Efficacy of urapidil in the management of essential hypertension. A comparison with captopril

Alpha-1 blockers. A new generation of antihypertensive agents

Alpha-1 blockers have certain disadvantages over conventional and antihypertensive therapies in their haemodynamic profile and metabolic effects. This paper reviews the development of alpha-blockade, the therapeutic efficacy of prazosin, the prototype alpha-1 blocker, and the rationale for the once-daily antihypertensive compounds, terazosin and doxazosin. These drugs offer a useful alternative to first- or second-line therapy in suitable hypertensive patients, particularly with their potentially beneficial effects on serum lipids.

Urapidil in the treatment of hypertension

Urapidil is an alpha 1-adrenoceptor antagonist which also has a central antihypertensive effect, the mechanism of which has yet to be conclusively defined. A number of open and comparative studies have produced evidence for the efficacy and safety of urapidil. A study recently completed by the author produced a dose-dependent antihypertensive effect of urapidil which, however, failed to achieve statistical significance, probably due to a large variance of the data and an unexpectedly large placebo effect. Adverse reactions are those expected from an alpha 1-blocker, particularly dizziness, as well as nausea and fatigue. Urapidil is potentially an important new antihypertensive agent; further variable dose and combination (with other antihypertensive agents) studies would help further define its therapeutic niche.