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Role of selective alpha 1 blockers in the therapy of hypertension
Insights
New research questions the routine use of diuretics for mild hypertension due to adverse effects. Selective alpha 1 blockers, like terazosin, show promise as safer, effective alternatives for long-term blood pressure management.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Millions of mild hypertension patients require long-term drug therapy.
- Previous trials (Oslo Study, MRFIT) noted adverse coronary heart disease mortality with diuretic-first approaches.
- Diuretics can cause adverse biochemical changes (hypokalemia, hypercholesterolemia, hyperglycemia).
Purpose of the Study:
- To evaluate the safety and efficacy of alternative initial therapies for mild hypertension.
- To compare the effects of diuretics, beta blockers, and selective alpha 1 blockers on patient outcomes and biochemical profiles.
Main Methods:
- Review of therapeutic trial data and pharmacological profiles of antihypertensive drug classes.
- Analysis of hemodynamic effects and lipid profile changes associated with different drug classes.
Main Results:
- Diuretics are associated with unfavorable biochemical abnormalities.
- Beta blockers can negatively impact lipid profiles, cardiac output, and peripheral resistance.
- Selective alpha 1 blockers offer favorable hemodynamics and potential lipid profile improvement.
Conclusions:
- Routine diuretic use for mild hypertension is increasingly questioned.
- Selective alpha 1 blockers, exemplified by terazosin, are attractive alternatives for initial therapy.
- Terazosin shows favorable results supporting its use in mild to severe hypertension management.
Abstract:
As millions more patients with mild hypertension are being brought into active drug therapy, the need for effective medications that are safe for long-term use has increased. This is, in part, as a result of the adverse effect on coronary heart disease mortality observed in two of the major therapeutic trials, the Oslo Study and the Multiple Risk Factor Intervention Trial. In both of these, the diuretic-first, stepped-care approach was used. Administration of diuretics is frequently associated with such biochemical abnormalities as hypokalemia, hypercholesterolemia, and hyperglycemia. Thus, the wisdom of the routine use of a diuretic as the first choice of therapy is being questioned. Alternative drugs for initial therapy include beta blockers and selective alpha 1 blockers. With beta blockers, there is a tendency for serum triglycerides to increase and high-density lipoprotein cholesterol to decline, as well as a tendency for an undesirable reduction in cardiac output and an increase in peripheral resistance. Selective alpha 1 blockers, because they lower blood pressure in a hemodynamically more favorable manner and have a tendency to improve the lipid profile, are becoming increasingly attractive as initial therapy for mild hypertension and also as part of the combination needed for more severe disease. The favorable results noted with the new selective alpha 1 blocker terazosin strongly support its addition to the list of preferred drugs for initial therapy.