SYMPTOMATIC BPH AND HYPERTENSION - DOES COMORBIDITY AFFECT QUALITY-OF-LIFE

Most alpha(1)-adrenoceptor antagonists are non-subtype selective and a ct on smooth muscle in the prostate, as well as in the vascular system and, as such, have effects on blood pressure as well as relieving LUT S (lower urinary tract symptoms) in symptomatic benign prostatic hyper plasia (BPH). As many elderly patients with LUTS also take concomitant antihypertensive therapy, it has been suggested by some that these pa tients should be treated with an alpha(1)-adrenoceptor antagonist that targets both symptomatic BPH and hypertension simultaneously. However , an alternative school of thought believes that hypertension, as a ma lignant disease, should be treated optimally first, before the LUTS ar e controlled. Many different classes of antihypertensive drugs have be en developed and evidence, with regard to reduction of cardiovascular morbidity and mortality, supports the use of diuretics and beta-blocke rs in this indication. However, from this point of view, few data supp ort the use of alpha(1)-adrenoceptor antagonists in antihypertensive t herapy, and studies indicate that elderly patients in particular are p rone to orthostatic hypotension and its effects when treated with alph a(1)-adrenoceptor antagonists. This, together with the fact that hyper tension is such a potentially morbid disease, suggests that alpha(1)-a drenoceptor antagonists should not be used as a first line treatment f or the treatment of hypertension. Rather, patients with comorbidity sh ould be treated optimally for both diseases, being treated initially f or hypertension with the optimal agent available and then with an alph a(1)-adrenoceptor antagonist that is not haemodynamically active to ta rget their LUTS. Tamsulosin, a selective alpha(1A)-adrenoceptor antago nist, has no clinically significant effect on blood pressure compared with placebo, thus posing less risk for the patient, especially with r egard to symptomatic orthostatic hypotension.