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噻嗪类利尿剂30.年前开始成为治疗原发型高血压的基本药物。近来,长期用药所致的副作用比30年前严重得多,主要反映在脂蛋白代谢的变化上,导致了胆固醇和阿朴脂蛋白B浓度的升高及低血钾倾向。这些反应与剂量有关,在不影响降压效果的前提下,仅仅减少剂量就能大大地避免上述副作用。噻嗪类药物的剂量是基于短时药效关系的。有证据表明,3个月治疗后,给予非常低的剂量时即能观察到完全的降压效果。257名丹麦成年病人,平均舒张压为100～120mmHg,每天服1.25mg苄氟噻嗪,与推荐剂量10mg/d相比,疗程后期在降压方面没有右觉察到的差别。相反在副作用方面,高
Thiazide diuretics 30. Years ago began to become essential drugs for the treatment of essential hypertension. Recently, side effects caused by long-term medication are much more severe than 30 years ago, mainly due to changes in lipoprotein metabolism, resulting in elevated cholesterol and apolipoprotein B concentrations and a tendency toward hypokalemia. These reactions are dose-dependent and can be largely avoided by just reducing the dose without affecting the antihypertensive effect. The dose of thiazide drugs is based on short-term pharmacodynamic effects. There is evidence that a complete antihypertensive effect can be observed at very low doses after 3 months of treatment. 257 Danish adults with an average diastolic blood pressure of 100 to 120 mm Hg and 1.25 mg of bendroflumethiazide daily had no right perceived difference in blood pressure reduction at the end of the course of treatment compared with the recommended dose of 10 mg / d. On the contrary in terms of side effects, high