利尿剂治疗高血压的回顾与展望

Diuretics in Treatment of Hypertension: A Review and Update

临床研究和实践证实利尿剂治疗高血压能有效降压和减少心血管事件的发生风险,为国内外指南一致性推荐的高血压初始和维持的一线药物。利尿剂(尤其是大剂量时)能够产生低钠血症、低钾血症、高血糖、高血脂和高尿酸血症等。现从利尿剂分类、作用机制、循证学证据、注意事项、联合策略及其临床证据和指南推荐等方面进行阐述,将有助于利尿剂在高血压治疗中定位的认识与应用。

Clinical research and practice have indicated that diuretics can effectively decrease blood pressure and reduce the risk of cardiovascular events in the treatment of hypertension. In addition,diuretics are consistently recommended as a initial drug or persistent drug use for the first-line treatment of hypertension by guidelines at home and abroad. However, the use of diuretics, while often effective, especially in large doses, can result in hyponatrernia, hypokalemia, hyperglycemia, hyperlipoidemia, hyperuricemia and more. Therefore, this paper reviewed the classification, mechanism, evidence-based medicine, attentions of diuretics, its combination strategy, clinical evidence and guidelines recommendation,which contributes to understand positioning and application of diuretics in the treatment of hypertension.