Evaluation of the Effects of Prazosin on Resistant Diastolic Hypertension With a Focus on Sex Difference

Authors

1 Department of Echocardiography, Dezful University of Medical Sciences, Dezful, IR Iran

2 Department of Echocardiography, Atherosclerosis Research Center, Baqiatallah University of Medical Sciences, Tehran, IR Iran

3 Chemical Injuries Research Center, Systems Biology and Poisons Institute, Baqiatallah University of Medical Sciences, Tehran, IR Iran

Abstract

Background: Despite all the focus on systolic blood pressure (SBP), few studies exist on high diastolic blood pressure (DBP) treatment between the different genders. In this study, we investigated the effects of prazosin as an additional treatment for refractory DBP. Methods: Totally, 75 nonblack adults were enrolled in this study with primary hypertension and DBP >100 mm Hg as isolated diastolic hypertension or systolic-diastolic hypertension. All the patients were treated with 1 or more drugs the 5 major antihypertensive group drugs (ACE-I, ARB, diuretic, Ca-channel blockers, and beta-blockers). If hypertension did not respond to these drugs, prazosin was added at a mean dose of 1–2 mg (1.6 mg) daily. Result: Many of the patients needed additional low doses of prazosin for the control of DBP. The response of the females was significantly better than that of the males to the 5 major antihypertensive drugs (P=0.001) . This study showed that the 5 major drug groups, albeit conferring good SBP control (25.8% reduction in SBP), in the majority of the patients only caused a 10% decrease in DBP. However, prazosin led to a 21.8% decrease in DBP and a 9.5% decrease in SBP. Consequently, prazosin could be an effective drug in controlling resistant DBP with minimal side effects. Conclusions: Low-dose prazosin as an additional drug to other major antihypertensive drugs with minor and transient complications can be reliably effective in reducing resistant DBP. 

Keywords

References

Chobanian AV. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-52.
Seideman P, Grahnén A, Haglund K, Lindström B, von Bahr C. Prazosin dynamics in hypertension: relationship to plasma concentration. Clinical Pharmacology & Therapeutics. 1981;30(4):447-54.
Goldberg MR, Sushak CS, Rockhold FW, Thompson WL, pinacidil vs prazosin multicenter investigator group I, Ind. Vasodilator monotherapy in the treatment of hypertension: comparative efficacy and safety of pinacidil, a potassium channel opener, and prazosin. Clinical Pharmacology & Therapeutics. 1988;44(1):78-92.
Brogden R, Heel R, Speight T, Avery G. Prazosin: a review of its pharmacological properties and therapeutic efficacy in hypertension. Drugs. 1977;14(3):163-97.
Wykretowicz A, Guzik P, Wysocki H. Doxazosin in the current treatment of hypertension. Expert opinion on pharmacotherapy. 2008;9(4):625-33.
Rodilla E, Costa JA, Pérez-Lahiguera F, Baldó E, González C, Pascual JM. Spironolactone and doxazosin treatment in patients with resistant hypertension. Revista Española de Cardiología (English Edition). 2009;62(2):158-66.
Chapman N, Chen C-Y, Fujita T, Hobbs FR, Kim S-J, Staessen JA, et al. Time to re-appraise the role of alpha-1 adrenoceptor antagonists in the management of hypertension? Journal of hypertension. 2010;28(9):1796-803.
Saruta T. Studies on the effect of prazosin on blood pressure and serum lipids in Japanese hypertensive patients. The American journal of medicine. 1984;76(2):117-21.
Usuda K, Katayama Y. The effect of doxazosin mesilate on cerebral blood flow in patients with hypertension and chronic cerebral infarction. Journal of Nippon Medical School. 2009;76(3):148-53.
Miller RR, Awan NA, Maxwell KS, Mason DT. Sustained reduction of cardiac impedance and preload in congestive heart failure with the antihypertensive vasodilator prazosin. New England Journal of Medicine. 1977;297(6):303-7.
Guzik P, Wykretowicz A, Krauze T, Piskorski J, Adamska K, Milewska A, et al. Add-on therapy with a nighttime dose of doxazosin in patients with uncontrolled hypertension: effects on autonomic modulation of the cardiovascular system. Hypertension Research. 2008;31(3):443.
Leenen FH, Smith DL, Farkas RM, Reeves RA, Marquez-Julio A. Vasodilators and regression of left ventricular hypertrophy: hydralazine versus prazosin in hypertensive humans. The American journal of medicine. 1987;82(5):969-78.
Curtis J, Bateman F. Use of prazosin in management of hypertension in patients with chronic renal failure and in renal transplant recipients. Br Med J. 1975;4(5994):432-4.
XHF YFH, K. Sun WJL, Wang XJ, Cheng JZ, Zhen YS, Zheng Y, et al. The Effects Of Anti-Hypertensive Drugs On Diastolic And Systolic Hypertension In Chinese International Academy of Cardiology . 2016.
Babick A, Elimban V, Dhalla NS. Reversal of Cardiac Remodeling and Subcellular Defects by Prazosin in Heart Failure Due to Myocardial Infarction. Journal of Clinical & Experimental Cardiology. 2013;2012.
Fagard R, Van den Enden M. Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care. Journal of human hypertension. 2003;17(10):681.
Mancia G, Grassi G. Systolic and diastolic blood pressure control in antihypertensive drug trials. Journal of hypertension. 2002;20(8):1461-4.
Jiménez PM, Conde C, Casanegra A, Romero C, Tabares AH, Orías M. Association of ACE genotype and predominantly diastolic hypertension: a preliminary study. Journal of Renin-Angiotensin-Aldosterone System. 2007;8(1):42-4.
Reckelhoff JF. Gender differences in the regulation of blood pressure. Hypertension. 2001;37(5):1199-208.
Huang J. Low diastolic blood pressure as a risk for all-cause mortality in VA patients. International Journal of Hypertension. 2013;2013.
Okun R. Effectiveness of prazosin as initial antihypertensive therapy. American Journal of Cardiology. 1983;51(4):644-50.
Gradman AH, Basile JN, Carter BL, Bakris GL, Group ASoHW. Combination therapy in hypertension. Journal of the American Society of Hypertension. 2010;4(2):90-8.
Iranian Heart Journal
Volume 20, Issue 2
Spring 2019
Pages 32-39

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