长期小剂量氢氯噻嗪的降压疗效观察

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

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。

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 significandy 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.