Symptomatic BPH and Hypertention: Does Comorbidity Affect Quality of Life?

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Abstract
Most α1-adrenoceptor antagonists are non-subtype selective and act on smooth muscle in the prostate, as well as in the vascular system and, as such, have effects on blood pressure as well as relieving LUTS (lower urinary tract symptoms) in symptomatic benign prostatic hyperplasia (BPH). As many elderly patients with LUTS also take concomitant antihypertensive therapy, it has been suggested by some that these patients should be treated with an α1-adrenoceptor antagonist that targets both symptomatic BPH and hypertension simultaneously. However, an alternative school of thought believes that hypertension, as a malignant disease, should be treated optimally first, before the LUTS are controlled. Many different classes of antihypertensive drugs have been developed and evidence, with regard to reduction of cardiovascular morbidity and mortality, supports the use of diuretics and β-blockers in this indication. However, from this point of view, few data support the use of α1-adrenoceptor antagonists in antihypertensive therapy, and studies indicate that elderly patients in particular are prone to orthostatic hypotension and its effects when treated with α1-adrenoceptor antagonists. This, together with the fact that hypertension is such a potentially morbid disease, suggests that α1-adrenoceptor antagonists should not be used as a first line treatment for the treatment of hypertension. Rather, patients with comorbidity should be treated optimally for both diseases, being treated initially for hypertension with the optimal agent available and then with an α1-adrenoceptor antagonist that is not haemodynamically active to target their LUTS. Tamsulosin, a selective α1A-adrenoceptor antagonist, has no clinically significant effect on blood pressure compared with placebo, thus posing less risk for the patient, especially with regard to symptomatic orthostatic hypotension.

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