Which is a Better Treatment for Hypertensive Patients with Diabetes: A Combination of Losartan and Hydrochlorothiazide or a Maximum Dose of Losartan?
Which is a Better Treatment for Hypertensive Patients with Diabetes: A Combination of Losartan and Hydrochlorothiazide or a Maximum Dose of Losartan?
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DOI：
10.3109/10641963.2013.776564
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发表时间：
2013-01-01
影响因子：
12.3
通讯作者：
Baba, Yasuto
中科院分区：
文献类型：
--
作者：
Nishimura, Haruo;Shintani, Mitsuyo;Baba, Yasuto
背景资料：这项为期12个月的研究比较了氯沙坦50 mg和氢氯噻嗪12.5 mg联合治疗与最大剂量氯沙坦（100 mg）治疗高血压合并糖尿病患者的效果。方法：这是一项多中心、随机、开放性研究。结果：从基线到第3个月，两组的收缩压/舒张压下降幅度相似。两组的UACR也有类似的下降。仅在最大剂量组中观察到尿酸显著降低。1年后，联合治疗组的eGFR降低。结论：在密切监测代谢参数的情况下，氯沙坦和利尿剂的组合可能是此类高血压合并糖尿病患者的有用选择。在高尿酸血症和肾功能受损的患者中，最大剂量的氯沙坦可能更有益。
Background: This 12-month study compared the effects of a combination of losartan 50 mg and hydrochlorothiazide 12.5 mg with a maximum dose of losartan (100 mg) in hypertensive patients with diabetes. Methods: This was a multicenter randomized open-label study. Results: A similar reduction in systolic/diastolic blood pressure from baseline to month 3 was observed in both groups. There was also a similar decrease in UACR in both groups. A significant decrease in uric acid was observed in the maximum-dose group only. eGFR decreased in the combination group after 1 year. Conclusions: The combination of losartan and a diuretic may be a useful option in such hypertensive patients with diabetes, provided that metabolic parameters are closely monitored. In patients with hyperuricemia and impaired renal function, a maximum dose of losartan may be more beneficial.