title: Doxazosin to treat hypertension: it's time to take it personally--a retrospective analysis of 19, 495 patients.
abstract: OBJECTIVE
  The aim of the current study was to evaluate the effect of α blockers on the cardiac outcomes of hypertensive patients who underwent myocardial perfusion imaging (MPI).
  
  
  METHODS
  A retrospective analysis of the nuclear cardiology laboratory database was performed. The study group included only hypertensive patients (n = 19 ,495). The cohort was divided into three groups - a reference group of no α-blocker therapy (n = 17 ,053), α blockers for benign prostatic hypertrophy (BPH) (n = 1164), and doxazosin for hypertension (HTN) (n = 1258). We used Cox proportional regression models to examine the patient cardiac outcomes (composite of cardiovascular mortality and myocardial infarction) adjusted for the myocardial perfusion study results. The mean age was 65 ± 11.1 years, 55% were men, and the average follow-up was 79.2 ± 37.3 months.
  
  
  RESULTS
  In univariate analysis, the doxazosin for HTN group had the highest rate of adverse cardiac events in comparison to the BPH and reference groups (14.1 vs. 11.3% and 8.9%, respectively, P < 0.001). After stratifying for the degree of reversibility of perfusion defect, only individuals with a moderate-to-severe perfusion defect in the doxazosin for HTN group had a significant increase in adverse cardiac events [hazard ratio 1.50 95% confidence interval (1.14-1.98)].
  
  
  CONCLUSIONS
  Our data show that doxazosin treatment for HTN is associated with adverse cardiac outcome only among patients with moderate-to-severe ischemia on myocardial perfusion imaging. Doxazosin and other α blockers appear to be safe in the vast majority of patients with a lesser degree of ischemia.
authors: aHypertension Unit bClinical Research Center cCardiology Department, Soroka University Medical Center dFaculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Talya
authors: T
authors: Wolak
authors: Ronen
authors: R
authors: Toledano
authors: Victor
authors: V
authors: Novack
authors: Amir
authors: A
authors: Sharon
authors: Aryeh
authors: A
authors: Shalev
authors: Arik
authors: A
authors: Wolak
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D017292:Doxazosin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000959:Antihypertensive Agents; D017292:Doxazosin