reviewing Raskind MA et al. Biol Psychiatry 2016 Apr 11
It seems more effective in patients with higher baseline systolic blood pressure.
The noradrenergic alpha-1 receptor blocker prazosin has repeatedly been shown to be beneficial in post-traumatic stress disorder (PTSD), especially for insomnia, nightmares, and arousal. To examine the relationship of pretreatment blood pressure (BP) parameters to treatment response, researchers conducted a secondary analysis of data on 46 participants who had completed a 15-week, randomized, placebo-controlled, clinical trial of prazosin (mean dose: men, 20 mg/day; women, 9 mg/day) for combat-related PTSD accompanied by frequent nightmares (
and Am J Psychiatry 2013; 170:1003).
The original study found that prazosin was associated with global improvement and with reductions in nightmares, sleep quality, and overall PTSD symptoms, a secondary outcome measure. Overall, baseline BP had no relationship with baseline features, outcomes, or prazosin dose, and BP levels did not vary significantly over time. Still, patients with higher baseline standing and supine systolic BPs had greater symptom improvement that was proportional to the degree to which BP exceeded 110 mm Hg