The treatment of benign prostatic hyperplasia with alpha blockers in men over the age of 80 years

OBJECTIVE: To determine the safety and efficacy of alpha blockade with doxazosin and terazosin in men over the age of 80 years with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Thirty-six men (mean age 83.6 years, SD 5.6, range 80-96) received either doxazosin 4 mg (11 men) or 8 mg (10 men), or terazosin 5 mg (five men) or 10 mg (10 men), once daily at night. Twenty-eight men (78%) were on other anti-hypertensive medication; the type and dosage were not changed during the study. Efficacy and safety were assessed using measurements of peak urinary flow rate, symptom scores and the incidence of adverse events. RESULTS: Of the 36 men, 33 (92%) remained on study medication at 6 months; the remaining three (8%) discontinued because of asthenia. After 3 months of treatment, the peak urinary flow rate increased significantly (P < 0.008) for both doxazosin (+3.7 mL/s) and terazosin (+3.2 mL/s). The American Urological Association symptom score improved significantly (P < 0.01) with both alpha blocker after 3 months of treatment and efficacy was maintained at 6 months. There were small, non-significant decreases in blood pressure in patients receiving doxazosin or terazosin, but no differences between patients who were normotensive at baseline and those whose blood pressure was controlled by other anti-hypertensive drugs. CONCLUSION: These results suggest that alpha blockade with either doxazosin or terazosin is well tolerated and effective in older men with symptomatic BPH. Furthermore, patients on concomitant anti-hypertensive medication need no alteration of their therapeutic regimen before the initiation of alpha blockade for BPH.