Low-dose antihypertensive treatment with a thiazide diuretic is not diabetogenic. A 10-year controlled trial with bendroflumethiazide.
Low-dose antihypertensive treatment with a thiazide diuretic is not diabetogenic. A 10-year controlled trial with bendroflumethiazide.
复制标题
使用噻嗪类利尿剂进行低剂量抗高血压治疗不会导致糖尿病。
DOI：
10.1111/j.0954-6820.1986.tb02790.x
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发表时间：
2009
影响因子：
--
通讯作者：
B. Widgren
中科院分区：
文献类型：
--
作者：
G. Berglund;O. Andersson;B. Widgren
观察两组男性高血压患者治疗1、2、4、6、10年后的血压和代谢指标，并随机分为两组，分别服用苯妥英2.5~5 mg/d和心得安160~320 mg/d。入选时，两组患者的血压或代谢变量没有显著差异。两种治疗方法对血压均有相同程度的降低。普萘洛尔组中5名男性和噻嗪组中1名男性在随访期间发展为临床显性糖尿病。空腹血糖略有上升，但在两组中都很明显。两组患者最初的口服葡萄糖耐量受损程度相同，但在两种药物的治疗过程中显著改善。空腹胰岛素略有升高，但幅度相同。噻嗪组在血钾显著下降的同时，全身钾无明显变化。普萘洛尔组血钾升高，全身钾显著下降。两组患者的血尿酸均升高，但在噻嗪治疗期间略有增加。每组均发现1例痛风。两组间血脂水平无明显差异。这项长期试验的结果表明，在患有轻中度高血压的中年男性中，低剂量的噻嗪类利尿剂，如苯达氟甲肼，是一种与β-受体阻滞剂心得安一样有效和安全的降压药，而且不会导致糖尿病。总体临床情况支持将噻嗪类利尿剂保留为高血压的首选药物。
Blood pressure (BP) and metabolic variables were determined initially and after 1, 2, 4, 6 and 10 years' treatment in two groups of hypertensive men (n = 53 each) randomized to bendroflumethiazide 2.5-5 mg/day or propranolol 160-320 mg daily. There was no significant differences in BP or metabolic variables between the two groups at entry. BP was reduced to the same degree by both treatments. Five men in the propranolol group and one man in the thiazide group developed clinically overt diabetes during follow-up. Fasting blood sugar increased slightly but significantly though equally in both groups. Oral glucose tolerance was initially impaired to the same degree in both groups but improved significantly during treatment with both drugs. Fasting insulin increased slightly but to the same degree. While serum potassium decreased significantly in the thiazide group, the total body potassium was unchanged in this group. In the propranolol group, serum potassium rose, while total body potassium decreased significantly. Serum urate increased in both groups, though slightly more during thiazide treatment. One case of gout was found in each group. There was no difference in serum lipids between the two groups. The finding in this long-term trial indicate that in middle-aged men with mild to moderate hypertension a low-dose thiazide diuretic like bendroflumethiazide is as effective and safe an antihypertensive agent as the beta-blocker propranolol is and that it does not induce diabetes. The total clinical picture favors the retention of thiazide diuretics as a first choice drug in hypertension.