Man in't Veld A J
University Hospital Dijkzigt, Department of Internal Medicine 1, Rotterdam, The Netherlands.
Eur Urol. 1998;34 Suppl 2:29-36; discussion 47. doi: 10.1159/000052285.
Most alpha 1-adrenoceptor antagonists are non-subtype selective and act on smooth muscle in the prostate, as well as in the vascular system and, as such, have effects on blood pressure as well as relieving LUTS (lower urinary tract symptoms) in symptomatic benign prostatic hyperplasia (BPH). As many elderly patients with LUTS also take concomitant antihypertensive therapy, it has been suggested by some that these patients should be treated with an alpha 1-adrenoceptor antagonist that targets both symptomatic BPH and hypertension simultaneously. However, an alternative school of thought believes that hypertension, as a malignant disease, should be treated optimally first, before the LUTS are controlled. Many different classes of antihypertensive drugs have been developed and evidence, with regard to reduction of cardiovascular morbidity and mortality, supports the use of diuretics and beta-blockers in this indication. However, from this point of view, few data support the use of alpha 1-adrenoceptor antagonists in antihypertensive therapy, and studies indicate that elderly patients in particular are prone to orthostatic hypotension and its effects when treated with alpha 1-adrenoceptor antagonists. This, together with the fact that hypertension is such a potentially morbid disease, suggests that alpha 1-adrenoceptor antagonists should not be used as a first line treatment for the treatment of hypertension. Rather, patients with comorbidity should be treated optimally for both diseases, being treated initially for hypertension with the optimal agent available and then with an alpha 1-adrenoceptor antagonist that is not haemodynamically active to target their LUTS. Tamsulosin, a selective alpha 1A-adrenoceptor antagonist, has no clinically significant effect on blood pressure compared with placebo, thus posing less risk for the patient, especially with regard to symptomatic orthostatic hypotension.
大多数α1肾上腺素能受体拮抗剂是非亚型选择性的，作用于前列腺以及血管系统的平滑肌，因此，它们在缓解症状性良性前列腺增生（BPH）的下尿路症状（LUTS）的同时，也会对血压产生影响。由于许多有LUTS的老年患者同时也接受抗高血压治疗，一些人建议这些患者应使用能同时针对症状性BPH和高血压的α1肾上腺素能受体拮抗剂进行治疗。然而，另一种观点认为，高血压作为一种恶性疾病，应在控制LUTS之前首先进行最佳治疗。已经开发出许多不同类别的抗高血压药物，关于降低心血管发病率和死亡率的证据支持在该适应症中使用利尿剂和β受体阻滞剂。然而，从这个角度来看，很少有数据支持α1肾上腺素能受体拮抗剂用于抗高血压治疗，并且研究表明，老年患者在使用α1肾上腺素能受体拮抗剂治疗时尤其容易出现体位性低血压及其影响。这一点，再加上高血压是一种潜在的致病疾病这一事实，表明α1肾上腺素能受体拮抗剂不应作为治疗高血压的一线药物。相反，患有合并症的患者应针对两种疾病进行最佳治疗，首先使用可用的最佳药物治疗高血压，然后使用对血流动力学无活性的α1肾上腺素能受体拮抗剂来治疗其LUTS。与安慰剂相比，选择性α1A肾上腺素能受体拮抗剂坦索罗辛对血压没有临床显著影响，因此对患者造成的风险较小，尤其是在症状性体位性低血压方面。
