Alpha vs. Beta Blockers for Hypertensive Target Organ Damage
Alpha vs. Beta Blockers for Hypertensive Target Organ Damage
Despite demonstrated benefit from antihypertensive therapy with beta blockers and diuretics on cardiovascular end points, patients do not appear to be restored to unit risk by currently available therapies. Whether alternative choice of therapy will provide more satisfying results is as yet undetermined. The current study compared the effects of alpha blockers and beta blockers on left ventricular hypertrophy, renal function (e.g., GFR, protein excretion), and lipids.
In 43 patients, hypertensive patients received up to 12 mg of bunazosin or 200 mg of metoprolol once daily, adding HCTZ 25 mg if target pressure was not achieved. End points were measured after six months of therapy.
By ambulatory monitoring, both treatments were equally efficacious in lowering blood pressure. The metoprolol provided a greater degree of LVH regression, and in a higher percentage of recipients, than the alpha blocker. Beta blocker recipients had lesser protein excretion than alpha blocker recipients. Lipid changes (LDL) trended toward greater beneficial change in the alpha blocker group, and triglycerides were significantly more reduced by the alpha blockers than beta blockers.
Both categories of drug evoked favorable changes. Pre-existing pathology may help direct our therapeutic choice (i.e., when a hypertensive patient presents with concomitant hyperlipidemia, it is anticipated that alpha blockade will provide more favorable lipid effect). On the other hand, we still lack large-scale, long-term, randomized trials confirming anticipated benefits of non-diuretic, non-beta-blocker therapies for hypertension.
Schmieder RE, et al. Am J Hypertens 1997;10:985-991.
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