Diuretic therapy for hypertension and the risk of primary cardiac arrest.
Diuretic therapy for hypertension and the risk of primary cardiac arrest.
复制标题
DOI：
10.1097/00006205-199408000-00006
复制
发表时间：
1994-06
期刊：
影响因子：
--
通讯作者：
D. Siscovick;T. Raghunathan;B. Psaty;T. Koepsell;K. Wicklund;Xihong Lin;L. Cobb;P. Rautaharju;M. Copass;Edward H. Wagner
中科院分区：
文献类型：
--
作者：
D. Siscovick;T. Raghunathan;B. Psaty;T. Koepsell;K. Wicklund;Xihong Lin;L. Cobb;P. Rautaharju;M. Copass;Edward H. Wagner
背景冠心病一级预防的试验结果提示，大剂量噻嗪类利尿剂治疗高血压可能会增加心源性猝死的风险。相反，低剂量噻嗪治疗可降低冠心病的风险。方法：为了研究噻嗪类药物治疗高血压与原发性心脏骤停之间的关系，我们在一家健康维护组织的入组者中进行了一项基于人群的病例对照研究。病例患者为114例高血压患者，他们在1977年至1990年间发生原发性心脏骤停。对照患者为535例高血压患者分层随机抽样。使用计算机化药房数据库评估患者的治疗情况。回顾了他们的门诊护理记录，以确定其他临床特征。结果：接受噻嗪类药物联合保钾利尿剂治疗的患者发生原发性心脏骤停的风险低于不接受保钾噻嗪类药物治疗的患者（优势比为0.3；95%可信区间为0.1 ~ 0.7）。与低剂量噻嗪治疗（每天25mg）相比，中等剂量噻嗪治疗（每天50mg）与中度风险增加相关（优势比为1.7,95%可信区间为0.7 - 4.5），高剂量噻嗪治疗（每天100mg）与较大的风险增加相关（优势比为3.6,95%可信区间为1.2 - 10.8）（趋势P值为0.02）。在低剂量噻嗪治疗中加入保钾药物与心脏骤停风险降低相关（优势比为0.4；95%可信区间为0.1至1.5）。结论噻嗪类药物的剂量和保钾药物的加入均影响原发性心脏骤停的发生风险。这些结果可能解释了以往临床试验中降压治疗对冠心病死亡率影响的差异。
BACKGROUND The results of trials of the primary prevention of coronary heart disease have suggested that treating hypertension with high doses of thiazide diuretic drugs might increase the risk of sudden death from cardiac causes. In contrast, treatment with low doses of thiazide reduces the risk of coronary heart disease. METHODS To examine the association between thiazide treatment for hypertension and the occurrence of primary cardiac arrest, we conducted a population-based case-control study among enrollees of a health maintenance organization. The case patients were 114 persons with hypertension who had a primary cardiac arrest from 1977 through 1990. The control patients were a stratified random sample of 535 persons with hypertension. The patients' treatment was assessed with the use of a computerized pharmacy data base. Records of their ambulatory care were reviewed to determine other clinical characteristics. RESULTS The risk of primary cardiac arrest among patients receiving combined thiazide and potassium-sparing diuretic therapy was lower than that among patients treated with a thiazide without potassium-sparing therapy (odds ratio, 0.3; 95 percent confidence interval, 0.1 to 0.7). As compared with low-dose thiazide therapy (25 mg daily), moderate-dose therapy (50 mg daily) was associated with a moderate increase in risk (odds ratio, 1.7; 95 percent confidence interval, 0.7 to 4.5), and high-dose therapy (100 mg daily) was associated with a larger increase in risk (odds ratio, 3.6; 95 percent confidence interval, 1.2 to 10.8) (P value for trend, 0.02). The addition of a potassium-sparing drug to low-dose thiazide therapy was associated with a reduced risk of cardiac arrest (odds ratio, 0.4; 95 percent confidence interval, 0.1 to 1.5). CONCLUSIONS Both the dose of thiazide drugs and the addition of potassium-sparing drugs influence the risk of primary cardiac arrest. These results may explain the differences in the effect of antihypertensive therapy on mortality from coronary heart disease in previous clinical trials.