Are alpha blockers (alpha-adrenergic blocking agents) a suitable first-line treatment for patients with hypertension?

From the Guidelines

Alpha blockers are not recommended as first-line treatment for patients with hypertension. Preferred first-line medications include thiazide diuretics (like hydrochlorothiazide or chlorthalidone), calcium channel blockers (such as amlodipine), ACE inhibitors (like lisinopril), or ARBs (such as losartan) 1. Alpha blockers, which include medications like doxazosin, prazosin, and terazosin, are typically reserved for specific situations or as add-on therapy when initial treatments are insufficient.

Key Points to Consider

• The 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline recommends thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs as first-line agents for the treatment of hypertension 1.
• Alpha blockers are less effective for prevention of cardiovascular disease (CVD) than other first-step agents, such as thiazide diuretics 1.
• The ALLHAT trial showed that patients on doxazosin had higher rates of heart failure and cardiovascular events compared to those on chlorthalidone 1.
• Alpha blockers may be appropriate in specific situations, such as in men with concurrent benign prostatic hyperplasia (BPH), as they can improve urinary symptoms while also lowering blood pressure 1.

Clinical Implications

• When initiating pharmacological therapy for hypertension, primary consideration should be given to comorbid conditions (e.g., heart failure, chronic kidney disease) for which specific classes of blood pressure-lowering medication are indicated 1.
• Thiazide diuretics, such as chlorthalidone, have been shown to be superior to other agents in preventing heart failure and stroke in certain populations 1.
• Calcium channel blockers and ACE inhibitors are also effective options for the treatment of hypertension, but may have different benefits and risks depending on the individual patient 1.

From the FDA Drug Label

The mechanism of action of doxazosin is selective blockade of the alpha 1 (postjunctional) subtype of adrenergic receptors. The antihypertensive effect of doxazosin results from a decrease in systemic vascular resistance. Although blockade of alpha 1 adrenoceptors also lowers blood pressure in hypertensive patients with increased peripheral vascular resistance, doxazosin treatment of normotensive men with BPH did not result in a clinically significant blood pressure lowering effect

Alpha blockers are not typically considered a first-line treatment for patients with hypertension.

• The primary use of alpha blockers, such as doxazosin and terazosin, is to treat symptoms of benign prostatic hyperplasia (BPH).
• While alpha blockers can lower blood pressure, their use as a primary treatment for hypertension is not well established.
• The FDA drug labels for doxazosin and terazosin provide information on their mechanism of action and effects on blood pressure, but do not support their use as a first-line treatment for hypertension 2, 3.

From the Research

Alpha Blockers for Hypertension

• Alpha blockers, also known as alpha-adrenergic blocking agents, are a type of medication used to treat hypertension.
• According to a study published in 1991 4, alpha 1 blockers are safe, effective, and well-tolerated in the management of hypertension, offering unique advantages such as maintaining cardiac output and blood flow to vital organs.
• Another study from 1993 5 supports the use of alpha 1 blockers in the treatment of hypertension, highlighting their ability to not only lower blood pressure but also improve insulin sensitivity and adverse lipid profiles.

Comparison with Other Treatments

• A study from 2009 6 discusses the use of renin-angiotensin system blockers and calcium channel blockers as first-line treatments for hypertension, but does not mention alpha blockers as a primary option.
• In contrast, studies from 2010 7 and 2011 8 focus on the limitations of beta-blockers as first-line therapy for hypertension, suggesting that other medications may be more effective.

Suitability as First-Line Treatment

• While alpha blockers have been shown to be effective in treating hypertension, there is limited evidence to suggest they are commonly used as a first-line treatment.
• The studies provided do not directly compare alpha blockers to other first-line treatments for hypertension, making it difficult to determine their suitability as a primary option.
• However, the available evidence suggests that alpha blockers may be a viable alternative for certain patients, particularly those with specific comorbidities or those who cannot tolerate other medications 4, 5.