![]() ![]() Their major adverse effects are dizziness, headache, orthostatic hypotension (particularly first-dose hypotension), and an increased risk of falls and hip fractures). ![]() Α-Blockers block neuromuscular transmission by occupying the postsynaptic α1-adrenoceptor on the smooth muscle cell, causing vasodilation. Lerma, in Nephrology Secrets (Fourth Edition), 2019 12. There is no evidence that this effect can be used therapeutically, although it may occasionally prove helpful to change to doxazosin treatment when a hypertensive male is having erectile problems during treatment with a thiazide diuretic. This was seen in TOMHS, where erectile dysfunction was reported in only 3% of patients receiving doxazosin compared to 17% of patients receiving chlorthalidone. There is evidence also that male sexual dysfunction occurs less frequently with alpha blockers than with other types of antihypertensive agent. Unfortunately, this predictable pharmacologic effect may occasionally lead to urinary incontinence in females. Accordingly, alpha blockers are used for the relief of obstructive urinary symptoms in males with benign prostatic hyperplasia/hypertrophy (BPH). ![]() Elliott, in Comprehensive Hypertension, 2007 Genitourinary effectsĪlpha blockers (particularly those with effects on the alpha-1b receptor subtype) are well recognized to have effects on the genitourinary system. However, alpha-blockers may be considered after a thiazide-type diuretic, a calcium channel blocker, an ACEI, or an ARB have already been used and blood pressure remains uncontrolled. Thus alpha-blockers are not recommended as initial antihypertensive therapy. In the ALLHAT, the largest hypertensive clinical trial that randomized hypertensive patients to an ACEI, a calcium channel blocker, or an alpha-blocker versus a thiazide diuretic, the alpha-blocker arm of the trial was prematurely terminated because of an almost doubling of the risk of heart failure and a 25% excess cardiovascular death among patients treated with an alpha-blocker compared with a thiazide diuretic. Habib, in Cardiology Secrets (Fifth Edition), 2018 21 Are alpha-blockers effective in preventing cardiovascular complications of hypertension, and when is it appropriate to use them in hypertensive patients?Īlpha-blockers are effective antihypertensive agents but have not been shown in either placebo-controlled or active-controlled clinical prospective trials to be effective in preventing cardiovascular complications of hypertension. ![]()
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