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Doxazosin and congestive heart failure
1Department of Internal Medicine, Section on Hypertensive Diseases, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA. fmesserli@aol.com
Insights
Congestive heart failure (CHF) risk is significantly higher with doxazosin compared to chlorthalidone. Alpha-blockers like doxazosin should not be first-line hypertension treatments until safety is confirmed.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Research
Background:
- Long-standing hypertension is a major risk factor for congestive heart failure (CHF).
- The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) investigated treatments for hypertension.
- Previous studies indicated a link between antihypertensive medications and CHF risk.
Purpose of the Study:
- To evaluate the comparative risk of congestive heart failure (CHF) associated with different antihypertensive medications.
- To determine if alpha-blockers pose a higher risk for CHF compared to diuretics.
- To inform first-line treatment recommendations for hypertension based on CHF risk.
Main Methods:
- Analysis of data from the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
- Comparison of congestive heart failure (CHF) incidence between patients treated with doxazosin (an alpha-blocker) and chlorthalidone (a diuretic).
- Assessment of cardiac and overall mortality in relation to treatment arms.
Main Results:
- The risk of congestive heart failure (CHF) was found to be twice as high in patients treated with doxazosin compared to chlorthalidone.
- The ALLHAT trial provided significant data on the differential risk of CHF between these antihypertensive drug classes.
- Some uncertainties remain regarding CHF diagnosis and malignancy risk in specific ALLHAT arms.
Conclusions:
- Doxazosin, and potentially all alpha-blockers, demonstrated an increased risk for congestive heart failure (CHF).
- Current evidence suggests alpha-blockers should not be considered a first-line therapy for hypertension.
- Further safety data are required before reconsidering the use of alpha-blockers in initial hypertension management.
Abstract:
Congestive heart failure (CHF) is the most devastating cardiac sequella of long-standing hypertension. Recent data from the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have shown the risk of CHF to be twice as high with doxazosin than with chlorthalidone. Although some questions remain regarding the diagnosis and mortality of CHF in the doxazosin arm and regarding the risk of dying from malignancy in the diuretic arm of ALLHAT, drugs used to treat hypertension should lower the CHF risk. Therefore, until ironclad safety data are provided, doxazosin, and probably all alpha-blockers, should no longer be used as first-line antihypertensive therapy.