α-receptor blocker blood pressure lowering in everyone’s mind is “obvious blood pressure lowering effect, no adverse effect on blood sugar and blood lipid metabolism, but easy to cause orthostatic hypotension. drug”. Although it is a classic drug for the treatment of hypertension, it is generally not used as a first-line treatment for hypertension. So do alpha-blockers still have a place in the treatment of hypertension? In what clinical situations should these drugs be used? Recently, the first “Chinese Expert Consensus on Alpha-Blocker Antihypertensive Treatment” was released, providing detailed guidance for the clinical use of this type of drug. This article takes you to sort out the core knowledge points together.
< p>α-blockers can be used as a drug for the combined treatment of refractory hypertension
In clinical practice, “A+C+D” is often used “The triple antihypertensive regimen of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) combined with calcium channel blocker (CCB) and diuretics, when the antihypertensive effect is not good , also need to add a fourth or even a fifth antihypertensive drugs. Diuretics should not be used in patients with refractory hypertension complicated with hyperuricemia, or when long-term use of beta-blockers has adverse reactions such as male sexual dysfunction, they may be considered Alpha-blockers are preferred.
Alpha blockers as screening for primary aldosteronism Antihypertensive drugs during the period
Screening for primary aldosteronism: Primary aldosteronism is the most common secondary The investigation mainly relies on the detection of plasma aldosterone and renin levels and the calculation of the serum aldosterone/renin ratio (ARR). A variety of antihypertensive drugs can affect the concentration of aldosterone and/or renin, thereby affecting the accuracy of ARR detection. Studies have shown that alpha-blockers have little effect on ARR and are one of the commonly used alternative antihypertensive drugs.
Alpha blockers for chromaffin cells Preoperative blood pressure control and hypertensive crisis therapy
α-blockers are first-line antihypertensive drugs for preoperative blood pressure control in pheochromocytoma. Preoperative alpha-blockers for pheochromocytoma can reduce blood pressure, reduce cardiac load, and expand previously reduced blood volume. Alpha-blockers are generally used for at least 2 weeks before surgery. In patients with hypertensive crisis due to pheochromocytoma, an intravenous bolus of the fast-acting alpha-blocker phentolamine can be used, followed by an intravenous infusion.
Alpha-blockers for hypertension Antihypertensive therapy in BPH patients
Benign prostatic hyperplasia (BPH) is common in middle-aged and elderly men, and alpha-blockers can act on the prostate and bladder neck The α1 receptor on smooth muscle improves the symptoms of BPH and is one of the commonly used therapeutic drugs for BPH. Selective α1-receptor blockers are more effective in reducing blood pressure and improving BPH symptoms, and are more advantageous for patients with hypertension and BPH. Because alpha-blockers have the dual effect of lowering blood pressure and improving symptoms of BPH.
Doxazosin and terazosin for additional antihypertensive treatment of hypertension and CKD
Hypertension and chronic kidney disease (CKD) They are closely related to each other, and they are the etiology and aggravating factors of each other. α1-receptor blockers can dilate peripheral blood vessels, decrease vascular resistance, lower blood pressure, and prevent the reflex increase of sympathetic tone.Reduce blood pressure and renal vascular resistance without reducing renal blood flow and renal blood flow. Glomerular filtration rate (GFR).
doxazosin , Terazosin is used for the antihypertensive treatment of hypertension complicated with metabolic syndrome, which has the additional benefit of improving glucose and lipid metabolism
The abnormal glucose and lipid metabolism is Common comorbidities in hypertensive patients. Diuretics and β-blockers have certain adverse effects on glucose and lipid metabolism, while α-blockers have no obvious adverse metabolic reactions. Alpha-blockers may also improve insulin resistance.
Intravenous urapidil as a treatment for hypertensive emergencies First-line clinical drugs
α receptor antagonists can be used for antihypertensive treatment of hypertensive emergencies. Urapidil has obvious efficacy and safety advantages in the antihypertensive treatment of hypertensive emergencies. Table 1.Indications for alpha blockers
Principles of Use
1. IndividualizationMedication principles: There are certain differences in the efficacy of different α-blockers; the clinical characteristics, comorbidities, and concomitant medication of hypertensive patients can all affect α-blockers. Therefore, the principle of individualized medication should be followed. 2. The principle of “dose titration”: The risk of adverse reactions is dose-dependent, usually α-receptor blocking The stagnation agent needs to be used from a small dose and gradually increase the dose to observe the changes in the patient’s blood pressure and heart rate. After titrating to the blood pressure target, if it is well tolerated, the titrated dose is maintained. Dose titration can reduce adverse reactions due to overdosing. 3. Additional treatment: α-blockers are generally not used as first-line treatment for hypertension. If the patient’s blood pressure is not controlled, alpha-blockers can be combined with beta-blockers, ACEIs, ARBs, CCBs, and thiazide diuretics.
1. Not only should the supine blood pressure be measured after taking the medicine , and standing or sitting blood pressure should also be measured; patients should take a supine position when they experience discomfort after medication, and pay close attention to blood pressure. If the blood pressure is too low, vasopressors can be used to correct it. It is best to take the medicine in a sitting position. 2. Working at heights, driving cars and other high-risk workers should not be used, In the early stage of administration or in the case of sudden dose increase, it is easy to Orthostatic hypotension may cause symptoms such as dizziness, dizziness, nausea, chest discomfort, and difficulty breathing when standing up. If overdose causes hypotension, the patient should immediately lie down with the head lowered. Use with caution in patients with heart failure. 3. The tablet should be swallowed whole when taking it.It should not be chewed, broken or crushed, as it may cause transient bleeding The possibility of side effects due to increased drug concentration increases. 4. Recent Myocardial infarction is prohibited;< strong>It is contraindicated in patients with any history of gastrointestinal tract narrowing. Contraindicated for those who are known to be allergic to any of its ingredients;
Introduction to commonly used alpha-blockers
Alpha-blockers can be divided into short-acting and long-acting alpha-blockers according to the length of time they bind to alpha-receptors. The former binds weakly to α receptors, maintains a short duration, and has a mild effect. Representative drugs include phentolamine and tolazoline. The latter has a long duration of action, long-lasting efficacy, and a significant and stable antihypertensive effect. It is currently a commonly used antihypertensive drug in clinical practice. The representative drugs are doxazosin and terazosin.. Doxazosin is available in two dosage forms: ordinary tablets and sustained-release tablets. The plasma drug concentration of sustained-release tablets is more stable than that of flat tablets, the action time is longer, and the antihypertensive effect is more stable. Table 2. Commonly used alpha blockersplanning: JING Email: [email protected]