Urologie pro praxi 3/2004
Volba inhibitoru alfa–1 adrenergního receptoru v současné terapii benigní hyperplazie prostaty a hypertenze
THE CHOICE OF ALPHA-1 ADRENERGIC RECEPTOR INHIBITOR IN COMBINED TREATMENT OF BENIGN PROSTATIC HYPERPLASIA AND HYPERTENSION Benign prostatic hyperplasia (BPH) and hypertension (HTN) are disease with high mutual coincidence. Symptomatic BPH is accompanied with a hypertension in up to 40 %, asymptomatic depending on age in up to 100 % (all men above 70 with hypertension have BPH, unless they have been castrated before puberty). Some common conditions can be traced in both diseases, as it is a stimulation of sympathetic nervous system (7) and that’s why the possibility of influencing it interferes with both diagnosed units. Besides a tamsulosin, all inhibitors of type 1-alpha-adrenoceptor (AR) (subtype A) are the derivatives of prazosin. Their introduction to the market 20 years ago represented a turn in the treatment of BPH and HTN. Within the time progress there come drugs not only more active, but save above all (measured by the percentage of adverse and side effects). Until now the last commercially used derivate of prazosin, alfuzosin, got over two breaking drugs of their time – doxazosin and terazosin (8). The question is, whether it is suitable to use an alpha-inhibitor with the influence on a blood pressure as a monotherapy in patients with BPH and HTN (we can get to know from companies’ materials, that it is “the gold standard” and “suitable and efficient monotherapy of BPH and HTN…”) (3). Especially with a correlation to new opinions of cardiologists on the proper treatment of HTN it seems, that an affection of sympathetic system is one of many possibilities in the treatment of hypertension and neither the first nor the second one. So, if there comes a man with BPH and pharmacologically corrected hypertension, is the administration of alpha-inhibitor with the effect on blood pressure (and subsequent withdrawal of previous antihypertensive therapy) justified therapeutically (and pharmacologically)? Regarding the efficacy of alpha-adrenergic receptors inhibitor, it is doubtless the therapy is effective and mutually comparable. The difference is “only” in the percentage of adverse events. Key words: hypertension, benign prostatic hyperplasia, alpha-blockers.
