Alpha 1-blockers, their antihypertensive efficacy and effects on lipids and lipoprotein.

Alpha adrenergic receptor-blocking drugs lower the blood pressure but until prazosin, a post synaptic alpha 1 receptor-blocking drug was introduced, they had limited clinical application. Prazosin, terazosin and doxazosin are all effective as single therapy or in combination with other anti-hypertensive drugs. As vasodilators they combine particularly well with beta adrenergic-blocking drugs. The only serious side effect, namely first dose postural hypotension, can be avoided by starting with a small dose and avoiding concomitant salt depletion. The disappointing results of trials in mild hypertension, in terms of prevention of coronary artery disease and its complications, have been attributed in part to the fact that several of the drugs used in these studies have an adverse effect on atherogenic lipids. alpha 1 adrenergic-blocking drugs have a beneficial effect on the lipid profile. Anti-hypertensive therapy usually needs to be continued on a long term, often permanent, basis. For this reason, drugs which have a beneficial effect on atherogenic lipids are preferable as initial therapy and, where possible, single therapy in the treatment of mild hypertension.