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Doxazosin and congestive heart failure
1Department of Clinical Pharmacology, Medical College of Virginia of Virginia Commonwealth University, Richmond, VA 23298, USA. dsica@hsc.vcu.edu
Congestive Heart Failure (Greenwich, Conn.)
|June 5, 2002
Summary
Doxazosin, an antihypertensive drug, showed increased cardiovascular disease, mainly congestive heart failure, in the ALLHAT trial. It should now be considered a secondary or tertiary treatment option.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Doxazosin is a widely prescribed antihypertensive medication.
- Recent findings from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have raised concerns regarding its use.
Purpose of the Study:
- To evaluate the efficacy and safety of doxazosin compared to other antihypertensive agents in high-risk patients.
- To assess the primary outcome of fatal coronary heart disease and nonfatal myocardial infarction.
Main Methods:
- The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a large, simple clinical trial.
- It compared chlorthalidone (diuretic) with amlodipine (calcium-channel blocker), lisinopril (ACE inhibitor), and doxazosin (alpha-blocker) in hypertensive patients aged 55 years or older.
Main Results:
- Doxazosin was withdrawn from the ALLHAT trial due to interim analysis.
- An interim analysis revealed a 25% increase in combined cardiovascular disease in patients on doxazosin compared to chlorthalidone.
- This increase was primarily driven by a higher incidence of congestive heart failure.
Conclusions:
- The ALLHAT findings indicate a potential increased risk of cardiovascular events, particularly heart failure, with doxazosin.
- Clinicians should carefully consider these results, viewing doxazosin as a secondary or tertiary antihypertensive therapy.
- Further comprehensive review of the ALLHAT data is warranted before definitive clinical practice changes are made.