Peripheral Alpha Blockers

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.