Peripheral Alpha Blockers

Orit Barrett, Talya Wolak

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


From the mid-1970s until the beginning of the current century (2000), alpha1-adrenergic receptor (α1-AR) blockers were widely used and considered safe and effective antihypertensive medications. In 2000, the landmark Antihypertensive and Lipid-Lowering [to prevent] Heart Attack Trial (ALLHAT trial) was published, which demonstrated greater incidence of combined cardiovascular diseases, especially heart failure, in patients assigned to the α1-AR blocker, doxazosin, arm. Since this publication, the usage of α1-AR blocker as antihypertensive medication declined dramatically due to cardiac safety concern. Currently, latest clinical guidelines place α1-AR blocker not in the first line of hypertension treatment, but as part of a multiple-drug combination, saved for patients with resistant hypertension. After the ALLHAT trial publication, several large-scale studies were conducted using α1-AR blockers as part of a drug regimen to achieve the desired blood pressure target. These studies showed that the effective blood pressure reduction achieved by α1-AR blockers was not associated with increased cardiac morbidity. Considering current guidelines and results from recent studies, α1-AR blockers can be used as third or fourth medication in patients who did not achieve blood pressure control under treatment with angiotensin converting enzyme (ACE-I)/angiotensin receptor blockers (ARB), calcium channel blockers, and diuretics.

Original languageEnglish
Title of host publicationHypertension
Subtitle of host publicationA Companion to Braunwald's Heart Disease
Number of pages7
ISBN (Electronic)9780323883696
ISBN (Print)9780323931731
StatePublished - 1 Jan 2023
Externally publishedYes


  • alpha adrenergic receptors
  • alpha blocker
  • sympathetic nervous system

ASJC Scopus subject areas

  • General Medicine


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