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PRISMA flow diagram
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Figure 1

PRISMA flow diagram

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Comparison 1 Doxazosin vs Placebo, Outcome 1 Change in trough SBP.
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Analysis 1.1

Comparison 1 Doxazosin vs Placebo, Outcome 1 Change in trough SBP.

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Comparison 1 Doxazosin vs Placebo, Outcome 2 Change in trough DBP.
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Analysis 1.2

Comparison 1 Doxazosin vs Placebo, Outcome 2 Change in trough DBP.

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Comparison 1 Doxazosin vs Placebo, Outcome 3 Change in peak SBP.
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Analysis 1.3

Comparison 1 Doxazosin vs Placebo, Outcome 3 Change in peak SBP.

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Comparison 1 Doxazosin vs Placebo, Outcome 4 Change in peak DBP.
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Analysis 1.4

Comparison 1 Doxazosin vs Placebo, Outcome 4 Change in peak DBP.

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Comparison 1 Doxazosin vs Placebo, Outcome 5 Change in trough heart rate.
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Analysis 1.5

Comparison 1 Doxazosin vs Placebo, Outcome 5 Change in trough heart rate.

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Comparison 1 Doxazosin vs Placebo, Outcome 6 Change in peak heart rate.
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Analysis 1.6

Comparison 1 Doxazosin vs Placebo, Outcome 6 Change in peak heart rate.

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Comparison 1 Doxazosin vs Placebo, Outcome 7 Total withdrawals due to adverse effects.
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Analysis 1.7

Comparison 1 Doxazosin vs Placebo, Outcome 7 Total withdrawals due to adverse effects.

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Comparison 2 Prazosin vs Placebo, Outcome 1 Change in trough SBP.
Figuras y tablas -
Analysis 2.1

Comparison 2 Prazosin vs Placebo, Outcome 1 Change in trough SBP.

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Comparison 2 Prazosin vs Placebo, Outcome 2 Change in trough DBP.
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Analysis 2.2

Comparison 2 Prazosin vs Placebo, Outcome 2 Change in trough DBP.

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Comparison 2 Prazosin vs Placebo, Outcome 3 Change in trough heart rate.
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Analysis 2.3

Comparison 2 Prazosin vs Placebo, Outcome 3 Change in trough heart rate.

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Comparison 2 Prazosin vs Placebo, Outcome 4 Total withdrawals due to adverse effects.
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Analysis 2.4

Comparison 2 Prazosin vs Placebo, Outcome 4 Total withdrawals due to adverse effects.

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Comparison 3 Terazosin vs Placebo, Outcome 1 Change in trough SBP.
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Analysis 3.1

Comparison 3 Terazosin vs Placebo, Outcome 1 Change in trough SBP.

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Comparison 3 Terazosin vs Placebo, Outcome 2 Change in trough DBP.
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Analysis 3.2

Comparison 3 Terazosin vs Placebo, Outcome 2 Change in trough DBP.

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Table 1. Overview of the 10 studies investigating alpha blockers as monotherapy

Alpha blocker

Dose range (mg/day)

Number of studies

Alpha patients (n)

Placebo patients (n)

Mean duration (weeks)

Mean age (years)

Baseline BP (mm Hg)

Bunazosin

3‐12

1

12

4

8.0

Not reported

163.3/102.8

Doxazosin

2‐12

3

347

125

7.1

58.1

157.8/101.4

Prazosin

2.5‐20

2

108

32

4.2

55.1

151.9/99.9

Terazosin

5‐20

4

203

159

4.0

Not reported

155.4/101.4
Figuras y tablas -
Table 1. Overview of the 10 studies investigating alpha blockers as monotherapy
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Table 2. Summary of the blood pressure lowering efficacy of alpha blockers

Alpha blocker

Lowest effective dose (mg/day)

Lowest dose with near maximal BP lowering (mg/day)

Near maximal trough SBP lowering

Near maximal trough DBP lowering

Trough SBP lowering (mm Hg), 95% CI

Trough DBP lowering (mm Hg), 95% CI

Bunazosin

Not estimable

Not estimable

Not estimable

Not estimable

Not estimable

Not estimable

Doxazosin

4

Not estimable

Not estimable

Not estimable

‐6.42 (‐10.12, ‐2.80)

‐3.53 (‐4.99, ‐2.07)

Prazosin

10

Not estimable

Not estimable

Not estimable

‐10.38 (‐16.21, ‐4.56)

‐6.90 (‐9.79, ‐4.01)

Terazosin

5

Not estimable

Not estimable

Not estimable

‐6.59 (‐10.22, ‐2.96)

‐4.40 (‐5.95, ‐2.84)
Figuras y tablas -
Table 2. Summary of the blood pressure lowering efficacy of alpha blockers
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Comparison 1. Doxazosin vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in trough SBP Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 2 mg

2

93

Mean Difference (IV, Fixed, 95% CI)

‐5.03 [‐10.71, 0.64]

1.2 4 mg

2

91

Mean Difference (IV, Fixed, 95% CI)

‐5.84 [‐11.44, ‐0.23]

1.3 8 mg

2

91

Mean Difference (IV, Fixed, 95% CI)

‐7.24 [‐12.93, ‐1.56]

1.4 12 mg

1

55

Mean Difference (IV, Fixed, 95% CI)

‐6.1 [‐15.27, 3.07]

2 Change in trough DBP Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 2 mg

2

93

Mean Difference (IV, Fixed, 95% CI)

‐3.01 [‐6.43, 0.42]

2.2 4 mg

3

326

Mean Difference (IV, Fixed, 95% CI)

‐3.36 [‐5.06, ‐1.66]

2.3 8 mg

2

90

Mean Difference (IV, Fixed, 95% CI)

‐4.13 [‐7.61, ‐0.65]

2.4 12 mg

1

56

Mean Difference (IV, Fixed, 95% CI)

‐3.8 [‐8.64, 1.04]

3 Change in peak SBP Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 2 mg

1

44

Mean Difference (IV, Fixed, 95% CI)

‐6.8 [‐13.96, 0.36]

3.2 4 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

‐6.0 [‐13.08, 1.08]

3.3 8 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

‐12.90 [‐20.34, ‐5.46]

4 Change in peak DBP Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 2 mg

1

44

Mean Difference (IV, Fixed, 95% CI)

‐4.30 [‐8.92, 0.32]

4.2 4 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

‐4.4 [‐9.02, 0.22]

4.3 8 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

‐8.5 [‐13.32, ‐3.68]

5 Change in trough heart rate Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 2 mg

1

44

Mean Difference (IV, Fixed, 95% CI)

‐1.90 [‐6.62, 2.82]

5.2 4 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

‐1.5 [‐6.22, 3.22]

5.3 8 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐4.67, 6.67]

6 Change in peak heart rate Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 2 mg

1

44

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐4.82, 4.62]

6.2 4 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

1.30 [‐3.42, 6.02]

6.3 8 mg

1

35

Mean Difference (IV, Fixed, 95% CI)

3.2 [‐2.47, 8.87]

7 Total withdrawals due to adverse effects Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 2‐8 mg

1

135

Risk Ratio (M‐H, Fixed, 95% CI)

1.94 [0.24, 15.54]

7.2 2‐12 mg

1

248

Risk Ratio (M‐H, Fixed, 95% CI)

2.71 [0.66, 11.13]
Figuras y tablas -
Comparison 1. Doxazosin vs Placebo
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Comparison 2. Prazosin vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in trough SBP Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 2.5 mg GITS

1

65

Mean Difference (IV, Fixed, 95% CI)

‐3.60 [‐11.86, 4.66]

1.2 3 mg

1

28

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐13.88, 7.88]

1.3 10 mg GITS

1

72

Mean Difference (IV, Fixed, 95% CI)

‐9.20 [‐17.23, ‐1.17]

1.4 20 mg GITS

1

68

Mean Difference (IV, Fixed, 95% CI)

‐11.7 [‐20.17, ‐3.23]

2 Change in trough DBP Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 2.5 mg GITS

1

65

Mean Difference (IV, Fixed, 95% CI)

‐2.4 [‐6.54, 1.74]

2.2 3 mg

1

28

Mean Difference (IV, Fixed, 95% CI)

‐4.0 [‐8.00, 2.00]

2.3 10 mg GITS

1

72

Mean Difference (IV, Fixed, 95% CI)

‐6.80 [‐10.87, ‐2.73]

2.4 20 mg GITS

1

68

Mean Difference (IV, Fixed, 95% CI)

‐7.0 [‐11.11, ‐2.89]

3 Change in trough heart rate Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 2.5 mg GITS

1

65

Mean Difference (IV, Fixed, 95% CI)

2.1 [‐2.53, 6.73]

3.2 10 mg GITS

1

72

Mean Difference (IV, Fixed, 95% CI)

1.80 [‐2.79, 6.39]

3.3 20 mg GITS

1

68

Mean Difference (IV, Fixed, 95% CI)

2.9 [‐1.69, 7.49]

4 Total withdrawals due to adverse effects Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 2.5‐20 mg GITS

1

220

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.21, 2.43]
Figuras y tablas -
Comparison 2. Prazosin vs Placebo
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Comparison 3. Terazosin vs Placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Change in trough SBP Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 5 mg

1

79

Mean Difference (IV, Fixed, 95% CI)

‐6.9 [‐12.20, ‐1.60]

1.2 10 mg

1

93

Mean Difference (IV, Fixed, 95% CI)

‐6.10 [‐12.08, ‐0.12]

1.3 20 mg

1

64

Mean Difference (IV, Fixed, 95% CI)

‐6.80 [‐15.73, 2.13]

2 Change in trough DBP Show forest plot

4

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 5 mg

2

205

Mean Difference (IV, Fixed, 95% CI)

‐4.92 [‐6.87, ‐2.97]

2.2 10 mg

1

93

Mean Difference (IV, Fixed, 95% CI)

‐3.2 [‐6.54, 0.14]

2.3 20 mg

1

64

Mean Difference (IV, Fixed, 95% CI)

‐3.9 [‐7.95, 0.15]
Figuras y tablas -
Comparison 3. Terazosin vs Placebo
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