The alpha-blockers doxazosin, indoramin, prazosin and terazosin are used to treat resistant hypertension. These four agents, along with alfuzosin and tamsulosin, may also be used to treat benign prostatic hyperplasia (BPH).

Dosage regimen

* Should be introduced cautiously as they can cause first-dose hypotension, so the first dose is often recommended to be taken at bedtime. Dose regimens vary according to the agent being used.

* Patients with BPH and already on antihypertensive therapy may need reduced dosage and specialist supervision.

Patient's knowledge of the medicine's use

* Ensure the patient knows why he or she is taking their medication. Hypertension is usually asymptomatic so compliance can be an issue, particularly if side effects are present.

Is the medicine working?

* Has the patient been taking the correct dosage of their medication?

* Has the patients symptoms/condition deteriorated? If so, refer back to the prescriber.

* Is the patient taking any OTC/herbal remedies, which may interact with their medication?

Side effects

* Common side effects include first dose hypotension, drowsiness, dizziness and oedema.

Monitoring

* Blood pressure must be monitored because of the high risk of postural hypotension.

Lifestyle

* If the patient is on an alpha-blocker for hypertension, offer advice on weight loss, exercise (if approved by GP), healthy diet (including salt and fat reduction), and smoking cessation if needed.

* Advise hypertensive patients that they may be eligible for a one-off pneumococcal vaccination and a yearly flu vaccination.

* Patients with BPH should be advised on a number of measure they can take to improve symptoms, including avoiding alcoholic and caffeinated drinks, avoiding drinks late in the evening, and avoiding constipation to reduce pressure on the bladder.

AF

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