Role of the newer alpha1-adrenergic-receptor antagonists in the treatment of benign prostatic hyperplasia-related lower urinary tract symptoms

Background: Although initially introduced for the management of hypertension, alpha(1)-adrenergic-receptor antagonists (alpha(1)-blockers) have become the standard of care for the medical management of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). However, these agents have the potential to produce orthostatic hypotension and other blood pressure-related adverse effects in normotensive patients and in those receiving concurrent treatment with other antihypertensive agents. As a result, more uroselective, less vasoactive alpha(1)-blockers have been developed. Objective: This article reviews current information on the role of alpha(1)-blockers in the treatment of BPH-related LUTS. The focus is on tamsulosin and alfuzosin, newer uroselective agents in this class that have a decreased potential for cardiovascular adverse effects. Methods: Relevant articles were identified through a search of the English-language literature indexed on MEDLINE and the proceedings of scientific meetings from 1976 to 2003. The search terms were benign prostatic hyperplasia treatment, alpha(1)-adrenergic-receptor blocker, uroselectivity, lower urinary tract symptoms, complications, and cardiovascular. Results: Tamsulosin has selectivity for the alpha(1a) and alpha(1d) receptor subtypes. Alfuzosin, although not receptor-subtype selective, is clinically uroselective and does not significantly affect vascular alpha-adrenergic receptors. Both agents are efficacious in relieving LUTS and have a decreased potential for such cardiovascular adverse effects as postural hypotension. Common adverse events with these agents include dizziness and asthenia. Conclusion: Based on the available data, uroselective alpha(1)-blockers should be considered over older, more vasoactive agents for the medical management of LUTS, particularly in patients with BPH and hypertension. Copyright (C) 2004 Excerpta Medica, Inc.