Treatment of Benign Prostatic Hyperplasia in Hypertensive Men

Abstract

As the proportion of the US population over the age of 65 continues to rise, it is likely that the number of individuals with concomitant benign prostatic hyperplasia and hypertension will also increase. To reduce morbidity and mortality, it is important to treat patients with hypertension optimally. Evidence from outcome trials suggests that alpha1 blockers should not be used as first-line antihypertensive therapy. Although some clinicians previously recommended alpha1 blocker monotherapy for patients with both hypertension and benign prostatic hyperplasia, the most recent American Urologic Association and Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend independent treatment with the most appropriate pharmacologic agents for each condition. When treating patients with benign prostatic hyperplasia, clinicians should be aware of the potential impacts that alpha1 blockers may have on blood pressure and potential adverse events in patients who are normotensive as well as in patients with treated hypertension.

Can Metabolic Disorders in Aging Men Contribute to Prostatic Hyperplasia Eligible for Transurethral Resection of the Prostate (TURP)?

“…Due to the aging of the population, both BPH and hypertension are found in a growing number of patients. It is estimated that these disorders occur simultaneously in about 30% of men [ 71 ]. BPH and hypertension are different diseases, although they share an etiology associated with the sympathetic nervous system.…”

Incident depression increases medical utilization in Medicaid patients with hypertension

“…Quan et al's [41] enhanced algorithm was used to identify the 17 disease categories included in the CCI using ICD-9 diagnosis codes on medical claims in Year 1. Depression and control cases were also matched on indicators for the presence of selected comorbidities that are not components of the CCI but are either cardiovascular-related, mental-health related or are conditions for which antihypertensive medications are sometimes prescribed (cardiac dysrhythmia, hypertensive heart disease, dyslipidemia, other heart diseases, edema, benign prostatic hyperplasia [42], schizophrenia, episodic mood disorder, delusional disorder, other psychoses and alcohol-and drug-induced mental illness).…”

Alpha1‐Adrenergic Blockers: Current Usage Considerations

“…Alpha 1 ‐adrenergic antagonists have emerged as an effective form of therapy for symptomatic BPH 4–6 . Alpha‐adrenergic receptors have been identified in the bladder neck and prostatic capsule, and their stimulation is responsible for the dynamic pressure component of BPH symptoms.…”

“…Alpha‐adrenergic receptors have been identified in the bladder neck and prostatic capsule, and their stimulation is responsible for the dynamic pressure component of BPH symptoms. In clinical studies, use of α 1 ‐adrenergic blockers in patients with BPH increases urinary flow rate and reduces residual volume and obstructive symptoms 4,6 . In those BPH patients who are hypertensive, BP will fall in a dose‐dependent fashion with α 1 ‐adrenergic antagonists; however, single‐drug therapy with an α 1 ‐adrenergic antagonist—for BP control and BPH symptom relief—may require doses larger than those used for the treatment of patients with BPH alone.…”

“…More recently, sustained‐release formulations for prazosin and doxazosin have been released. Tamsulosin and alfuzosin are so‐called uroselective agents with a higher affinity for prostatic α 1 adrenoceptors and are commonly used in the management of patients with benign prostatic hypertrophy (BPH) 4 …”