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Prazosin: Preliminary Report and Comparative Studies with Other 298 BRITISH MEDICAL JOURNAL 1 1 MAY 1974 Prazosin: Preliminary Report and Comparative Studies with Other Antihypertensive Agents Br Med J: first published as 10.1136/bmj.2.5914.298 on 11 May 1974. Downloaded from GORDON S. STOKES, MICHAEL A. WEBER British Medical Journal, 1974, 2, 298-300 bilirubin. One patient had minimal grade 3 hypertensive ocu- lar fundus changes, 10 had grade 1 or 2 changes, and four had normal fundi. Serum crea-tinine concentration was normal in Summary every patient. A diagnosis of uncomplicated essential hypertension was In a group of 14 hypertensive patients a 10-week course made in 12 patients. In two other patients pyelographic of treatment with prazosin 3-7 5 mg/day produced a signifi- evidence of analgesic nephropathy was found. The remaining cant reduction in mean blood pressure without serious side patient had essential hypertension and stable angina pectoris. effects. The fall in diastolic pressure exceeded the response After at least two baseline blood pressure readings, taken mm more to a placebo by 10 Hg or in 9 patients. The average when patients were recumbent and standing, treatment was decrease in diastolic pressure was similar to that produced started with prazosin, 1-mg capsules by mouth, three times or by methyldopa 750 mg/day propranolol 120-160 mg/day daily. Thereafter the patient visited the clinic at intervals of was but the fall in systolic pressure comparatively smaller, one to three weeks. At each visit blood pressure was meas- that the consistent with reported experimental work showing ured to the nearest 5 mm Hg with an Accoson sphygmomo- drug causes vasodilatation. The hypotensive effect of meter with a 14-5 cm cuff. Side effects were assessed by means was prazosin 1-5-3 mg/day combined with propranolol of a standard questionnaire, which was filled in by the doctor significantly greater than that of propranolol alone and after discussion with the patient. resulted in good control of blood pressure. If, after 4 weeks of treatment, the diastolic blood pres- sure exceeded 95 mm Hg, the dose of prazosin was increased to 2 5 mg three times daily. If the diastolic blood pressure Introduction remained above 95 mm Hg after seven weeks of treatment or if, at any stage, there was evidence of weight gain or ankle a new to have a Prazosin is antihypertensive drug thought oedema a diuretic, cyclopenthiazide 0 5mg/day, was added to peripheral action involving direot relaxation of vascular smooth the treatment. After 10 weeks counterfeit placebo capsules Its chemical muscle and sympathetic blockade (Pfizer, 1970). were substituted for prazosin and were given for two to eight to of other used structure is unrelated that any drug currently weeks (mean 4-3 weeks) depending upon -the blood pressure for the itreatment of hypertension (fig. 1). response. Next came periods of treatment with methyldopa of Our aim was Ito conduct a short-'term clinical trial prazo- 750 mg/day for up to 12 weeks and propranolol 120-160 mg/ and to its sin (Minipress) compare antihypertensive efficacy day for six weeks. Finally, the propranolol was given with http://www.bmj.com/ with that of methyldopa and propranolol. prazosin 1-5-3 mg/day for six weeks and without prazosin for a further six weeks. The first four patients in the trial were admitted for close observation and metabolic studies before prazosin therapy and during its introduction. For one week before admission CH30 N N-C they received a diet containing sodium 100 mEq/day and this 0 was continued in ithe metabolic ward. Plasma renin activity CH30 was determined using the method of Haber et al. (1969). on 30 September 2021 by guest. Protected copyright. MH2 [.HCIJ FIG. 1-Chemical structure of prazosin hydrochloride. Results Patients and Methods EFFECT OF PRAZOSIN ON BLOOD PRESSURE A 10-week tial of prazosin 3-7 5 mg/day was completed in all The informed consent of 15 hypertensive patients, seven men 15 patients. One patient, whose blood pressure fell to normal and eight women aged 24-51 years and weighing 54-93 kg with .prazosin, reacted equally well to placebo alone and was (mean 73 kg) was obtained for their participation in this trial. excluded from analysis. The results in the other patients were Twelve patients had had no previous treatment. Three had defined as "satisfactory" if standing diastolic blood pressure had previous -treatment with a thiazide diuretic, which was was reduced by 10 mm Hg or more in excess of the effect conitinued ithroughout the trial. In all patients a detailed clini- produced by placebo or placebo plus diuretic. Such a result cal assessment was made, including a full history, physical ex- was achieved in nine patients while in five little or no excess amination, chest x-ray exation, electrocardiography, intra- effect was observed (table I). Overall the fall in blood pressure, venous pyelography, microscopical examination of urine, full both recumbent and standing, during treatment with prazosin blood count, and measurement of serum eleotrolytes, was statistically significant and significantly greater than the uric alkaline and creatmiine, acid, transaninases, phosphatase, placebo effect (table II). The response was about 50% greater in the erect than in the recumben,t posture. The time taken for the optimal effect to develop was found Cardio-Renal Unit, Medical Research Department and Cardio- to be between two weeks and nine weeks, usually about four. vascular Clinic, Sydney Hospital, Sydney, Australia Increasing the dosage of prazosin from 3 mg to 7-5 mg per day G. S. STOKES, M.D., M.R.A.C.P., Staff Physician caused no appreciable improvement in blood pressure con-trol M. A. WEBER, M.B., B.S., Research Fellow in five patien-ts cases 7, 8, 10, 12, 13, table I). In the four other BRITISH MEDICAL JOURNAL 1 mAY 1974 TABLE i-Serial Changes in Standing Blood Pressure (mm Hg) During in seven, dry mouthi in five, headaches in four, nausea in three, Treatmenst with Prazosin ankle swelling or weight increase in -three, diarrhoea in -two, nasal Br Med J: first published as 10.1136/bmj.2.5914.298 on 11 May 1974. Downloaded from Weeks of Treatment stuffiness in two, cheist pain in two, irritability in two, Base- and depression in one. Though they were included in the Case No. Prnes- 5-7 8-10 Placebo Result questionnaire the following symptoms were not found: hot sure 3 mg/Day 7-5 mg/Day or cold sweats, change in urine volume, palpi-tations, impo- {160 150 130 120 155 tence. The side effects weire in general evanescent and patients - 1 -- - - ~~~~~~~~~~~S 110 95 98 78 100 mentioned them only on specific questioning. TIhey dlid not 175 125 115 125 145 cause suspension of the treatment in any case and led to a 2 - - - -- S reduction of dosage in three pa-tients only, all of whom were 120 83 80 85 105 160* 140* 123* 128* 175* receiving -propranolol at the same time (see -below). In 10 3 - - -- S patients the blood count and serum levels of electroly-tes, 15 103 83 88 125 {165 127 152* 145* 160* creatinine, uric acid, transaminases, alkaline phosphatase, and 4 - - - -- S bilirubin determnined after four -to 10 weeks of treatment 125 90 103 105 120 no {160 150 140* 120* 130* showed significant changes from, their baseline values. 5 - - - -- S 112 108 100 90 105 {158 148 140 130 140 6 - - -- - S 110 105 100 95 108 COMPARISON WITH METHYLDOPA AND PROPRANOLOL {177* 158* 160* 152* 185* 7 -- S We found prazosin, methyldopa, and propranolol equalIly effec- 117 100 103 100 120 tive in reducing diastolic pressure (table III). The average fall r 150 137 150* 148* 150* in systolic pressure produced by prazosin, however, was less 110 95 100 103 105 than that -produced by methyldopa or propranolol., particularly {170 160 145 135 170 in the recumbent To determine -for each -th-e num- 9 - -- - - S posture. drug 120 110 105 95 110 ber of patients who responded -satisfactorily t-he blood pressure 170* 165* 155* 151* 160* in the recumbent and erect were - readings -- - postures 10 - F averaged', 1.118 100 95 101 110 and those whose mean blood pressure (diastolic pressure plus {210 177* 170* 160* 188* one thiird of pulse pressure) was reduced to less than 110 mm 11 - -- - - S 145 108 105 100 128 Hg or fell by more than 15 mm Hg from the placebo level f160 150 148 140* 145* were classified as responders. By these cri-teria two patients 12 - -- - - F 114 93 98 100 108 (cases 12 and 13) failed to respond to any of -the drugs used, f160 140 142 140* 145* and three did not respond to -prazosin but responded to 13 -- - - F 122 95 98 110 106 methyldopa and propranolol. Of -the nine prazosin-responders f190 167 177 140* 130* one (case 9) did not respond either to methyldopa or to pro- 14 - -- - - F 1.105 92 93 89 90 pranolol. Only five patients responded -to all -three drugs and i-n 'two of these methyldopa had to be withdrawn within *Cyclopenthiazide 0-5 mg/day given as adjunct. one week because of severe side effects (diarrhoea in one S = Satisfactory. F = Failed. patient, lassitude in the ot-her). http://www.bmj.com/ TABLE II-Statistical Significance of Effects of Prazosin on Blood Pressure TABLE ii-Comnparison of Effects of Treatment with Prazosin, Methyldopa, and Propranolol on Blood Pressure Difference* Difference* between Base- between Place- Posture line and P bo and P Mean Blood Pressuret Treatment Treatment Dose Duration of (mm Hg) No.
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