Abstract
The lowering of high blood pressure is supposed to protect target organs from hypertensive damage. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial was designed to compare the cardioprotective properties of three antihypertensives from different classes (lisinopril, amlodipine and doxazosin) with chlorthalidone. Despite effective blood pressure lowering and a favorable metabolic profile, the doxazosin arm of the trial had a significantly higher relative risk of cardiovascular disease and heart failure compared with the chlorthalidone arm. This article speculates on possible causes for this unexpected result and suggests that the culprit may be accentuation of the vascular effects of vasopressin, which are maximized under α-adrenergic blockade. These findings may have implications for the large number of older men who receive monotherapy with α-blockers for treatment of prostatic symptoms.
Highlights
The purpose of lowering high blood pressure is to prevent morbidity and mortality from hypertensive complications, such as heart attack, stroke, renal failure, and heart failure
The Veterans Administration studies in the 1960s proved beyond doubt that treating hypertension with thiazides and β-blockers significantly diminished the rates of strokes, renal failure, and heart failure, the decrease in the rate of myocardial infarcts did not reach statistical significance
It has been estimated that a 10–15 mmHg fall in systolic blood pressure should lead to a 15% reduction in relative risk for heart attack and to a 40% reduction for stroke [1]
Summary
The purpose of lowering high blood pressure is to prevent morbidity and mortality from hypertensive complications, such as heart attack, stroke, renal failure, and heart failure. Controlled clinical trials have indicated that drugs from different classes have different neurohumoral and metabolic profiles, which might enhance or partially offset the benefits from blood pressure lowering per se.
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