What is the role of Terazosin (Hytrin) in managing hypertension?

From the Guidelines

Terazosin is not the preferred first-line treatment for high blood pressure, and its use should be considered only when other agents are not tolerated or are ineffective, due to its potential for orthostatic hypotension and other side effects, as well as the availability of more effective and safer alternatives, such as thiazide diuretics, ACE inhibitors, angiotensin-receptor blockers, and calcium channel blockers, as recommended by the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.

Key Points to Consider

• Terazosin is an alpha-blocker that can lower blood pressure by relaxing blood vessels, but it is not typically recommended as a first-line treatment for hypertension due to its side effect profile and the availability of more effective alternatives.
• The typical starting dose of terazosin is 1 mg taken at bedtime, which may be gradually increased to 5-10 mg daily based on blood pressure response, with careful monitoring for orthostatic hypotension and other side effects.
• Patients taking terazosin should be advised to rise slowly from sitting or lying positions to reduce dizziness, and to report any symptoms of orthostatic hypotension, such as dizziness or fainting, to their healthcare provider.
• Terazosin can be taken with or without food, but it is essential not to stop taking it suddenly without consulting a healthcare provider, as this can lead to rebound hypertension.

Alternative Treatment Options

• Thiazide diuretics, such as chlorthalidone, are often recommended as first-line treatment for hypertension due to their efficacy and safety profile, as well as their ability to reduce the risk of cardiovascular events, including heart failure, stroke, and myocardial infarction 1.
• ACE inhibitors, angiotensin-receptor blockers, and calcium channel blockers are also effective and commonly used treatments for hypertension, with a strong evidence base supporting their use in reducing cardiovascular risk, as demonstrated by numerous clinical trials and meta-analyses 1.
• The choice of antihypertensive agent should be individualized based on the patient's specific clinical characteristics, including the presence of comorbidities, such as diabetes, kidney disease, or heart failure, as well as their tolerance to potential side effects and the need for dose adjustments.

From the FDA Drug Label

Terazosin Capsules are used to treat high blood pressure (hypertension). Terazosin Capsules work by relaxing blood vessels so that blood passes through them more easily. This helps to lower blood pressure. Although blockade of alpha-1 adrenoceptors also lowers blood pressure in hypertensive patients with increased peripheral vascular resistance, terazosin treatment of normotensive men with BPH did not result in a clinically significant blood pressure lowering effect

Terazosin is used to treat high blood pressure (hypertension) by relaxing blood vessels, making it easier for blood to pass through and lowering blood pressure.

• Key points:
  • Terazosin works by blocking alpha-1 adrenoceptors, which helps to relax blood vessels.
  • It is used to treat hypertension and benign prostatic hyperplasia (BPH).
  • The medication can cause a sudden drop in blood pressure, especially after the first dose. 2 2 2

From the Research

Terazosin for Blood Pressure Management

• Terazosin is an alpha 1-blocking agent that has been shown to be effective in reducing blood pressure in patients with hypertension 3.
• The drug has been found to produce significant reductions in systolic and diastolic blood pressure, with equal antihypertensive efficacy in men, women, blacks, and whites of all ages 3.
• Terazosin has also been shown to be effective in combination with other antihypertensive agents, such as diuretics, beta-blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors 3, 4.

Dose-Response Relationship

• The dose-response relationship between terazosin and blood pressure reduction has been studied, with results showing a strong dose-response relationship between fall in blood pressure and terazosin doses of 1 to 10 mg 5.
• The maximum antihypertensive response to terazosin was found to be 10.7 mmHg for systolic blood pressure and 8.0 mmHg for diastolic blood pressure, with a daily dose of 3.0 mg producing 50% of the maximum response for systolic blood pressure and 1.5 mg for diastolic blood pressure 5.

Comparison with Other Antihypertensive Agents

• Terazosin has been compared with other antihypertensive agents, such as ACE inhibitors, beta-blockers, calcium blockers, and diuretics, with results showing that diuretics and calcium-blocking drugs are more effective in elderly patients at lowering systolic blood pressure 6.
• A meta-analysis of 20,451 hypertensive patients found that angiotensin system blockade combined with calcium channel blockers is superior to other combinations in cardiovascular protection with similar blood pressure reduction 7.

Safety and Tolerability

• Terazosin has been found to be well tolerated, with adverse effects occurring in 17.9% of patients and causing 2.2% to drop out of the study 3.
• The most frequent adverse effects were dizziness, headache, and asthenia, with only 0.4% of patients experiencing syncope and 0.2% experiencing impotence 3.