Selective Alpha-1 Inhibitors: First-or Second-Line Antihypertensive Agents?

It is well documented that in the treatment of mild or moderate hypertension selective α<sub>1</sub>-inhibitors such as doxazosin and prazosin lower blood pressure to approximately the same extent as β-blockers, diuretics, ACE inhibitors and calcium antagonists. However, treatment with selective αi-inhibitors is also associated with a number of other favourable effects. For example, in contrast to most β-blockers, selective αi-inhibitors have a favourable effect on serum lipids, primarily lowering the triglycerides but also increasing the ratio of high-density lipoprotein (HDL) cholesterohtotal cholesterol. In addition, selective αi-inhibitors do not aggravate glucose metabolism or increase uric acid concentration, as thiazide diuretics frequently do. Some patients gain particular benefit from treatment with a selective α<sub>1</sub>-inhibitor, namely those with non-insulin-dependent diabetes mellitus, peripheral vascular disease, chronic obstructive pulmonary disease, and kidney failure. While no controlled mortality trials with selective α<sub>1</sub>-inhibitors have yet been completed, new vasodilator drugs such as these do lower blood pressur