Effects of withdrawing diuretic therapy on blood pressure in mild hypertension.
Effects of withdrawing diuretic therapy on blood pressure in mild hypertension.
复制标题
停止利尿治疗对轻度高血压患者血压的影响。
DOI：
10.1161/01.hyp.5.4.539
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发表时间：
1983
期刊：
影响因子：
8.3
通讯作者：
C. Castle
中科院分区：
文献类型：
--
作者：
L. Maland;L. J. Lutz;C. Castle
对一组62例既往控制良好的轻度高血压患者进行了一项为期1年的双盲安慰剂对照研究，研究利尿剂停药的影响。收集了血压（BP）、生化实验室值和副作用的主观报告数据。26%的安慰剂组受试者和3%的活性药物治疗组受试者达到了高血压复发（逆转）的预设标准。所有未恢复的安慰剂治疗患者的平均收缩压和舒张压均显示统计学显著性升高。通过重新开始利尿剂治疗，恢复者的血压迅速恢复控制。两组之间未报告副作用的实质性差异，实验室变化与噻嗪类和噻嗪类利尿剂的已知代谢作用一致。这项研究表明，治疗停药后的逆转率比其他研究者以前报告的要低得多。它还显示，安慰剂组患者的血压显著升高，但没有恢复。长期利尿剂治疗在有反应的轻度高血压患者中保持其有效性，潜在地提供保护，防止与甚至轻微的BP升高相关的死亡率和发病率增加的风险。不建议轻度高血压患者停用利尿剂，除非使用其他同样有效的干预措施来维持最佳血压控制。
A 1-year double-blind placebo-controlled study on the effects of diuretic withdrawal was conducted on a group of 62 previously well-controlled, mildly hypertensive patients. Data were collected on blood pressure (BP), biochemical laboratory values, and subjective reports of side-effects. Twenty-six percent of placebo subjects and 3% of the active treatment subjects reached preset criteria for the return of hypertension (reverters). The average systolic and diastolic pressures of all placebo-treated patients who did not revert showed statistically significant increases. BP control was quickly reestablished in reverters by restarting diuretic therapy. No substantial differences in side-effects were reported between the groups, and laboratory changes were those consistent with known metabolic effects of thiazide and thiazide-like diuretics. This study showed a much lower reversion rate after treatment withdrawal than previously reported by other investigators. It also showed significant increases in BP of placebo patients who did not revert. Long-term diuretic therapy retains its effectiveness in responsive mild hypertensive patients, potentially offering protection against the increased risks of mortality and morbidity associated with even slight elevations of BP. Withdrawal of diuretics cannot be recommended for patients with mild hypertension without use of other equally effective interventions to maintain optimum BP control.