摘要
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 Studies have shown that thiazide diuretics may have adverse effects on the glucose metabolism of essential hypertensive patients. Objective To investigate the effects of long-term treatment with hydroehlorothiazide （HCTZ） combined with spironolactone or captopril on the glucose metabolism of hypertensive patients. Methods A multicenter, randomized, parallel control study was carried. A total of 701 patients with mild to moderate hypertension. HCTZ 12.5 mg qd plus spironolactone 20 mg qd or HCTZ 12.5 mg qd plus captopril 25 mg bid were administered and followed up for four years. Based on compliance, the participants were divided into high level compliance and low level compliance. Primary outcome comprised fast blood sugar and the new- onset diabetes. Results After four years, the fasting glucose was increased by （0.2 ± 1.5 ） mmol/L in the high level compliance group, while it increased by （0.3 ± 1.3 ） mmol/L in the low level compliance group, no significant statistical difference was found between the two group [P〉0. 05）. Eight new-onset diabetes was occurred in the high level compliance group and 6 in the low level compliance group（P〉0.05）, although serum potassium was decreased in the high level compliance group [（4.6±0.7） vs after （4.4±0.6）mmol/L, P〈0.01）, compared with the low level compliance group （ P〈0. 01 ）. Conclusion Long-term treatment with HCTZ combined with spironolactone or captopril has no adverse effects on the glucose metabolism, even serum potassium was decreased in the range of --4%.
出处
《中华高血压杂志》
CAS
CSCD
北大核心
2009年第2期128-132,共5页
Chinese Journal of Hypertension
关键词
氢氯噻嗪
原发性高血压
糖尿病
糖代谢
血钾
Hydrochlorothiazide
Essential hypertension
Diabetes mellitus
Glucose metabolism
Serum potassium
