Hydrochlorothiazide is not the most useful nor versatile thiazide diuretic.
Hydrochlorothiazide is not the most useful nor versatile thiazide diuretic.
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DOI：
10.1097/hco.0000000000000178
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发表时间：
2015-07
影响因子：
2.3
通讯作者：
Vongpatanasin W
中科院分区：
文献类型：
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作者：
Vongpatanasin W
确定氢氯噻嗪（HCTZ）相对于其他噻嗪类利尿剂治疗高血压的有效性和通用性。氢氯噻嗪（HCTZ）降低血压的效力低于其他噻嗪类利尿剂，包括氯噻酮（CTD）和苄氟噻嗪。最近的一项荟萃分析也表明，HCTZ（每日12.5-25 mg）的效力低于其他几类抗高血压药物，包括血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂和钙拮抗剂。与CTD相比，HCTZ相关的低钠血症、低钾血症和高尿酸血症的风险较低，而痛风性关节炎的风险相似。尽管代谢副作用的风险较低，但临床试验的荟萃分析显示，对于达到的临床收缩压的任何给定差异，与CTD相比，HCTZ治疗与高18%的不良心血管事件相关。越来越多的证据表明，HCTZ在降低高血压患者的血压和心血管结局方面劣于同类其他药物，特别是氯噻酮和吲达帕胺。因此，HCTZ既不是比其他噻嗪类利尿剂更有用，也不是通用的。在大多数需要利尿剂治疗高血压的高血压患者中，CTD和吲达帕胺应优于HCTZ。
To determine usefulness and versatility of hydrochlorothiazide (HCTZ) relative to other thiazide diuretics in the treatment of hypertension. Hydrochlorothiazide (HCTZ) was found to be less potent in lowering BP than other thiazide diuretics, including chlorthalidone (CTD) and bendroflumethiazide. A recent meta-analysis also suggested HCTZ (12.5–25 mg daily) to be less potent than antihypertensive agents from several other classes, including angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium antagonists. The risk of hyponatremia, hypokalemia, and hyperuricemia associated with HCTZ was lower than CTD while the risk of gouty arthritis was similar. Despite lower risks of metabolic side effects, meta-analysis of clinical trials showed that, for any given difference in achieved clinic systolic BP, HCTZ therapy was associated with 18% higher adverse cardiovascular events when compared to CTD. Increasing evidence suggested inferiority of HCTZ in lowering BP and cardiovascular outcomes in hypertensive patients when compared to other drugs in the same class, particularly chlorthalidone and Indapamide. Thus, HCTZ is neither more useful nor versatile than other thiazide diuretics. CTD and indapamide should be preferred over HCTZ in most hypertensive patients when diuretics are required for treatment of hypertension.