Comparative Effects of Doxazosin and Carvedilol on Clinical Status and Left Ventricular Function in Hypertensive Patients with Mild Heart Failure

Abstract

Introduction: β-Blockers have been shown to be effective in the treatment of both arterial hypertension and heart failure. However, slow titration of β-blockers over several weeks and rigorous supervision are essential to minimise antiadrenergic adverse effects in patients with heart failure. α1-Blockers are well tolerated and effectively lower blood pressure by reducing peripheral resistance. Patients and methods: This study assessed changes in left ventricular function and quality of life in hypertensive patients with mild heart failure treated with enalapril and furosemide combined with a β-blocker with peripheral vasodilating activity (carvedilol) or an α-blocker (doxazosin), over a 1-year period. Sixty patients aged 45–65 years with untreated essential arterial hypertension and mild heart failure were randomised to receive enalapril + furosemide in combination with carvedilol or doxazosin. Results: In the carvedilol compared with the doxazosin group, ejection fraction diminished significantly (38% vs 42%, p < 0.05) and quality of life worsened significantly (Minnesota Living Heart Failure score 54 vs 47, p < 0.05) during the first 3 weeks of treatment. Ejection fraction and quality of life had significantly improved from baseline in both groups by 12 months. Conclusion: Doxazosin in combination antihypertensive therapy rapidly improves clinical status and haemodynamics in hypertensive patients with mild heart failure by reducing afterload. After 1 year, doxazosin and carvedilol improve clinical and haemodynamic parameters.