Cardiovascular effects of doxazosin in the treatment of prostatic hyperplasia

Doxazosin, a selective α1-receptor antagonist, is widely used to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). However, its cardiovascular effects remain clinically relevant, particularly in older patients. This systematic review and meta-analysis evaluated blood pressure, heart rate, headache and vertigo during doxazosin treatment. PubMed/MEDLINE, the Cochrane Library, CNKI, Wanfang Data, Google Scholar and ScienceDirect were searched using Chinese and English terms related to doxazosin, BPH, prostate and cardiovascular outcomes. Sixteen evidence reports were included: 12 primary studies, 2 pooled analyses and 2 secondary review sources that supplied aggregate trial data. The pooled analyses showed no statistically significant difference in systolic blood pressure (MD 1.44, 95% CI -4.17 to 7.06; p=0.61), diastolic blood pressure (MD -0.33, 95% CI -3.68 to 3.03; p=0.85), headache (OR 0.99, 95% CI 0.73-1.34; p=0.95) or heart rate (MD 0.98, 95% CI -0.89 to 2.84; p=0.30). Vertigo was more frequent with doxazosin than with control treatment (OR 1.93, 95% CI 1.50-2.49; p<0.00001). Risk-of-bias assessment identified 2 reports at low risk, 10 with some concerns, 1 at high risk, 1 observational study of moderate quality, and 2 secondary reviews for which Cochrane Risk of Bias 2 and the Newcastle-Ottawa Scale were not applicable. Doxazosin was not associated with statistically significant average changes in blood pressure or heart rate, but the increased occurrence of vertigo warrants counselling and monitoring, particularly in older patients at risk of falls.