Hypertension and CHD risk: whither alpha-1 blockers?

With the inclusion of alpha-blockers in the list of drugs recommended as firstline agents for managing hypertension, there has been a resurgence of interest in this group of drugs. The selective alpha-1 blockers reduce peripheral vascular resistance by blocking the alpha-1 receptors and preventing norepinephrine from reaching them. Their antihypertensive efficacy has been shown to be comparable to all other major classes of antihypertensive agents. They are also as well tolerated as the other currently used drugs, both facts being confirmed by the TOMHS. What differentiates them from the rest of the drugs is their beneficial effects on various other coronary heart disease (CHD) risk factors. While lowering blood pressure (a CHD risk factor by itself), the selective alpha-1 blockers also reduce serum total cholesterol and increase serum HDL cholesterol (yet another major CHD risk factor). These drugs have been shown to increase insulin sensitivity and lower blood glucose levels. In addition, they also cause regression of left ventricular hypertrophy. Given these added beneficial effects, the lipid- and glucose-friendly selective alpha-1 blockers are increasingly being used.