Our recent physiology TBL
topic included several categories of drugs that help to lower blood pressure,
but some of those medications may be doing more harm than good.
An article published in March 2018 described
a study by researcher Dr. Brian
Clements and his team in Utah that looked at individuals with hypertension who
used alpha blockers and alpha-2 agonists and found that these medications could
have an increase in mortality risk due to the medications causing blood
pressures to vary a lot. Alpha blockers (such as doxazosin/Cardura) work by dilating
blood vessels, and alpha-2 agonists (such as methyldopa and clonidine) target
the SNS and reduce blood vessel constriction. The two types of medication end
up causing higher variability of systolic blood pressure (more variability of pressure on the arteries), resulting in a 15%
increase in mortality.
The researchers took over
10,000 adults with high blood pressure and monitored the variability for 4 years and found that
there are other medications that might be a safer option. Medications such as ACE
inhibitors, calcium channel blockers, diuretics, and angiotensin receptor
blockers do not cause the great amount of systolic variability that the alpha
blockers and alpha-2 agonists cause.
Therefore, those who have a family history of high blood pressure, or know someone with hypertension who is on medication, should maybe check in to see which medications they are taking, because it may be causing more problems than providing a solution. This leads to a major ethical dilemma where providers may not take into account the dangers of the prescriptions. Also, the ideas of malfeasance and beneficence come into play as the alpha blockers and alpha-2-agonists may help reduce blood pressure for a time, but then end up increasing the risk of death for patients. Providers need to make sure they are taking into account the risks of the medications, and make sure that the benefits outweigh the risk, or many lawsuits may surface in the future.
Therefore, those who have a family history of high blood pressure, or know someone with hypertension who is on medication, should maybe check in to see which medications they are taking, because it may be causing more problems than providing a solution. This leads to a major ethical dilemma where providers may not take into account the dangers of the prescriptions. Also, the ideas of malfeasance and beneficence come into play as the alpha blockers and alpha-2-agonists may help reduce blood pressure for a time, but then end up increasing the risk of death for patients. Providers need to make sure they are taking into account the risks of the medications, and make sure that the benefits outweigh the risk, or many lawsuits may surface in the future.
Cassidy,
ReplyDeleteGreat post considering we just learned this material. I know that we discussed that the drugs being provided to patients are based on doctor preference for their patient. I wonder if this preference impacts the outcome. But I agree with you that this study has brought the patient to be more involved in their health care choices.
Interesting! I was doing some reading, and something that wouldn't have come up in class is that based on their actions dilating small blood vessels as well as relaxing certain muscles, another common clinical use for alpha-blockers is as treatment for lower urinary tract symptoms in men specifically caused by benign prostatic hyperplasia (BPH). BPH is essentially an enlarged prostate, and affected men primarily experience voiding symptoms, including nocturia, acute urinary retention, incomplete emptying, urinary hesitancy, weak stream, frequency, and urgency.
ReplyDeleteMen who present with BPH are most often started on alpha-blockers, which function to relax the smooth muscle at the bladder neck and prostate as well as improve symptoms. Of the 5 alpha-blockers that are approved for use for a BPH diagnosis in the U.S., the example you mentioned, dosazosin, is one of them. Doxazosin does have to be titrated, and does have some cardiovascular side affects like hypotension and dizziness. This would make it more dangerous for older populations who would have more issues with the CV side effects. I imagine some of the risks with increased mortality might apply to patients who are taking an alpha-blocker like doxazosin for BPH as well, but I didn't find any information on it.
Dahm, P., Brasure, M., & MacDonald, R. (2017). Comparative Effectiveness of Newer Medications for Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis. European Urology, 71(4), 570.
McVary, K., Roehrborn, C., & Avins, A. (2011). Update on AUA guideline on the management of benign prostatic hyperplasia. Journal of Urology, 185(5), 1793.