Doxazosin, a selective α1-receptor antagonist, is widely used to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). However, its cardiovascular effects remain clinically relevant, particularly in older patients. This systematic review and meta-analysis evaluated blood pressure, heart rate, headache and vertigo during doxazosin treatment. PubMed/MEDLINE, the Cochrane Library, CNKI, Wanfang Data, Google Scholar and ScienceDirect were searched using Chinese and English terms related to doxazosin, BPH, prostate and cardiovascular outcomes. Sixteen evidence reports were included: 12 primary studies, 2 pooled analyses and 2 secondary review sources that supplied aggregate trial data. The pooled analyses showed no statistically significant difference in systolic blood pressure (MD 1.44, 95% CI -4.17 to 7.06; p=0.61), diastolic blood pressure (MD -0.33, 95% CI -3.68 to 3.03; p=0.85), headache (OR 0.99, 95% CI 0.73-1.34; p=0.95) or heart rate (MD 0.98, 95% CI -0.89 to 2.84; p=0.30). Vertigo was more frequent with doxazosin than with control treatment (OR 1.93, 95% CI 1.50-2.49; p<0.00001). Risk-of-bias assessment identified 2 reports at low risk, 10 with some concerns, 1 at high risk, 1 observational study of moderate quality, and 2 secondary reviews for which Cochrane Risk of Bias 2 and the Newcastle-Ottawa Scale were not applicable. Doxazosin was not associated with statistically significant average changes in blood pressure or heart rate, but the increased occurrence of vertigo warrants counselling and monitoring, particularly in older patients at risk of falls.

[This corrects the article DOI: 10.15171/bi.30257.].

Cardiac paragangliomas are rare neoplasms, comprising only 1%-3% of primary cardiac tumours, and often pose a diagnostic challenge.

Background: Resistant hypertension poses a significant therapeutic challenge, often leading to severe polypharmacy. Renal denervation (RDN) has re-emerged as a valuable adjunctive intervention for blood pressure control. Case Presentation: We report the case of a 64-year-old man (body mass index [BMI] 34 kg/m2) with long-standing resistant hypertension (RH), after previous percutaneous coronary intervention (PCI) to the left anterior descending artery, heart failure with preserved ejection fraction (HFpEF), and prior nephron-sparing surgery for clear cell renal carcinoma. Despite treatment with an extensive antihypertensive regimen encompassing nine pharmacological classes including diuretic therapy (angiotensin-converting enzyme inhibitor; calcium channel blocker, thiazide diuretic, β-blocker, α1-blocker, central α2-agonist, mineralocorticoid receptor antagonist, loop diuretic, long-acting nitrates), blood pressure remained severely uncontrolled on both home and office measurements. Persistent hypertension was accompanied by exertional dyspnoea and episodes of exertional chest discomfort. Following comprehensive evaluation and exclusion of secondary causes of hypertension, the patient underwent catheter-based renal denervation using the SymplicitySpyral™ (Medtronic) multi-electrode radiofrequency system. The procedure was associated with substantial and sustained improvement in blood pressure control, with mean 24 h ambulatory blood pressure measurements decreasing to 130/80 mmHg at six-month follow-up. Importantly, successful blood pressure reduction enabled major simplification of pharmacotherapy, including complete discontinuation of clonidine, loop diuretic therapy, and long-acting nitrates, together with marked dose reduction in doxazosin. Conclusions: This case illustrates the potential clinical utility of renal denervation in carefully selected patients with true resistant hypertension and pronounced sympathetic overactivity. Beyond achieving satisfactory blood pressure control, RDN may facilitate meaningful reduction in medication burden, potentially improving treatment adherence, quality of life, and long-term cardiovascular risk. Written informed consent was obtained from the patient for both the procedure and the publication of this case report.

This is a classic and complete representation of the multiple endocrine neoplasia type 2A (MEN2A) syndrome, involving primary hyperparathyroidism, medullary thyroid carcinoma, and pheochromocytomas. This case is particularly noteworthy for the recurrent, contralateral presentation of the pheochromocytoma, which emerged years after the initial surgical management. Recurrent and contralateral pheochromocytomas present unique anesthetic, surgical, and postoperative problems due to excess catecholamines and severe, potentially life-threatening hemodynamic instability in the perioperative phase. We report an unusual case of a 29-year-old female with MEN2A who had a right adrenalectomy, subsequently total thyroidectomy and parathyroidectomy, and was under follow-up with an endocrinologist. During follow-up, she was found to have very high plasma normetanephrine levels (>760 pg/mL), and radiological imaging revealed an avid adrenal nodule in the left adrenal gland, which was consistent with the diagnosis of recurrent contralateral pheochromocytoma. She was managed preoperatively on doxazosin and metoprolol. During the anesthetic evaluation, she had orthostatic hypotension, but no other symptoms related to pheochromocytomas. Elective open left adrenalectomy was carried out under general anesthesia, aiming to blunt stress responses. Hemodynamics were monitored invasively and managed with vasodilator and vasopressor infusions. After the removal of the adrenal tumor, the noradrenaline infusion was stopped as she maintained her stable hemodynamic parameters. She had an uneventful recovery and an orderly discharge from the post-anesthesia recovery unit. This case highlights the importance of meticulous preoperative optimization, vigilant intraoperative monitoring, and readiness with vasoactive agents in managing pheochromocytomas in patients with MEN2A. A multidisciplinary approach is essential to achieve a safe anesthetic course and a favorable outcome in such high-risk scenarios.

Pheochromocytoma is an uncommon neuroendocrine tumor that may present with highly variable and misleading clinical manifestations. We report the case of a 64-year-old woman with a history of hypertension who presented with acute chest pain, electrocardiographic changes, and marked elevation of cardiac biomarkers, initially suggestive of an acute coronary syndrome. Coronary angiography revealed no obstructive coronary disease. During hospitalization, the patient developed severe hemodynamic instability with alternating hypertensive crises and hypotension. Imaging studies identified a large heterogeneous right adrenal mass with high attenuation and associated hemoperitoneum. Biochemical evaluation demonstrated markedly elevated urinary metanephrines and normetanephrines, confirming the diagnosis of pheochromocytoma. The patient was stabilized medically and treated with preoperative α-adrenergic blockade using doxazosin, followed by successful surgical resection. Histopathological examination revealed extensive tumor necrosis with minimal viable tissue. Postoperatively, the patient had an uneventful recovery, with normalization of blood pressure and no recurrence of symptoms during follow-up. This case highlights the diagnostic and therapeutic challenges posed by pheochromocytoma presenting as acute myocardial injury and complicated by spontaneous tumor rupture with hemoperitoneum.

A novel, sensitive, and green spectrofluorometric approach was established and validated for the estimation of doxazosin (DXN), a selective α1-adrenergic receptor blocker used in treating benign prostatic hyperplasia and hypertension. The technique relies on the condensation reaction between DXN, ninhydrin, and phenylacetaldehyde in Teorell-Stenhagen buffer (pH 7.0), forming a fluorescent diaryl pyrrolone derivative with maximum excitation and emission wavelengths at 340 and 410 nm, respectively. After optimizing the procedure variables, a calibration curve was established, and the data were statistically analyzed using linear regression, which revealed a significant correlation. The International Council for Harmonization's (ICH) recommendations were followed when validating the approach. The proposed approach showed linearity when DXN concentration was plotted versus the fluorescent response over the range of 10-120 ng mL-1. The detection and quantitation limits were 1.8 and 5.5 ng mL-1, respectively. The suggested approach has been effectively used for the determination of DXN in tablets and spiked human plasma with high percentage recoveries (100.40 ± 1.05 and 100.09 ± 0.91, for tablets and plasma, respectively). Furthermore, the method's greenness was verified by three up-to-date tools that assessed its environmental sustainability. Additionally, the practical efficiency of the technique was also evaluated using an up-to-date tool.

Doxazosin mesylate is a selective α1-adrenergic receptor antagonist with low oral bioavailability due to poor aqueous solubility and extensive first-pass hepatic metabolism. This study aimed to design and optimize a doxazosin mucoadhesive buccal film to overcome hepatic metabolism and enable rapid drug onset. The buccal films were prepared by solvent casting, using a Plackett-Burman design to screen formulation variables affecting ex vivo mucoadhesive force, followed by a 2[2] full factorial design to optimize in vitro drug release by varying the concentrations of HPMC, the main film-forming polymer, and glycerin, a plasticizer. The prepared films were characterized for physico-mechanical properties, surface pH, mucoadhesive force, swelling properties, and drug release. In addition, the optimized formula was further characterized by scanning electron microscopy and ex vivo permeation study. The screening study showed that mucoadhesive strength ranged from 28 to 41 g, with the polymer type, polymer concentration, plasticizer type, and plasticizer concentration identified as the most influential variables. The optimized formula (FF3), containing 66 w/w% HPMC K15M and 21 w/w% glycerin, achieved 100% drug release within 15 min with acceptable film properties, in addition, SEM analysis showed a relatively uniform and compact surface with slight undulations, furthermore the ex vivo permeation reached 91% within 15 min, corresponding to a cumulative permeated amount of 1820 µg, a cumulative amount per unit area of 2275 µg/cm[2], and an estimated steady-state flux of 12750 µg/cm[2]/h. It was concluded that the developed buccal film is a promising system for improving doxazosin bioavailability and providing rapid therapeutic onset.

Exercise is known to promote systemic health and prevent various chronic diseases. However, the molecular mechanisms underlying its beneficial effects remain incompletely understood. Although the health benefits of exercise have been widely studied, most research has treated exercise as a general intervention, without clearly standardizing its intensity. This study focused on a physiologically and molecularly defined moderate intensity, which may uniquely capture the core health-promoting mechanisms of exercise. To characterize the molecularly defined moderate intensity exercise, integrative multi-omics analyses-including transcriptomics, epigenomics, and phosphoproteomics-were performed using skeletal muscle tissue. These analyses revealed that this specifically defined exercise consistently modulated shared molecular pathways across both exercise modalities, especially insulin signaling, FoxO signaling, and circadian rhythm regulation. To explore the translational relevance of the identified molecular signatures, Connectivity Map analysis was used to search for compounds with similar transcriptional profiles. As a secondary outcome, apigenin and doxazosin were found to mimic exercise-associated molecular responses partially. These compounds exerted distinct physiological effects in vivo, including enhanced mitochondrial function and endurance and muscle hypertrophy with musculoskeletal protection. In conclusion, this study primarily elucidates the systemic molecular basis of physiologically and molecularly defined moderate-intensity exercise. The identification of candidate exercise mimetics serves as a potential application of these findings.

Hypertensive crises, encompassing emergencies and urgencies, are acute, severe blood pressure elevations associated with significant morbidity and mortality. Despite available guidelines, variability in clinical practice persists. This systematic review aims to synthesise evidence on pharmacological management strategies for hypertensive crises, focusing on efficacy, safety, and setting-specific considerations. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library was conducted for studies published between January 2020 and December 2025. Studies evaluating pharmacological interventions in adult patients with hypertensive crises were included. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). A narrative synthesis was performed due to clinical and methodological heterogeneity. The search yielded 629 records, of which six studies met the inclusion criteria, with two randomised controlled trials, two retrospective cohort studies, and two cross-sectional studies conducted across India, Taiwan, the United States, Ethiopia, the Netherlands, and Europe. All studies demonstrated low risk of bias, with NOS scores ranging from 7 to 9 stars. Continuous intravenous infusion achieved the fastest blood pressure reduction, while intravenous bolus alone was associated with the shortest intensive care unit (ICU) stay. One study found no significant difference in time to blood pressure control between treated and untreated emergency department patients, but observed reduced three-year and five-year mortality in treated patients. Overall mortality among ICU patients was 8%, with higher rates in those presenting with acute coronary syndrome. Both phenoxybenzamine and doxazosin were effective in preventing intraoperative haemodynamic instability during pheochromocytoma resection, with zero 30-day mortality. Acute kidney injury occurred in 20-30% of patients with hypertensive emergencies complicated by heart failure. Guidelines recommended against routine early intensive blood pressure lowering in acute ischaemic stroke due to the absence of proven mortality benefit and potential harm. Factors associated with better outcomes included polypharmacy approaches, formal end-organ damage evaluation, and absence of target organ damage. Multiple pharmacological strategies are effective in hypertensive crises, with choice guided by clinical context and target organ damage. Continuous infusion offers the fastest reduction, and bolus strategies reduce ICU utilisation. Target organ damage, especially acute coronary syndrome, predicts worse outcomes. Emergency department intervention confers long-term mortality benefits. Standardised definitions and larger trials are needed, particularly in resource-limited settings.