论文部分内容阅读
背景有研究提示噻嗪类利尿剂可能对原发性高血压患者糖代谢存在不良影响。目的探讨氢氯噻嗪(HCTZ)与螺内酯或卡托普利长期联用对高血压病患者糖代谢的影响。方法采用多中心、随机、平行对照研究,选择轻、中度高血压病患者701例,给予HCTZ12.5mg/(次·d)+螺内酯20mg/(次·d)或HCTZ12.5mg/(次·d)+卡托普利25mg/(2次·d)治疗。随访4年,依据患者的依从性分为依从性好组和依从性差组,比较治疗前后的生化指标和治疗过程中新发糖尿病例数。结果4年末,依从性好组空腹血糖水平较基线升高(0.2±1.5)mmol/L,依从性差组空腹血糖水平较基线升高(0.3±1.3)mmol/L,两组间比较,差异无统计学意义(P>0.05);4年末,依从性好组新发糖尿病8例,依从性差组6例,组间比较差异无统计学意义(P>0.05);依从性好组患者血K+较基线水平下降[(4.6±0.7)比治疗后(4.4±0.6)mmol/L,P<0.01],且与依从性差组比较降低幅度差异有统计学意义(P<0.01)。结论氢氯噻嗪与螺内酯或卡托普利长期联用对原发性高血压患者糖代谢无不良影响,即使血钾下降-4%。
Background Some studies suggest that thiazide diuretics may have adverse effects on glycometabolism in patients with essential hypertension. Objective To investigate the long-term effect of hydrochlorothiazide (HCTZ) combined with spironolactone or captopril on glycometabolism in hypertensive patients. Methods A multicenter, randomized, parallel-controlled study was conducted. Among 701 patients with mild to moderate essential hypertension, HCTZ 12.5 mg / (d · d) + spironolactone 20 mg / (d · d) or HCTZ 12.5 mg / d) Captopril 25 mg / (twice daily). Followed up for 4 years, according to the patient’s compliance was divided into good compliance group and poor compliance group, before and after treatment of biochemical indicators and the number of new cases of diabetes during treatment. Results At the end of the 4th year, the fasting blood glucose level in the good compliance group was higher than that in the baseline (0.2 ± 1.5) mmol / L, and the fasting blood glucose level in the poor compliance group was higher than that in the baseline (0.3 ± 1.3) mmol / L There was no significant difference between the two groups (P> 0.05). At the end of the fourth year, 8 cases of newly diagnosed diabetes mellitus with good compliance group and 6 cases of poor compliance group showed no significant difference (P> 0.05) The baseline level decreased (4.6 ± 0.7) compared with 4.4 ± 0.6 mmol / L after treatment (P <0.01), and the difference between the two groups was statistically significant (P <0.01). Conclusions Long-term use of hydrochlorothiazide with spironolactone or captopril has no adverse effect on glycometabolism in patients with essential hypertension, even if potassium is decreased by 4%.