长期小剂量氢氯噻嗪的降压疗效观察

目的观察原发性高血压病患者长期服用小剂量氢氯噻嗪的降压疗效。方法232例轻、中度高血压病患者服用氢氯噻嗪12.5mg,每日1次,每月发放一次药物并测量血压,观察1年。比较服药6周及1年的降压疗效及生化指标的变化。结果(1)观察结束时资料完整的观察对象为231例,治疗后6周的收缩压、舒张压、平均动脉压下降值分别为(6.01±16.05)mmHg(1mmHg=0.133kPa)、(2.90±10.33)mmHg、(3.94±10.68)mmHg;治疗1年的收缩压、舒张压、平均动脉压下降值分别为(10.45±17.28)mmHg、(8.45±11.06)mmHg、(9.12±10.88)mmHg。1年时血压下降值高于6周时血压下降值,差异有统计学意义(P<0.05)。治疗6周时的降压达标率为20.3%,治疗1年时降压达标率为35.1%,差异有统计学意义(P<0.05)。(2)观察结束时未发现有症状的低钾血症,但血尿酸值明显增加,与基线值比较差异有统计学意义(P<0.05)。结论长期服用小剂量氢氯噻嗪可有效降低轻、中度原发性高血压患者的血压,对电解质、糖、脂代谢无明显不良影响。

Chronic effects of low-dose hydrochlorothiazide in patients with mild to moderate essential hypertension

OBJECTIVE: To investigate the chronic efficacy of low-dose hydrochlorothiazide (HCTZ) in patients with mild-to-moderate hypertension. METHODS: After a 2-weeks placebo run-in period, 232 patients with mild or moderate hypertension were recruited and received HCTZ (12.5 mg once daily) therapy for one year. Patient compliance and blood pressure were monitored and serum BUN, Cr, glucose, electrolytes, and lipids were measured before, 6 weeks and 1 year after treatment. RESULTS: (1) Reduction of SBP, DBP and MAP were more significantly at 1 year (10.45 +/- 17.28) mm Hg, (8.45 +/- 11.06) mm Hg, (9.12 +/- 10.88) mm Hg] than that at 6 weeks post therapy (6.01 +/- 16.05) mm Hg, (2.90 +/- 10.33) mm Hg, (3.94 +/- 10.68) mm Hg, all P < 0.05]. Blood pressure were reduced to normal in 35.1% patients at 1 year and in 20.3% patients at 6 weeks (P < 0.05). (2) No patient developed diabetes mellitus or hypokalemia during therapy while the serum uric acid at 1 year post therapy was significantly higher than that at before therapy (P < 0.05). CONCLUSION: The study indicates that low dose HCTZ is an effective and safe antihypertensive agent for patients with mild-to-moderate hypertension and uric acid changes during therapy need to be monitored.