利尿劑在高血壓治療中的地位_West China Medical Journal

Authors：

 廖行 , 劉凱 ,  陳曉平

四川大學華西醫院心臟內科（成都 610041）;

Corresponding?author：

廖行, Email: 18180237207@163.com; 陳曉平, Email: xiaopingchen21@163.com

Keywords：

利尿劑; 高血壓; 心血管事件; 新發糖尿病

DOI：

10.7507/1002-0179.20150510

Video：

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Abstract Full text Figures/Tables Video References Cited by

利尿劑一直作為降壓治療中不可或缺的一種藥物，能顯著降低心血管事件發生風險，然而其作為降壓一線藥物還是作為聯合使用藥物目前仍然存在爭議。同時它對新發糖尿病、脂質代謝等方面的影響也不容忽視。現結合近年來發表的相關文獻，對利尿劑在降壓過程中的地位與困惑進行綜述，從而為降壓藥的選擇提供一定的參考。

Citation： 廖行, 劉凱, 陳曉平. 利尿劑在高血壓治療中的地位. West China Medical Journal, 2015, 30(9): 1779-1783. doi: 10.7507/1002-0179.20150510 Copy

1.	Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension[J]. Eur Heart J, 2013, 34(28):2159.
2.	李鎰沖, 王麗敏, 姜勇, 等. 2010年中國成年人高血壓患病情況[J]. 中華預防醫學雜志, 2012, 46(5):409-413.
3.	Chobanian AV, Bakris GL, Black HR. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report[J]. ACC Curr J Rev, 2003, 12 (4):31-32.
4.	Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management:a European Society of Hypertension Task Force document[J]. J Hypertens, 2009, 27(11):2121-2158.
5.	Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly:a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents[J]. Circulation, 2011, 123(21):2434-2506.
6.	Grossman E, Angeli F, Verdecchia P, et al. Diuretics treatment of hypertension[J]. Diabetes Care, 2011, 34(2):315-317.
7.	Turnbull F, Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events:results of prospectively-designed overviews of randomised trials[J]. Lancet, 2003, 62(9395):1527-1535.
8.	王增武, 劉力生, 龔蘭生, 等. 降壓治療與腦卒中二級預防:腦卒中后降壓治療研究[J]. 中華高血壓雜志, 2010, 18(4):329-334.
9.	Party MW. Medical research council trial of treatment of hypertension in older adults:principal results. MRC working party[J]. BMJ, 1992, 304(6824):405-412.
10.	SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group[J]. JAMA, 1991, 265(24):3255-3264.
11.	PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack[J]. Lancet, 2001, 358(9287):1033-1041.
12.	Wing LM, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin-converting——enzyme inhibitors and diuretics for hypertension in the elderly[J]. N Engl J Med, 2003, 348(7):583-592.
13.	ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002, 288(23):2981-2997.
14.	Furberg CD, Wright JT, Davis BR, et al. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2000, 283(15):1967-1975.
15.	Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis[J]. JAMA, 1997, 277(9):739-745.
16.	Klungel OH, Heckbert SR, Longstreth WT Jr, et al. Antihypertensive drug therapies and the risk of ischemic stroke[J]. Arch Intern Med, 2001, 161(1):37-43.
17.	Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study:Intervention as a Goal in Hypertension Treatment (INSIGHT)[J]. Lancet, 2000, 356(9227):366-372.
18.	Wright JT, Probstfield JL, Cushman WC, et al. ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses[J]. Arch Intern Med, 2009, 169(9):832-842.
19.	Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older[J]. N Engl J Med, 2008, 358(18):1887-1898.
20.	Bolland MJ, Ames RW, Horne AM, et al. The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women[J]. Osteoporos Int, 2007, 18(4):479-486.
21.	Schoofs MW, Van Der Klift M, Hofman A, et al. Thiazide diuretics and the risk for hip fracture[J]. Ann Intern Med, 2003, 139(6):476-482.
22.	Reid IR, Ames RW, Orr-Walker BJ, et al. Hydrochlorothiazide reduces loss of cortical bone in normal postmenopausal women:a randomized controlled trial[J]. Am J Med, 2000,109(5):362-370.
23.	Aubin R, Ménard P, Lajeunesse D. Selective effect of thiazides on the human osteoblast-like cell line MG-63[J]. Kidney Int, 1996, 50(5):1476-1482.
24.	Aung K, Htay T. Thiazide diuretics and the risk of hip fracture[J]. Cochrane Database Syst Rev, 2011(10):CD005185.
25.	Marre M, Puig JG, Kokot F, et al. Equivalence of indapamide SR and enalapril on microalbuminufia reduction in hypertensive patients with type 2 diabetes:the NESTOR Study[J]. J Hypertens, 2004, 22(8):1613-1622.
26.	Gerc V, Buksa M. Arterial hypertension 2007:guidelines for the management of arterial hypertension[J]. Med Arh, 2007, 61(2 Suppl 1):27-30.
27.	Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease:meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies[J]. BMJ, 2009, 338(7705):b1665.
28.	Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients[J]. N Engl J Med, 2008, 359(23):2417-2428.
29.	Staessen A, Wang JG, Thijs L, et al. Cardiovascular prevention and blood pressure reduction:a quantitative overview updated until 1 March 2003[J]. J Hypertens, 2003, 21(6):1055-1076.
30.	Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs:a network meta-analysis[J]. Lancet, 2007, 369(9557):201-207.
31.	Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes:a quantitative review[J]. Hypertension, 2006, 48(2):219-224.
32.	Stump CS, Hamilton MT, Sowers JR. Effect of antihypertensive agents on the development of type 2 diabetes mellitus[J]. Mayo Clin Proc, 2006, 81(6):1637-1638.
33.	Kudoh T, Nagawaga T, Nakagawa I. Additional small amounts of diuretics improve blood pressure control at low cost without disadvantages in blood sugar metabolism[J]. Hypertens Res, 2008, 31(3):455-462.
34.	Kasiske BL, Ma JZ, Kalil RS, et al. Effects of antihypertensive therapy on serum lipids[J]. Ann Intern Med, 1995, 122(2):133-141.
35.	Wile D. Diuretics:a review[J]. Ann Clin Biochem, 2012, 49(5):419-431.
36.	Schmieder RE, Delles C, Messerli FH. Diuretic therapy and the risk for renal cell carcinoma[J]. J Nephrol, 2001, 13(5):343-346.
37.	Grossman E, Messerli FH, Goldbourt U. Does diuretic therapy increase the risk of renal cell carcinoma?[J]. Am J Cardiol, 1999, 83(7):1090-1093.

1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension[J]. Eur Heart J, 2013, 34(28):2159.
2. 李鎰沖, 王麗敏, 姜勇, 等. 2010年中國成年人高血壓患病情況[J]. 中華預防醫學雜志, 2012, 46(5):409-413.
3. Chobanian AV, Bakris GL, Black HR. The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The JNC 7 report[J]. ACC Curr J Rev, 2003, 12 (4):31-32.
4. Mancia G, Laurent S, Agabiti-Rosei E, et al. Reappraisal of European guidelines on hypertension management:a European Society of Hypertension Task Force document[J]. J Hypertens, 2009, 27(11):2121-2158.
5. Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly:a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents[J]. Circulation, 2011, 123(21):2434-2506.
6. Grossman E, Angeli F, Verdecchia P, et al. Diuretics treatment of hypertension[J]. Diabetes Care, 2011, 34(2):315-317.
7. Turnbull F, Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events:results of prospectively-designed overviews of randomised trials[J]. Lancet, 2003, 62(9395):1527-1535.
8. 王增武, 劉力生, 龔蘭生, 等. 降壓治療與腦卒中二級預防:腦卒中后降壓治療研究[J]. 中華高血壓雜志, 2010, 18(4):329-334.
9. Party MW. Medical research council trial of treatment of hypertension in older adults:principal results. MRC working party[J]. BMJ, 1992, 304(6824):405-412.
10. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group[J]. JAMA, 1991, 265(24):3255-3264.
11. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack[J]. Lancet, 2001, 358(9287):1033-1041.
12. Wing LM, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin-converting——enzyme inhibitors and diuretics for hypertension in the elderly[J]. N Engl J Med, 2003, 348(7):583-592.
13. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2002, 288(23):2981-2997.
14. Furberg CD, Wright JT, Davis BR, et al. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone:the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)[J]. JAMA, 2000, 283(15):1967-1975.
15. Psaty BM, Smith NL, Siscovick DS, et al. Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis[J]. JAMA, 1997, 277(9):739-745.
16. Klungel OH, Heckbert SR, Longstreth WT Jr, et al. Antihypertensive drug therapies and the risk of ischemic stroke[J]. Arch Intern Med, 2001, 161(1):37-43.
17. Brown MJ, Palmer CR, Castaigne A, et al. Morbidity and mortality in patients randomised to double-blind treatment with a long-acting calcium-channel blocker or diuretic in the International Nifedipine GITS study:Intervention as a Goal in Hypertension Treatment (INSIGHT)[J]. Lancet, 2000, 356(9227):366-372.
18. Wright JT, Probstfield JL, Cushman WC, et al. ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses[J]. Arch Intern Med, 2009, 169(9):832-842.
19. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older[J]. N Engl J Med, 2008, 358(18):1887-1898.
20. Bolland MJ, Ames RW, Horne AM, et al. The effect of treatment with a thiazide diuretic for 4 years on bone density in normal postmenopausal women[J]. Osteoporos Int, 2007, 18(4):479-486.
21. Schoofs MW, Van Der Klift M, Hofman A, et al. Thiazide diuretics and the risk for hip fracture[J]. Ann Intern Med, 2003, 139(6):476-482.
22. Reid IR, Ames RW, Orr-Walker BJ, et al. Hydrochlorothiazide reduces loss of cortical bone in normal postmenopausal women:a randomized controlled trial[J]. Am J Med, 2000,109(5):362-370.
23. Aubin R, Ménard P, Lajeunesse D. Selective effect of thiazides on the human osteoblast-like cell line MG-63[J]. Kidney Int, 1996, 50(5):1476-1482.
24. Aung K, Htay T. Thiazide diuretics and the risk of hip fracture[J]. Cochrane Database Syst Rev, 2011(10):CD005185.
25. Marre M, Puig JG, Kokot F, et al. Equivalence of indapamide SR and enalapril on microalbuminufia reduction in hypertensive patients with type 2 diabetes:the NESTOR Study[J]. J Hypertens, 2004, 22(8):1613-1622.
26. Gerc V, Buksa M. Arterial hypertension 2007:guidelines for the management of arterial hypertension[J]. Med Arh, 2007, 61(2 Suppl 1):27-30.
27. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease:meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies[J]. BMJ, 2009, 338(7705):b1665.
28. Jamerson K, Weber MA, Bakris GL, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients[J]. N Engl J Med, 2008, 359(23):2417-2428.
29. Staessen A, Wang JG, Thijs L, et al. Cardiovascular prevention and blood pressure reduction:a quantitative overview updated until 1 March 2003[J]. J Hypertens, 2003, 21(6):1055-1076.
30. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs:a network meta-analysis[J]. Lancet, 2007, 369(9557):201-207.
31. Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes:a quantitative review[J]. Hypertension, 2006, 48(2):219-224.
32. Stump CS, Hamilton MT, Sowers JR. Effect of antihypertensive agents on the development of type 2 diabetes mellitus[J]. Mayo Clin Proc, 2006, 81(6):1637-1638.
33. Kudoh T, Nagawaga T, Nakagawa I. Additional small amounts of diuretics improve blood pressure control at low cost without disadvantages in blood sugar metabolism[J]. Hypertens Res, 2008, 31(3):455-462.
34. Kasiske BL, Ma JZ, Kalil RS, et al. Effects of antihypertensive therapy on serum lipids[J]. Ann Intern Med, 1995, 122(2):133-141.
35. Wile D. Diuretics:a review[J]. Ann Clin Biochem, 2012, 49(5):419-431.
36. Schmieder RE, Delles C, Messerli FH. Diuretic therapy and the risk for renal cell carcinoma[J]. J Nephrol, 2001, 13(5):343-346.
37. Grossman E, Messerli FH, Goldbourt U. Does diuretic therapy increase the risk of renal cell carcinoma?[J]. Am J Cardiol, 1999, 83(7):1090-1093.

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利尿劑在高血壓治療中的地位

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