Role of the newer alpha, -adrenergic-receptor antagonists in the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms

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Abstract

Although initially introduced for the management of hypertension, alpha 1-adrenergic-receptorantagonists (a1-blockers) have become the standard of care for the medical management of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). However, these agents have the potential to produce orthostatic hypotension and other blood pressure-related adverse effects in normotensive patients and in those receiving concurrent treatment with other antihypertensive agents. As a result, more "uroselective," less vasoactive α 1-blockers have been developed. This article reviews current information on the role of α 1-blockers in the treatment of BPH-related LUTS. The focus is on tamsulosin and alfuzosin, newer "uroselective" agents in this class that have a decreased potential for cardiovascular adverse effects. Relevant articles were identified through a search of the English-language literature indexed onMEDLINE and the proceedings of scientific meetings from 1976 to 2003. The search terms were benign prostatic hyperplasia treatment, alpha 1-adrenergic-receptor blockep uroselectivity, lower urinary tract symptoms, complications, and cardiovascular. Tamsulosin has selectivity for the a α 1 and α 1d receptor subtypes. Alfuzosin, although not receptorsubtypeselective, is clinically "uroselective" and does not significantly affect vascular alpha-adrenergic receptors. Both agents are efficacious in relieving LUTS and have a decreased potential for such cardiovascular adverse effects as postural hypotension. Common adverse events with these agents include dizziness and asthenia. Based on the available data, "uroselective" α 1-blockers should be considered over older, morevasoactive agents for the medical management of LUTS, particularly in patients with BPH and hypertension.

Original languageEnglish (US)
Pages (from-to)1701-1713
Number of pages13
JournalClinical Therapeutics
Volume26
Issue number11
DOIs
StatePublished - Nov 2004
Externally publishedYes

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Receptors, Adrenergic, alpha
Lower Urinary Tract Symptoms
Adrenergic Antagonists
Prostatic Hyperplasia
tamsulosin
Orthostatic Hypotension
Adrenergic alpha-1 Receptors
Hypertension
Therapeutics
Asthenia
Dizziness
Standard of Care
Adrenergic Agents
Antihypertensive Agents
Blood Vessels
Language
Blood Pressure

Keywords

  • adrenergic-receptor antagonist
  • complications
  • hypertension
  • prostatic hyperplasia

ASJC Scopus subject areas

  • Pharmacology

Cite this

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title = "Role of the newer alpha, -adrenergic-receptor antagonists in the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms",
abstract = "Although initially introduced for the management of hypertension, alpha 1-adrenergic-receptorantagonists (a1-blockers) have become the standard of care for the medical management of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). However, these agents have the potential to produce orthostatic hypotension and other blood pressure-related adverse effects in normotensive patients and in those receiving concurrent treatment with other antihypertensive agents. As a result, more {"}uroselective,{"} less vasoactive α 1-blockers have been developed. This article reviews current information on the role of α 1-blockers in the treatment of BPH-related LUTS. The focus is on tamsulosin and alfuzosin, newer {"}uroselective{"} agents in this class that have a decreased potential for cardiovascular adverse effects. Relevant articles were identified through a search of the English-language literature indexed onMEDLINE and the proceedings of scientific meetings from 1976 to 2003. The search terms were benign prostatic hyperplasia treatment, alpha 1-adrenergic-receptor blockep uroselectivity, lower urinary tract symptoms, complications, and cardiovascular. Tamsulosin has selectivity for the a α 1 and α 1d receptor subtypes. Alfuzosin, although not receptorsubtypeselective, is clinically {"}uroselective{"} and does not significantly affect vascular alpha-adrenergic receptors. Both agents are efficacious in relieving LUTS and have a decreased potential for such cardiovascular adverse effects as postural hypotension. Common adverse events with these agents include dizziness and asthenia. Based on the available data, {"}uroselective{"} α 1-blockers should be considered over older, morevasoactive agents for the medical management of LUTS, particularly in patients with BPH and hypertension.",
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