Table 7 Recommendations for the use of alpha-1 antagonists in older people with LUTS suggestive of BPH or arterial hypertension
Recommendation | Strength of recommendation | Quality of evidence | Type of evidence |
|---|---|---|---|
Alpha-1 antagonists prove to be effective in the reduction of urinary symptoms (IPSS) in the treatment of bothersome LUTS suggestive of BPH irrespective of the patient’s age. Particularities of different agents’ risk profiles especially regarding hypotension related and sexual adverse events are to be considered on a patient-oriented basis | Strong (Benefits outweigh the undesirable effects and good results on the improvement of QoL) | Low (Downgraded for study limitations in the RCTs and indirectness as only the three RCTs focused on patients ≥ 65 years and two SRs did not define the IPSS as outcome) | • 1 guideline by European Association of Urology [43] • 2 Cochrane reviews [66, 67] 4 systematic reviews (SRs) incl. three meta-analyses [69,70,71,72] 1 network meta-analysis [68] |
It is recommended to replace doxazosin for the treatment of arterial hypertension as it is likely to be less effective than other antihypertensive drugs in reducing combined CVD, and heart failure in particular, unless there is no other suitable option (e.g. resistant hypertension if intolerant to spironolactone) | Strong (High quality evidence on clinically highly relevant outcomes) | High (Low risk of bias) | • 1 guideline by European Society of Cardiology and European Society of Hypertension [42] • 1 randomised controlled trial [47] |