The epidemiological survey shows that primary hypertension is one of the independent risk factors in the development and the progress of BPH, 25 percent of old male patients aged 60 or more suffer from the two diseases at the same time, which grievously affects their quality of life. There is little literature about the appropriate therapeutic regimen of BPH associated hypertension. The article reviews the progress in the studies of alpha1-adrenoceptor blocker for BPH associated hypertension, and explores the main problems facing us and ventures the prospects for the development in this field.
Adrenergic alpha-1 Receptor Antagonists ; Adrenergic alpha-Antagonists ; adverse effects ; therapeutic use ; Aged ; Aged, 80 and over ; Humans ; Hypertension ; complications ; drug therapy ; Male ; Middle Aged ; Prazosin ; adverse effects ; analogs & derivatives ; therapeutic use ; Prostatic Hyperplasia ; complications ; drug therapy

BACKGROUNDThe primary objectives of the treatment for the lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) are to produce rapid, sustained, and safe improvements in the symptoms that affect the quality of life in the majority of men over 50. In this study, we evaluated the efficacy and safety of the combined therapy with terazosin (apha1-adrenergic receptor antagonist) and tolterodine (anticholinergic agent) for LUTS associated with BPH.

METHODSThis combination study included 69 patients diagnosed with LUTS associated with BPH based on the International Prostate Symptom Scores (IPSS), urinary flow rate, prostate volume, urinary residual, and their serum prostate-specific antigen levels. Initially, 191 patients were treated with terazosin 2 mg once daily for one week. Those patients with continued LUTS after the initial treatment were allocated randomly into two groups: terazosin group (n = 36) in which patients were treated with terazosin 2 mg once daily for six weeks, and combination group (n = 33) in which patients were treated with both terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks.

RESULTSThe IPSS were significantly improved in both groups after treatment, and the reduction of IPSS in the combination group was significantly greater than that in the terazosin group (P < 0.01). A decrease in urgency, frequency and nocturia were the main contributory factors causing the reduction of IPSS in the combination group. The differences about the peak urinary flow rate and the residual urine from the baseline values were noted in both groups after treatment, but were not significant between the two groups. The incidence of adverse effects in the combination group was higher than that in the terazosin group. As expected the most common adverse effect was mouth dryness which was associated with anticholinergic drugs such as tolterodine.

CONCLUSIONSPatients with LUTS associated BPH appear the improved IPSS after combined therapy with terazosin and tolterodine. This study, although short term and limited numbers of patients, provides evidence that the combined therapy with terazosin plus tolterodine is a good approach for meeting the objectives of rapid, sustained, and safe improvements in the LUTS associated with BPH. And the profile of patients in this study might be used as the indication of such combined therapy for LUTS associated with BPH without urodynamic evaluation.

Adrenergic alpha-Antagonists ; administration & dosage ; Aged ; Benzhydryl Compounds ; administration & dosage ; adverse effects ; Cresols ; administration & dosage ; adverse effects ; Drug Therapy, Combination ; Humans ; Male ; Middle Aged ; Muscarinic Antagonists ; administration & dosage ; Phenylpropanolamine ; administration & dosage ; adverse effects ; Prazosin ; administration & dosage ; adverse effects ; analogs & derivatives ; Prospective Studies ; Prostatic Hyperplasia ; complications ; drug therapy ; Tolterodine Tartrate ; Urination Disorders ; drug therapy

PURPOSE: We determined the efficacy and safety of a relatively high dose of terazosin (5mg) in Korean patients with lower urinary tract symptoms (LUTS), with or without concomitant hypertension. MATERIALS AND METHODS: From July to December 2006, 200 men who consecutively presented with LUTS were prospectively studied. Eight weeks after treatment, blood pressure (BP), uroflowmetry, and International Prostate Symptom Score (I-PSS) were assessed. For analysis purposes, patients were stratified according to concomitant hypertension. Of the 200 patients, 173 completed the scheduled eight-week treatment period. RESULTS: At baseline, no differences were evident in the two groups in terms of I-PSS, Qmax, PVR and BP. After eight weeks of treatment-although I-PSS and uroflowmetry parameters were not significantly different in the two groups-systolic and diastolic BP in the non-hypertensive control group were higher than in the hypertensive group (p= 0.001 and p=0.0100, respectively). Changes in I-PSS, uroflowmetry parameters, and BPs measured at week eight post- treatment commencement did not significantly differ between the two groups. Moreover, the addition of 5mg of terazosin to antihypertensives did not cause a significant reduction in either systolic or diastolic BP in either group. CONCLUSION: Adding terazosin to existing antihypertensive regimens did not seem to increase the incidence of adverse events. Our findings suggest that 5mg terazosin is effective and that it has an acceptable safety profile as an add-on therapy for patients with LUTS and concomitant hypertension.
Adrenergic alpha-Antagonists/adverse effects/therapeutic use ; Aged ; Asian Continental Ancestry Group ; Blood Pressure/drug effects ; Humans ; Hypertension/complications/*drug therapy/physiopathology ; Korea ; Male ; Middle Aged ; Prazosin/adverse effects/*analogs & derivatives/therapeutic use ; Prospective Studies ; Prostate/drug effects/pathology ; Treatment Outcome ; Urodynamics/drug effects ; Urologic Diseases/complications/*drug therapy/ethnology

OBJECTIVESTo evaluate a new effective treatment for prostatodynia (PD) and chronic non-bacterial prostatitis (CNP).

METHODSOne hundred and thirty-six patients suffered from PD or CNP were divided randomly into experiment group (n = 76), which were treated with external RF hyperthermia (ERFH) combining with alpha 1-adrenergic receptor blocker Terazosin for 12 weeks, and control group (n = 60), which were only treated with ERFH. Symptoms scores, urodynamic indexes and expressed prostate secretion were recorded pre- and post-treatments.

RESULTSMFR and AFR were significantly improved and symptoms scores significantly decreased in both groups (P < 0.05). The efficacy was better in experiment group than that in control group. The combination treatment also led to a significantly decrease in MUP and MUCP (P < 0.05). Additionally, the leucocytes in expressed prostate secretion were also reduced in experiment group (P < 0.05).

CONCLUSIONSTreatment of ERFH combining with alpha 1-adrenergic receptor blocker for patients with PD or CNP was effective and had little side-effect, while the future curative effect should be observed furtherly.

Adrenergic alpha-1 Receptor Antagonists ; Adrenergic alpha-Antagonists ; adverse effects ; therapeutic use ; Adult ; Chronic Disease ; Combined Modality Therapy ; Humans ; Hyperthermia, Induced ; Male ; Middle Aged ; Pain ; drug therapy ; etiology ; Pain Management ; Prazosin ; adverse effects ; analogs & derivatives ; therapeutic use ; Prostatitis ; complications ; drug therapy ; therapy