Triamterene Enhances the Blood Pressure Lowering Effect of Hydrochlorothiazide in Patients with Hypertension.
Triamterene Enhances the Blood Pressure Lowering Effect of Hydrochlorothiazide in Patients with Hypertension.
复制标题
氨苯蝶啶增强氢氯噻嗪对高血压患者的降压作用。
DOI：
10.1007/s11606-015-3469-1
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发表时间：
2016
影响因子：
5.7
通讯作者：
Pratt,JHoward
中科院分区：
文献类型：
--
作者：
Tu,Wanzhu;Decker,BrianS;He,Zangdong;Erdel,BlakeL;Eckert,GeorgeJ;Hellman,RichardN;Murray,MichaelD;Oates,JohnA;Pratt,JHoward
氨苯蝶啶因其保钾特性，常与氢氯噻嗪（HCTZ）联合用于治疗高血压患者。通过抑制皮质集合管中的上皮钠通道（ENaC），氨苯蝶啶减少钾分泌，从而降低低钾血症的风险。氨苯蝶啶是否对血压（BP）具有独立的作用还没有得到很好的研究。为了确定氨苯蝶啶是否对用HCTZ治疗的患者提供进一步降低BP的作用，我们使用来自印第安纳州患者护理网络的电子病历数据进行了一项观察性研究。研究对象为2004年至2012年期间诊断为高血压的17，291例患者。我们通过倾向评分分析比较了服用HCTZ、氨苯蝶啶和氨苯蝶啶的患者之间的血压，无论是单独服用还是与其他降压药物联合服用。对于每种药物组合，我们估计了倾向评分（即，使用逻辑回归模型分析患者接受氨苯蝶啶的概率。将具有相似倾向评分的患者分为亚类，并在每个亚类中比较服用氨苯蝶啶或不服用氨苯蝶啶的患者的血压;然后通过结合所有亚类估计的血压差异来评估氨苯蝶啶的效果。（p< 0.0001）;氨苯蝶啶与其他药物联合治疗的患者收缩压同样较低。不同药物组合一致观察到收缩压降低。收缩压降低的范围为1和4毫米汞柱之间，这取决于同时使用的medications.CONCLUSIONSIn本研究中，氨苯蝶啶被发现提高HCTZ降低血压的效果。除了其保钾作用外，还应考虑氨苯蝶啶降低血压的能力。
BACKGROUNDTriamterene, because of its potassium-sparing properties, is frequently used in combination with hydrochlorothiazide (HCTZ) to treat patients with hypertension. By inhibiting the epithelial sodium channel (ENaC) in the cortical collecting duct, triamterene reduces potassium secretion, thus reducing the risk of hypokalemia. Whether triamterene has an independent effect on blood pressure (BP) has not been well studied.OBJECTIVETo determine if triamterene provides an effect to further lower BP in patients treated with HCTZ.DESIGNWe conducted an observational study using electronic medical record data from the Indiana Network for Patient Care. Participants were 17,291 patients with the diagnosis of hypertension between 2004 and 2012.MAIN MEASURESBP was the primary outcome. We compared the BP between patients who were taking HCTZ, with and without triamterene, either alone or in combination with other antihypertensive medications, by using a propensity score analysis. For each medication combination, we estimated the propensity score (i.e., probability) of a patient receiving triamterene using a logistic regression model. Patients with similar propensity scores were stratified into subclasses and BP was compared between those taking triamterene or not within each subclass; the effect of triamterene was then assessed by combining BP differences estimated from all subclasses.KEY RESULTSThe mean systolic BP in the triamterene + HCTZ group was 3.8 mmHg lower than in the HCTZ only group (p< 0.0001); systolic BP was similarly lower for patients taking triamterene with other medication combinations. Systolic BP reduction was consistently observed for different medication combinations. The range of systolic BP reduction was between 1 and 4 mm Hg, depending on the concurrently used medications.CONCLUSIONSIn the present study, triamterene was found to enhance the effect of HCTZ to lower BP. In addition to its potassium-sparing action, triamterene’s ability to lower BP should also be considered.