Interaction of alcohol and an α1-blocker on ambulatory blood pressure in patients with essential hypertension

Ingestion of alcohol acutely decreases vascular resistance and blood pressure (BP) with activation of the sympathetic nervous system in Orientals. Although α1-blockers are widely used in the treatment of hypertension, the possible interaction between alcohol and α1-blockers has not been clarified. We examined the effects of prazosin on the alcohol-induced BP changes in Japanese men with mild hypertension. Ten hypertensive patients (54 ± 3 years, mean ± SE) were given 1 mL/kg of alcohol or isocaloric control drink with a light meal in the evening before and 5 to 7 days after treatment with prazosin (1 mg three times daily). Ambulatory BP monitoring was carried out every 30 min for 24 h in each period using Colin ABPM-630. Blood samples were obtained before and 2 h after intake of alcohol or control drink. Before prazosin treatment, alcohol ingestion decreased BP for several hours with a significant reduction in average 24-h BP, whereas it increased heart rate, plasma norepinephrine, and plasma renin activity. Treatment with prazosin caused a significant decrease in 24-h BP (136.3 ± 4.0/82.8 ± 2.5 v 131.6 ± 3.2/80.0 ± 2.3 mm Hg). The alcohol-induced hypotension at 2–4 h after ingestion was enhanced by prazosin (−18.0 ± 3.7/−11.8 ± 2.7 v−24.4 ± 4.9/−17.8 ± 2.8 mm Hg, P< .05 for diastolic BP). These results suggested that inhibition of the sympathetic nervous system with α1-blockers accentuates alcohol-induced hypotension. Ingestion of alcohol may cause a marked BP reduction in hypertensive Orientals treated with α1-blockers.