Background Preclinical and clinical research suggest that the α1 receptor antagonist prazosin reduces alcohol consumption. Furthermore, clinical studies indicate a role of prazosin in treating Post-Traumatic Stress Disorder (PTSD) symptoms, while a recent trial suggested that pre-treatment blood pressure (BP) predicts therapeutic response for prazosin in PTSD patients. Whether pre-treatment BP may predict response to α1 blockers in alcohol-dependent (AD) patients is unknown. We previously reported a randomized controlled trial (RCT), where doxazosin, an α1 receptor antagonist with a more favorable pharmacokinetic profile than prazosin, reduced drinks per week (DPW) and heavy drinking days (HDD) in AD patients with a high family history density of alcoholism. In this study, we tested pre-treatment BP as another potentially valuable clinical moderator of doxazosin’s response on alcohol consumption. Methods This was a double-blind placebo-controlled RCT testing doxazosin up to 16 mg/day in AD treatment-seeking patients (N = 41). The hypothesized moderator effect of baseline standing systolic and diastolic BP on DPW and HDD was tested. Results With pre-treatment standing diastolic BP as a moderator, there were significant BP × medication interactions for both DPW [**p= 0.009, d = 0.80] and HDD [*p = 0.018, d = 1.11]. Post-hoc analyses indicated significant doxazosin effects in patients with higher standing BP in reducing both DPW and HDD. Conclusion These findings suggest that higher standing diastolic BP at baseline (pre-treatment) may represent a predictor of doxazosin’s response on alcohol consumption in AD patients. These results further elucidate the possible efficacy and mechanisms of action of α1 receptor antagonism in AD individuals.
Purpose Smoking cessation is the primary goal for managing patients with chronic obstructive pulmonary disease (COPD) who smoke. However, previous studies have demonstrated poor cessation rates. The “lung age” concept (an estimate of the age at which the FEV1 would be considered normal) was developed to present spirometry data in an understandable format and to serve as a tool to encourage smokers to quit. Primary care physicians’ (PCPs) views of using lung age to help COPD patients to quit smoking were assessed. Methods Post-intervention interviews were conducted with PCPs in the U.S. who participated in the randomized clinical trial, “Translating the GOLD COPD Guidelines into Primary Care Practice.” Results 29 physicians completed the interview. Themes identified during interviews included: general usefulness of lung age for smoking cessation counseling, ease of understanding the concept, impact on patients’ thoughts of quitting smoking, and comparison to FEV1. Most providers found lung age easy to communicate. Moreover, some found the tool to be less judgmental for smoking cessation and others remarked on the merits of having a simple, tangible number to discuss with their patients. However, some expressed doubt over the long-term benefits of lung age and several others thought that there might be a potential backfire for healthy smokers if their lung age was ≤ to their chronological age. Conclusions This study suggests that lung age was well received by the majority of PCPs and appears feasible to use with COPD patients who smoke. However, further investigation in needed to explore COPD patients’ perspectives of obtaining their lung age to help motivate them to quit in randomized clinical trials.
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