## Drug of Choice for BPH with Hypertension **Key Point:** Doxazosin is the preferred alpha blocker for patients with concurrent BPH and hypertension because it provides dual benefit: relief of lower urinary tract symptoms (LUTS) AND blood pressure reduction. ### Why Doxazosin? 1. **Selectivity & Dual Action** - Doxazosin is a long-acting, selective α₁-adrenergic antagonist - Blocks α₁A receptors in the prostate smooth muscle → urinary symptom relief - Also blocks α₁B receptors in vascular smooth muscle → antihypertensive effect 2. **Pharmacokinetic Advantage** - Long half-life (~22 hours) allows once-daily dosing - Better compliance and sustained effect - Extended-release formulation available 3. **Clinical Efficacy** - Improves peak urinary flow rate by 20–30% - Reduces nocturia significantly - Lowers systolic/diastolic BP by 5–10 mmHg ### Comparison with Other Alpha Blockers | Drug | Selectivity | LUTS Relief | BP Reduction | Dosing | Use in BPH+HTN | | --- | --- | --- | --- | --- | --- | | **Doxazosin** | α₁A & α₁B | ✓✓ | ✓✓ | Once daily | **DOC** | | Prazosin | Non-selective α₁ | ✓ | ✓✓ | TID–QID | Outdated; poor compliance | | Terazosin | α₁A & α₁B | ✓✓ | ✓ | Once daily | Alternative (less data) | | Tamsulosin | Uroselective α₁A | ✓✓ | ✗ | Once daily | BPH only; no HTN benefit | **High-Yield:** In a patient with BOTH BPH and hypertension, doxazosin or terazosin are superior to tamsulosin (which is uroselective and does not lower BP). ### Clinical Pearl Doxazosin should be started at a low dose (1 mg at bedtime) and titrated slowly to minimize first-dose syncope and orthostatic hypotension, especially in elderly patients. **Mnemonic:** **DOXAZOSIN = Dual-action (LUTS + BP)** [cite:KD Tripathi 8e Ch 12]
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