Alpha-Blocker Treatment Response in Men with Lower Urinary Tract Symptoms Based on Sympathetic Activity : Prospective, Multicenter, Open - Labeled, Observational Study

Abstract

PURPOSE: In this study, we compared the treatment outcomes for an α-blocker between 2 groups of men, one with high sympathetic activity (HSA) and another with low sympathetic activity (LSA) or normal sympathetic activity. METHODS: A total of 159 men (≥50 years of age) with lower urinary tract symptoms resulting from benign prostatic hyperplasia were analyzed. We assigned patients to groups according to their sympathetic activity, which was evaluated by heart rate variability measurements. HSA was defined as a low frequency/high frequency ratio greater than 1.6. All patients received 10mg of alfuzosin once a day for 12 weeks. The primary end point was a change in the total International Prostate SymptomScore (IPSS) at 12 weeks from baseline. RESULTS: Sixty-seven men were assigned to the HSA group and 92 men were assigned to the LSA group. The baseline characteristics were not significantly different between the 2 groups, and the response to alfuzosin was good in both groups. The mean total IPSS change was not different between the groups. Both groups were not significantly different with respect to the changes in maximal flow rate, IPSS voiding or storage symptom subscores, quality of life, and rates of adverse drug events. The HSA group showed a similar willingness to continue treatment compared to the LSA group, although their treatment satisfaction rating was lower. CONCLUSIONS: The therapeutic effects of alfuzosin did not differ in regards to the differences in sympathetic activity, but treatment satisfaction ratings were lower in the HSA group.

이 연구는 하부요로증상 남성에 대한 알파차단제의 치료 효과와 자율신경계의 변화의 상관 관계를 알아보기 위한 것으로 기관윤리심의위원회의 허가후 전향적 연구로 진행된 것이다. 하부요로증상의 정도 및 치료 효과는 개개인에 따라 다르게 나타나는데, 자율신경계의 활동성이 그 원인의 하나로 생각되고 있다. 이 연구에서는 알파차단제를 3개월간 치료후 교감신경이 항진되어 있는 환자군과 감소되어 있는 환자군 모두에서 증상의 호전을 확인하였으며, 치료후에는 교감신경의 활성도가 일정 수준으로 수렴하는 것을 확인할 수 있었다. 이는 자율신경계의 이상이 하부요로증상의 한 원인임을 다시 한번 증명해주는 결과라고 할 수 있다.