What anti-hypertensive medication should be initiated in a patient with benign prostatic hyperplasia (BPH) and newly developed hypertension, with a blood pressure of 142/90 mm Hg, after lifestyle modifications?

From the Guidelines

The nurse practitioner should initiate an alpha-1 adrenergic receptor blocker such as doxazosin, terazosin, or alfuzosin for this patient with benign prostatic hyperplasia (BPH) and hypertension. These medications are ideal because they serve dual purposes - they lower blood pressure while simultaneously improving urinary symptoms associated with BPH. Alpha blockers work by relaxing smooth muscle in both blood vessels and the prostate, reducing blood pressure and improving urinary flow. The patient's blood pressure of 142/90 mm Hg indicates stage 1 hypertension despite lifestyle modifications, warranting pharmacological intervention. When starting therapy, it's essential to begin with a low dose and titrate upward as needed, monitoring for potential side effects such as orthostatic hypotension, dizziness, and fatigue, as noted in 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. The patient should be advised to take the first dose at bedtime to minimize the risk of first-dose hypotension and to rise slowly from sitting or lying positions. Regular follow-up appointments should be scheduled to assess both blood pressure control and improvement in BPH symptoms.

Some key points to consider when initiating alpha-1 adrenergic receptor blocker therapy include:

• Starting with a low dose and titrating upward as needed to minimize side effects
• Monitoring for potential side effects such as orthostatic hypotension, dizziness, and fatigue
• Advising the patient to take the first dose at bedtime and to rise slowly from sitting or lying positions
• Scheduling regular follow-up appointments to assess both blood pressure control and improvement in BPH symptoms
• Being aware of the potential for drug interactions and adjusting the treatment plan accordingly, as outlined in the guidelines 1.

It's also important to note that while alpha-1 adrenergic receptor blockers are effective in managing BPH symptoms, they may not be sufficient to control hypertension in all patients, and additional antihypertensive medications may be necessary, as discussed in the guidelines 1.

From the FDA Drug Label

2.3 Hypertension The initial dosage of doxazosin tablets is 1 mg given once daily. Daily dosage may be doubled up 16 mg once daily, as needed, to achieve the desired reduction in blood pressure. 1.2 Hypertension Doxazosin tablets, USP are indicated for the treatment of hypertension, to lower blood pressure. The patient has a history of benign prostatic hypertrophy (BPH) and recently developed hypertension. The initial blood pressure was 150/92 mm Hg, and after dietary changes and exercise, it decreased to 142/90 mm Hg.

• The doxazosin tablet is indicated for the treatment of hypertension and BPH.
• The initial dosage of doxazosin for hypertension is 1 mg given once daily. The nurse practitioner should initiate doxazosin at a dose of 1 mg once daily 2 2.

From the Research

Patient Profile

• The patient has a history of benign prostatic hypertrophy (BPH) and has recently developed hypertension.
• The patient's initial blood pressure was 150/92 mm Hg, and after dietary changes and exercise, it decreased to 142/90 mm Hg.

Treatment Options

• Considering the patient's BPH and hypertension, an anti-hypertensive medication that can also alleviate BPH symptoms would be ideal.
• Doxazosin, a selective alpha 1 adrenoceptor inhibitor, has been shown to be effective in treating both BPH and hypertension 3, 4, 5.

Efficacy of Doxazosin

• Studies have demonstrated that doxazosin can significantly reduce blood pressure in hypertensive patients, while also improving urinary flow rates and symptoms in patients with BPH 3, 4, 5.
• Doxazosin has been shown to be well-tolerated and effective in patients with concomitant hypertension and BPH, making it a suitable treatment option for this patient 4, 5.

Combination Therapy

• If the patient's blood pressure is not adequately controlled with doxazosin alone, it can be used in combination with other antihypertensive agents to achieve better blood pressure control 6, 7.
• Alpha 1-blockers, such as doxazosin, have been shown to be effective and well-tolerated in combination therapy for hypertension, and can also provide therapeutic benefits beyond blood pressure management 7.