The treatment of
hypertension in patients with diabetes, obstructive airway disease, impaired renal function, or
congestive heart failure (CHF) is discussed. Specifically, the value of alpha 1-adrenoceptor blocking agents in such patients is reviewed. An individualized approach to
therapy is required, with careful consideration of the effects of different drugs on the existing metabolic and hemodynamic situation. In diabetic individuals, commonly used step-1 agents may impair
glucose tolerance; beta-
adrenergic blockade may increase
blood glucose levels and significantly change response to
insulin-induced
hypoglycemia. Diabetic patients may also be especially sensitive to side effects of some centrally acting
antihypertensive agents. In patients with obstructive airway disease, beta-blockade and alpha-stimulation worsen
bronchospasm; although beta-stimulants produce bronchodilatation, they often are contraindicated in hypertensive patients due to their stimulatory effects on the heart. In patients with impaired renal function,
therapy for
hypertension may include problems such as an increased half-life of
antihypertensive agents and retention of active metabolites. In patients with CHF, if blood pressure is not normalized with
diuretics, more aggressive
therapy may be required. According to results of several studies discussed, the alpha 1-adrenoceptor blocking-agent
prazosin appears to be a safe and effective
therapy, causing a minimum of side effects, for treatment of
hypertension in patients with these conditions.