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目的探讨以氢氯噻嗪为基础的降压治疗期间,血糖升高对原发性高血压患者心脑血管事件的影响。方法选择轻中度原发性高血压患者829例,入选患者经安慰剂洗脱2周和氢氯噻嗪导入6周后随机给予氢氯噻嗪12.5mg/d或(氢氯噻嗪12.5mg/d+螺内酯20mg/d)或(氢氯噻嗪12.5mg/d+卡托普利25mg两次/d)治疗。依据患者随访期内各次空腹血糖水平,血糖值≥7mmol/L的患者为暴露组,血糖值<7mmol/L者为对照组。治疗期间每月随访1次,监测血压,记录终点事件,每年进行一次血生化指标检测。随访7年。结果暴露组与对照组基线资料的比较:暴露组91例,对照组486例,暴露组年龄、体质量指数(BMI)、收缩压、空腹血糖均高于对照组(P<0.05)。终点事件比较:随访结束时共计发生心脑血管事件76例,暴露组发生心脑血管事件12例(13.2%),对照组发生心脑血管事件64例(13.2%),两组心脑血管事件发生率的差异无统计学意义(P>0.05)。结论以小剂量噻嗪类利尿剂作为基础降压药物长期降压治疗中所致的血糖升高不会引起心脑血管事件发生率的增加。
Objective To investigate the effect of hyperglycemia on cardiovascular and cerebrovascular events in patients with essential hypertension during hydrochlorothiazide-based antihypertensive treatment. Methods A total of 829 patients with mild-to-moderate essential hypertension were enrolled. The patients were randomly assigned to receive either hydrochlorothiazide 12.5 mg / d or hydrochlorothiazide 12.5 mg / d + spironolactone 20 mg / d after 6 weeks of placebo and 6 weeks of hydrochlorothiazide induction Hydrochlorothiazide 12.5mg / d + captopril 25mg twice / d) treatment. According to each fasting blood glucose level during the follow-up period of the patient, the patients with blood glucose≥7mmol / L were exposed, and the blood glucose <7mmol / L as the control group. During the treatment period, the patients were followed up once a month to monitor the blood pressure and record the end point events. Blood biochemical indexes were tested once a year. Follow-up for 7 years. Results The baseline data of exposed group and control group were 91 cases in exposure group and 486 cases in control group. The age, body mass index (BMI), systolic blood pressure and fasting blood glucose in exposed group were higher than those in control group (P <0.05). There were 76 cardiovascular and cerebrovascular events at the end of follow-up, 12 cardiovascular events (13.2%) in the exposure group, 64 cardiovascular events (13.2%) in the control group, and two cardiovascular and cerebrovascular events The difference was not statistically significant (P> 0.05). Conclusions Long-term antihypertensive treatment with low-dose thiazide diuretics as the basis for antihypertensive drugs does not cause an increase in the incidence of cardiovascular and cerebrovascular events.