Management of hypertension

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Editor, – The National Heart Foundation of Australia released its 1999 Guide to Management of Hypertension for Doctors in October last year.1 Since then a large outcome study (ALLHAT) in the USA has demonstrated that antihypertensive therapy with the alpha blocker doxazosin is associated with more cardiovascular events and a greater chance of patients being hospitalised for congestive heart failure than therapy with a regimen based on a thiazide diuretic.2 As a result of this study, the National Heart Foundation does not recommend that alpha blockers be considered as an option in the first-line management of hypertension.

This recommendation does not preclude considering alpha blockers as additional drugs, after initiation with a first-line drug, if combination therapy is required to achieve good blood pressure control.

Although alpha blockers may still be used for symptom relief in patients with prostatism without manifest or suspected heart failure, the ALLHAT results suggest that, if the person is also hypertensive, their outcome will not be as good as if they were treated with a regimen based on a thiazide diuretic. It is also likely that they will have a higher chance of being admitted to hospital with heart failure.

Professor Lindon Wing
Chair and members
National Blood Pressure Advisory Committee
National Heart Foundation