-blockers ever be used as antihypertensive drugs?

What we want to achieve when prescribing antihypertensive drugs is to reduce the rates of heart attacks, strokes, and other adverse cardiovascular adverse outcomes, including death. Unfortunately, alpha-blockers fall short in this regard. In the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack (ALLHAT) trial, doxazosin (Cardura) was found to carry a higher risk of combined cardiovascular disease (relative risk 1.19, P = .04), mostly stroke.

Articles of Interest

Alpha Blockers for BPH

You might have heard of alpha blocker medications for treating high blood pressure, but did you know alpha blockers can also help with benign prostatic hyperplasia (BPH) or an enlarged prostate?

Alpha blockers seen as safe for blood pressure control in patients on dialysis

Alpha blockers may be safe to prescribe to help lower blood pressure in patients on hemodialysis, according to study findings. The results of the Japanese study back up the safety of what is usually reserved as a second-line hypertension therapy, which clinicians are “hesitant” to prescribe after some studies have tied alpha blockers to increased fall and fracture risks, Ken Iseri, MD, PhD, and colleagues wrote in Kidney Medicine.

Are there any alternatives to Flomax?

Commonly known as alpha-blockers, these drugs change the behavior of the hormones adrenaline and noradrenaline. This can relax muscles in the urinary tract, making it easier to urinate. Flomax is considered a selective alpha-blocker, which means it targets the urinary tract specifically and has less effect on other muscles.

Centrally acting antihypertensives and alpha-blockers in people at risk of falls: therapeutic dilemmas—a clinical review

Alpha-blockers and centrally acting antihypertensives are no longer recommended for the treatment of hypertension unless all other agents are contraindicated or not tolerated. Multiple tools identify these agents as potentially inappropriate and recommend deprescribing. A number of protocols have been developed to safely guide deprescribing.

Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis

Despite the availability of various drugs for benign prostatic hyperplasia (BPH), alpha(α)-blockers are the preferred first-line treatment. However, there remains a scarcity of direct comparisons among various α-blockers. Therefore, this network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of α-blockers in the management of BPH.

Effects of α-blocker ‘add on' treatment on blood pressure in symptomatic BPH with or without concomitant hypertension

AB therapy for BPH can have an appropriate and beneficial effect on BP, especially in baseline hypertensive patients. Furthermore, doxazosin GITS treatment resulted in optimal management of BP within the normal range, especially in pharmacologically or physiologically hypertensive patients.

Resources

Doxazosin (Cardura)

Doxazosin is a medication used to manage and treat benign prostatic hyperplasia, hypertension, ureteral stones, and PTSD-associated nightmares. It is a quinazoline derivative that acts as a competitive alpha1-antagonist.

Flomax: 7 things you should know

Flomax restores urine flow in men with BPH but may cause a drop in blood pressure when going from a sitting to a standing position.

Blood Pressure UK

Alpha-blockers are usually used if other drugs are not working well or are not suitable for you. For example, if you have side effects, have other health problems or are taking certain medications. They’re not usually one of the first one’s you’ll try because other medicines seem to be better at protecting you from a heart attack or stroke, and at treating heart failure.

GlobalRPH

List of medications

StatPearls

Alpha-blockers are medications used in the management and treatment of essential hypertension, benign prostatic hyperplasia (BPH), and pheochromocytoma.

Tamsulosin (Flomax)

Tamsulosin is a selective alpha-1A and alpha-1B adrenoceptor antagonist that exerts its greatest effect in the prostate and bladder, where these receptors are most common. Other alpha-1 adrenoceptor antagonists developed in the 1980s were less selective and more likely to act on the smooth muscle of blood vessels, resulting in hypotension.

Terazosin (Hytrin)

The primary anti-hypertensive action occurs by blocking vascular smooth muscle in the arterioles. The anti-obstructive urinary tract effects result from smooth muscle relaxation in the ureters, bladder, and urethral sphincter

WikEM

Act as neutral antagonists or inverse agonists of α-adrenergic receptors (α-adrenoceptors).