Chlorthalidone for Poorly Controlled Hypertension in Chronic Kidney Disease: An Interventional Pilot Study
Chlorthalidone for Poorly Controlled Hypertension in Chronic Kidney Disease: An Interventional Pilot Study
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DOI：
10.1159/000358603
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发表时间：
2014-01-01
影响因子：
4.2
通讯作者：
Amrnous, Farah
中科院分区：
文献类型：
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作者：
Agarwal, Rajiv;Sinha, Arjun D.;Amrnous, Farah
为了验证在中晚期慢性肾脏病(CKD)中，噻嗪类利尿剂能有效降低血压(BP)的假设，在24小时动态血压监测证实高血压控制不佳后，在现有药物中加入氯苯吡酮25 mg/d，如果血压继续升高，剂量每4周翻一番。14名受试者的平均年龄为67.5岁，使用4种降压药的中位数，估计GFR为26.8+/-8.8ml/min/1.73m(2)。12名受试者完成了为期12周的治疗阶段，24小时血压从基线时的143.1/75.1毫米汞下降了10.5/3.1毫米汞(p=0.01/p=0.17)。服药前的家庭血压为152.4/82.6毫米汞柱，在第4、8和12周分别下降10.2/4.8、13.4/6.0和9.4/3.7毫米汞柱(均P<；0.05)。体重和总体积(通过空气置换体积图测量)的最大下降在8周时出现，同时血清肌酐浓度和血浆肾素活性也出现最大升高。蛋白尿显著减少40%-45%。7名受试者在接受氯替利酮治疗后出现了18种不良反应：低钾血症(n=4)、高尿酸血症(4)、低钠血症(3)、一过性肌酐改变(3)、头晕(2)、高血糖(1)和便秘(1)。一名受试者在研究过程中患上了缺血性中风。总而言之，在高血压控制不佳的中晚期CKD患者中，氯苯吡酮可能通过容量收缩显著降低血压；需要进行随机试验来确定风险和益处。不良反应可能在几周内发生，应仔细监测。(C)2014年S.Karger AG，巴塞尔
To test the hypothesis that thiazide-type diuretics effectively lower blood pressure (BP) in moderate to advanced chronic kidney disease (CKD; estimated GFR 20-45 ml/min/1.73 m(2)), after confirming poorly controlled hypertension with 24-hour ambulatory BP monitoring, chlorthalidone was added to existing medications in a dose of 25 mg/day, and the dose doubled every 4 weeks if the BP remained elevated. The average age of the 14 subjects was 67.5 years, a median of 4 antihypertensive drugs were used and estimated GFR was 26.8 +/- 8.8 ml/min/1.73 m(2). Twelve subjects completed the 12-week treatment phase, and the 24-hour BP, which was 143.1/75.1 mm Hg at baseline, was reduced by 10.5/3.1 mm Hg (p = 0.01/p = 0.17). Home BP prior to initiating chlorthalidone was 152.4/82.6 mm Hg and fell at 4, 8, and 12 weeks by 10.2/4.8, 13.4/6.0, and 9.4/3.7 mm Hg (all p < 0.05). Maximal reduction in body weight and total body volume (measured by air displacement plethysnnography) was seen at 8 weeks, concurrent with the maximal elevation in serum creatinine concentration and plasma renin activity. Albuminuria was significantly reduced by 40-45%. Adverse events were seen following chlorthalidone therapy in 7 subjects who experienced 18 events as follows: hypokalemia (n = 4), hyperuricemia (4), hyponatremia (3), transient creatinine changes (3), dizziness (2), hyperglycemia (1), and constipation (1). One subject had ischemic stroke during the study. In conclusion, among people with moderate to advanced CKD with poorly controlled hypertension, chlorthalidone may significantly reduce BP via volume contraction; a randomized trial is needed to define the risks and benefits. Adverse effects may occur within a few weeks and should be carefully monitored. (C) 2014 S. Karger AG, Basel