Hypertension often exists as part of a syndrome of cardiovascular, neuroendocrine and metabolic abnormalities. While antihypertensive pharmacotherapy has reduced the rates of stroke, congestive heart failure and renal failure, a disappointing benefit in terms of the reduction in coronary heart disease (CHD) mortality has been seen as a result of the adverse effects of some of the traditional antihypertensive agents on serum lipids and other factors. Doxazosin, a selective alpha 1-adrenoceptor inhibitor, is an effective antihypertensive agent with beneficial effects on an array of atherogenic risk factors. Treatment with doxazosin can lower blood pressure, reduce the levels of atherogenic lipids, increase the levels of cardioprotective lipids, reduce hyperinsulinaemia, insulin resistance and glucose intolerance, increase fibrinolysis, inhibit platelet aggregation, attenuate the adverse haemodynamic and haemostatic effects of smoking, and regress cardiac and smooth muscle hypertrophy. This unique combination of risk factor modifications should produce a reduction in CHD events.