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supplement to Journal of the association of physicians of india Published on 1st of every month 1st september, 2014 VOL. 62
Introduction
ypertension and benign prostatic hyperplasia are common, age related disorders in
men leading to a substantial burden on health care resources worldwide.
Although hypertension and BPH are two diverse disease entities, still they have some
features in common in the form of aetiological involvement of sympathetic nervous
system. These two diseases occur concomitantly in about 25% of men over 60 years of
age, hence the use of alpha receptor blockers (ABs) to treat both diseases simultaneously
is preferable and convenient for patient compliance, cost and safety. 1
Epidemiology of Hypertension
Nearly one billion adults i.e. more than a quarter of the worlds population
had hypertension in the year 2000 and is predicted to rise to 1.56 billion by 2025.
Hypertension is the fourth contributor to premature death in developed countries and
seventh in developing countries. 2
The direct and indirect costs of hypertension are enormous. In 2008, the total
estimated direct and indirect cost of hypertension was estimated at $69.9 billion. 3
In India, prevalence of hypertension has been reported by various studies ranging
between 2-15% in urban India and 2-8% in rural India. 4,5
Hypertension is an established and modifiable risk factor for cardiovascular disease
and the prevalence of hypertension increases with age. 6 The probability that a middleaged or elderly individual will develop hypertension in his or her lifetime is 90%.
The population of India with persons aged 65 and above has been projected to increase
from 51 million in 2005 to 65 million in 2015 and 76 million in 2020. 7
Epidemiology of BPH
*
Senior Consultant, **Associate
Professor, ***Assistant Professor,
Nephrology, Assistant
professor, Renal transplant and
Urology, Institute of Liver &
Biliary Sciences, New Delhi
BPH is a common and progressive disease of aging men and the prevalence of BPH
increases with age. 8 Around 50% of men above 65 years of age (more than 80% among
men 70-79 years of age) suffer some symptoms of BPH. 9 Over the coming years,
however, an increasing number of patients may report prostatic problems as the worlds
population is aging. With increasing public awareness about prostate gland, more men
are likely to present to their physician. Also, the men in their 50s and 60s no longer
consider themselves old and are not prepared to accept the negative impact of BPH on
their quality of life. 1 By the year 2020 around 200% increase in the number of persons
over 60 years of age is expected. 10
The cost of managing BPH has a considerable impact on healthcare budgets worldwide.
supplement to Journal of the association of physicians of india Published on 1st of every month 1st se ptember, 2014 VOL. 62
Urinary Bladder
-Adrenergic
Receptors
Selective Non Selective
1A
1B / 1D
Prostate Gland
41
42
supplement to Journal of the association of physicians of india Published on 1st of every month 1st september, 2014 VOL. 62
supplement to Journal of the association of physicians of india Published on 1st of every month 1st se ptember, 2014 VOL. 62
Dose
Receptor Selectivity
2-20 mg
1-8 mg
1-20 mg
10 mg
1A = 1B = 1D
1A = 1B = 1D
1B = 1D > 1A
1A = 1B = 1D
0.4-0.8 mg
1A = 1D > 1B
8 mg
1A > 1D >> 1B
43
44
supplement to Journal of the association of physicians of india Published on 1st of every month 1st september, 2014 VOL. 62
References
1.
2.
Available at http://www.who.int/gho/ncd/mortality_morbidity/
ncd_total_text/en/index.html. Last accessed on 16.01.2014
Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz
MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM,
Nelson SA, Nichol G, Orenstein D, Wilson PW, Woo YJ. Forecasting
the future of cardiovascular disease in the United States: a policy
statement from the American Heart Association. Circulation.
2011;123:933-944.
3.
4.
5.
6.
7.
8.
9.
Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human
benign prostatic hyperplasia with age. J Urol 1984;132:474-9.