Clinical Briefs

By Louis Kuritzky, MD

Doxazosin Added to Single-Drug Therapy in Hypertensive Patients with Benign Prostatic Hypertrophy

In middle age and beyond, both hypertension and benign prostatic hyperplasia (BPH) become increasingly common. Treatment of normotensive BPH patients can usually be accomplished using alpha-blockers without problematic episodes of hypotension. For hypertensive BPH patients, there has been some concern that addition of doxazosin to the antihypertensive regimen might produce hypotension or other untoward effects. This study evaluated the effect of 2-4 mg QD doxazosin added to the regimen of patients who had a achieved a diastolic blood pressure < 95 on nonalpha blocker monotherapy.

Patients (n = 2363, Spanish men > age 40) were followed for 14 weeks, and evaluated by a quality-of-life scale, prostatism symptom scale, blood pressure measurement, and recording of adverse events.

Doxazosin treatment resulted in a mean blood pressure reduction of 10.7/6.1 over baseline treatment with an ACE inhibitor, calcium channel blocker, or diuretic. Favorable effects for prostatism scores were consistently seen. Symptoms of dizziness, vertigo, hypotension, or syncope were seen uncommonly (2.7%, 0.4%, 0.8%, 0.3%, respectively). Martell and Luque conclude that addition of an alpha-blocker to the treatment regimen of hypertensive BPH patients is generally effective and well tolerated.

Martell N, Luque M. J Clin Hypertens. 2001;3:218-223.

One-Time Screening for Colorectal Cancer with Combined FOBT and Examination of the Distal Colon

Fecal occult-blood testing (FOBT) and sigmoidoscopy (SIGM), alone or in combination, have been shown to reduce colorectal cancer (CCA) mortality. Some evidence suggests that the combination may be superior. The current trial reports results from a study of the combination of one-time FOBT and colonoscopy (COL) in asymptomatic subjects (n = 2885, all male), in comparison with one-time FOBT and SIGM. All subjects underwent only COL; SIG was "defined" as the experience gained during COL that evaluated the rectum and sigmoid colon, but not beyond.

Advanced neoplasia (an adenoma > 10 mm diameter, with at least 25% villous involvement, high-grade dysplasia, or actual carcinoma) was found in almost one-fourth of persons with positive FOBT. Alone, SIGM detected 70% of neoplasia cases, enhanced by adding FOBT to 76%.

Though these results are encouraging, it is disheartening to think that as many as one-fourth of advanced neoplasia may be missed by the FOBT+SIGM combination. Since the level of penetration clinically attained in SIGM may be substantially less than described in this study, the actual sensitivity of SIGM may be even less than suggested by this trial. Whether COL should become the screening tool of choice remains a matter of some debate.

Lieberman DA, Weiss DG. N Engl J Med. 2001;345:555-560.

Bone Mineral Density Response to Estrogen Replacement in Frail Elderly Women

The role of estrogen and progesterone replacement (HRT) for osteoporosis (OSPS) prevention is well established. Most data have accrued from relatively younger women, (ie, < 75 years old). Whether HRT provides equally beneficial OSPS effects for more senior women has not been well documented, since most data in older women is from observational studies.

In this placebo-controlled trial, Villareal and associates randomized 67 women who were considered especially high risk because of their relative frailty, to combination therapy with conjugated estrogens (0.625 mg QD) plus medroxyprogesterone acetate (5 mg QD for 13 consecutive days every third month) for 9 months. Bone mineral density (BMD) was measured at the lumbar spine and femur. Bone turnover markers were also measured. More than 90% of the women were osteopenic or osteoporotic at baseline.

BMD at the lumbar spine, and femoral neck, were statistically significantly improved in women who received HRT (eg, at the femoral neck) BMD increased 2.5%, as compared with a decrease in BMD in the placebo group. Bone turnover markers were similarly favorably affected. These data encouragingly support the concept that age should not be a barrier for consideration of HRT in at-risk menopausal women.

Villareal DT, et al. JAMA. 2001;286: 815-820.

Dr. Kuritzky, Clinical Assistant Professor, University of Florida, Gainesville, is Associate Editor of Internal Medicine Alert.