Benefits and side effects of blood pressure lowering treatment: what was wrong with doxazosin in the ALLHAT?

The lowering of high blood pressure is supposed to protect target organs from hypertensive damage. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial was designed to compare the cardioprotective properties of three antihypertensives from different classes (lisinopril, am...

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Bibliographic Details
Published in:Current controlled trials in cardiovascular medicine 2001-01, Vol.2 (6), p.257-259, Article 257
Main Authors: Gavras, Irene, Gavras, Haralambos
Format: Article
Language:English
Subjects:
Adrenergic receptors
Analysis
Anticholesteremic agents
Antihypertensive drugs
Antihypertensives
Blood pressure
Cardiovascular disease
Chlorthalidone
Clinical trials
Complications and side effects
coronary constriction
Diabetes
Dosage and administration
Drug therapy
Drugs
Heart attack
Heart attacks
Heart failure
Hypertension
Insulin resistance
Ischemia
ischemic heart disease
Kidney diseases
Lipids
Measurement
Morbidity
Mortality
Patient outcomes
Prevention
Risk factors
Stroke
vasopressin
α1-adrenoceptor blockade
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Summary:The lowering of high blood pressure is supposed to protect target organs from hypertensive damage. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial was designed to compare the cardioprotective properties of three antihypertensives from different classes (lisinopril, amlodipine and doxazosin) with chlorthalidone. Despite effective blood pressure lowering and a favorable metabolic profile, the doxazosin arm of the trial had a significantly higher relative risk of cardiovascular disease and heart failure compared with the chlorthalidone arm. This article speculates on possible causes for this unexpected result and suggests that the culprit may be accentuation of the vascular effects of vasopressin, which are maximized under alpha-adrenergic blockade. These findings may have implications for the large number of older men who receive monotherapy with alpha-blockers for treatment of prostatic symptoms.
ISSN:1468-6708
1745-6215
1745-6215
1468-6694
DOI:10.1186/CVM-2-6-257