SELECTIVE ALPHA-1 INHIBITORS - FIRST-LINE OR 2ND-LINE ANTIHYPERTENSIVE AGENTS

It is well documented that in the treatment of mild or moderate hypert ension selective alpha(1)-inhibitors such as doxazosin and prazosin lo wer blood pressure to approximately the same extent as beta-blockers, diuretics, ACE inhibitors and calcium antagonists. However, treatment with selective alpha(1)-inhibitors is also associated with a number of other favourable effects. For example, in contrast to most beta-block ers, selective alpha(1)-inhibitors have a favourable effect on serum l ipids, primarily lowering the triglycerides but also increasing the ra tio of high-density lipoprotein (HDL) cholesterol:total cholesterol. I n addition, selective alpha(1)-inhibitors do not aggravate glucose met abolism or increase uric acid concentration, as thiazide diuretics fre quently do. Some patients gain particular benefit from treatment with a selective alpha(1)-inhibitor, namely those with noninsulin-dependent diabetes mellitus, peripheral vascular disease, chronic obstructive p ulmonary disease, and kidney failure. While no controlled mortality tr ials with selective alpha(1)-inhibitors have yet been completed, new v asodilator drugs such as these do lower blood pressure in a more physi ological manner than traditional antihypertensive agents, and appear t o cause fewer side effects. In this respect, with the exception of pat ients with manifest or strongly suspected coronary heart disease who a re not receiving beta-blocker treatment, selective alpha(1)-inhibitors should be recommended as first-line agents for the treatment of hyper tension.