From the Guidelines
Alpha-blockers, particularly selective alpha-1 blockers like doxazosin, prazosin, or terazosin, are excellent choices for patients with both hypertension and benign prostatic hyperplasia (BPH). These medications serve a dual purpose by relaxing smooth muscle in both blood vessels and the prostate, thereby lowering blood pressure while simultaneously improving urinary symptoms associated with BPH.
Key Points
- When starting these medications, patients should be monitored for potential side effects such as orthostatic hypotension, especially with the first dose, which may cause dizziness or lightheadedness upon standing.
- Patients should take the first dose at bedtime to minimize these effects.
- These medications work by blocking alpha-1 adrenergic receptors, preventing norepinephrine from binding and causing muscle contraction in both vascular smooth muscle and prostatic tissue.
- According to 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, alpha-1 blockers like doxazosin, prazosin, or terazosin may be considered as second-line agents in patients with concomitant BPH.
- The usual dose range for doxazosin is 1-16 mg/day, for prazosin is 2-20 mg/day, and for terazosin is 1-20 mg/day, as stated in the guideline 1.
From the FDA Drug Label
1.1 Benign Prostatic Hyperplasia (BPH) Doxazosin tablets, USP are indicated for the treatment of the signs and symptoms of BPH.
- 2 Hypertension Doxazosin tablets, USP are indicated for the treatment of hypertension, to lower blood pressure. Doxazosin tablets, USP may be used alone or in combination with other antihypertensives.
Doxazosin is a good anti-hypertensive medication for patients with BPH as it is indicated for the treatment of both hypertension and BPH 2.
INDICATIONS AND USAGE Terazosin Capsules, USP are indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH). Terazosin Capsules, USP are also indicated for the treatment of hypertension.
Terazosin is also a suitable option for patients with BPH and hypertension as it is indicated for the treatment of both conditions 3.
- Both doxazosin and terazosin can be used to treat hypertension and BPH.
- They may be used alone or in combination with other antihypertensive agents.
From the Research
Anti-Hypertensive Medications for Patients with BPH
- α1-blockers can be safely used in the treatment of hypertension and are a compelling indication for patients with benign prostatic hyperplasia (BPH) due to their dual treatment effect on both high blood pressure and lower urinary tract symptoms 4.
- Long-acting α1-blockers, such as doxazosin and terazosin, are recommended for the treatment of hypertension in patients with BPH, but require careful initial bedtime dosing and avoiding overdosing to minimize the risk of orthostatic hypotension 4.
- Selective α1A blockers like tamsulosin do not appear to have significant cardiovascular side effects and produce minimal blood pressure reductions, making them a suitable option for patients with BPH who are also taking antihypertensive medications 5, 6, 7.
- The combination of a low-dose diuretic, such as hydrochlorothiazide, and tamsulosin can be an effective treatment for patients with hypertension and BPH, with minimal adverse interactions 6.
- α-Adrenergic blockers, including prazosin, terazosin, and doxazosin, are established agents in the therapy of hypertension and BPH, and can be used as the treatment of choice for men with both conditions 8.
Considerations for Treatment
- Orthostatic hypotension is a concern with the use of α1-blockers, especially in the elderly, and requires careful monitoring and dosing 4, 6.
- Fluid retention is a potential concern with the use of α1-blockers, which may be overcome by combining an α1-blocker with a diuretic 4.
- The treatment regimen, including dose, dosage interval, and formulation, can impact the clinical selectivity and cardiovascular safety of α1-blockers 7.