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Doxazosin, an inferior antihypertensive agent?

Journal of Human Hypertension volume 16, pages 375–377 (2002)Cite this article

In the United States and Europe, there are more than 100 trade name drugs approved by regulatory agencies for the lowering of elevated blood pressure (BP). Some of these drugs have been shown in large, long-term, placebo-controlled clinical trials to reduce the risks of the cardiovascular complications of hypertension.1 Others have not, or they have not been tested. The aim of antihypertensive treatment is to prevent these often devastating complications, and not simply to lower an elevated BP. However, the medical community has assumed that the benefit of all antihypertensive agents is mediated through BP lowering so that it does not matter how this lowering is achieved. During the past several decades, the basis for this assumption has eroded for two reasons. First, investigators have realised that hypertension is more than elevated BP and involves many neurohormonal and metabolic functions. Second, the pharmaceutical companies have developed very potent drugs with multiple and unique mechanisms of action capable of interfering with the complex pathophysiology of hypertension. These lines of evidence provide a sound scientific and public health rationale for comparing the different groups of antihypertensive drugs in terms of their effect on reducing the risks of cardiovascular complications. Comparative outcome trials of antihypertensive drugs have in the past received low priority among pharmaceutical companies. There is always the possibility that one of the drugs in a comparison will emerge as the loser, a result that could have unfavourable ramifications for future sales. If the sponsor's product comes out ahead, there is always a suspicion that the trial was unfairly designed. Another concern is that a large number of comparative trials are underpowered to detect important treatment group differences.2

The Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial (ALLHAT) was launched in 1994 by the National Heart, Lung, and Blood Institute (NHLBI). One of the goals of the still ongoing ALLHAT trial is to answer the question whether the newer types of antihypertensive agents, which are currently more costly to purchase, are better than diuretics in reducing coronary heart disease (CHD) incidence. ALLHAT was designed to compare standard treatment with a low-dose diuretic (chlorthalidone) to each of three alternative treatments—a calcium antagonist (amlodipine), and angiotensin-converting enzyme (ACE) inhibitor (lisinopril) and an α-adrenergic blocker (doxazosin). ALLHAT also has a lipid-lowering component that will not be discussed further here.

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  1. Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    C D Furberg

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Correspondence to C D Furberg.

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Furberg, C. Doxazosin, an inferior antihypertensive agent?. J Hum Hypertens 16, 375–377 (2002). https://doi.org/10.1038/sj.jhh.1001313

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