Alpha blockers in hypertension

The use of doxazosin compared to that of chlorthalidone in patients with hypertension has been examined as part of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

• this was a blinded, randomised controlled trial. There was a median follow-up of 3.3 years
• patients included in the trial were >=55 years of age who had a mean systolic blood pressure >= 140 mmHg or diastolic blood pressure >= 90 mmHg, took medication for hypertension, and had at least one other risk factor for cardiovascular disease; exclusion criteria included stroke, MI or angina in the past 6 months and congestive heart failure; 24, 335 patients were included in the trial
• patients were allocated to treatment with chlorthalidone (n = 15 268) or doxazosin (n = 9067)
• this trial revealed that, in high risk hypertensive patients, doxazosin was associated with a higher incidence of stroke cardiovascular disease events, particularly congestive heart failure, than treatment with chlorthalidone

Reference:

1) The ALLHAT officers and Coordinators for the ALLHAT Collaborative Research Group (2000). Major cardiovascular events in hypertensive patients randomize to doxazosin vs chlorthalidone. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA, 283, 1967-75.