Assessment of the effects of alpha- and beta-blockade in hypertensive patients who smoke cigarettes.

A 24-week, crossover, comparison study was conducted to observe the effects of alpha-blockade with prazosin and beta-blockade with propranolol on blood pressure and plasma lipoprotein levels in 15 hypertensive cigarette smokers. Before treatment, mean sitting blood pressure was 140/100 mm Hg and rose to 147/105 mm Hg after the patients smoked two cigarettes. Treatment with prazosin and propranolol lowered sitting blood pressure to 127/89 mm Hg and 129/91 mm Hg, respectively (not significant), and did not alter the pressor response to smoking. The total cholesterol level at baseline was 207.3 +/- 11.0 mg/dl. This increased to 210.5 +/- 10.2 mg/dl with propranolol treatment and decreased to 201.0 +/- 11.1 mg/dl with prazosin treatment. The low-density lipoprotein cholesterol level was 132.5 +/- 8.1 mg/dl at baseline, 136.9 +/- 8.3 mg/dl with propranolol treatment, and 129.4 +/- 9.0 mg/dl with prazosin treatment (0.05 less than p less than 0.10 between-group comparison). The data indicated that whereas prazosin and propranolol are equally effective in controlling blood pressure in hypertensive cigarette smokers, effects on plasma lipoproteins also may need to be considered when selecting a first-step antihypertensive agent in this coronary-prone population.