抗高血压药物噻嗪类利尿剂应用新进展

New Application Progress of Thiazide Diuretics as Antihypertensive Drugs

目的介绍抗高血压药物噻嗪类利尿剂的应用新进展。方法以“噻嗪类”“利尿剂”“高血压”“氢氯噻嗪”“吲达帕胺”“氯噻酮”为中文关键词,以“thiazide”“diuretic”“hypertension”“hydrochlorothiazide”“indapamide”“chlorthalidone”为英文关键词,利用计算机检索中国知网、维普、PubMed及ScienceDirect等数据库中2015年10月至2020年10月的相关文献,总结利尿剂在抗高血压中的作用地位、噻嗪类利尿剂作用特点、低剂量利尿剂的应用,比较常用噻嗪类利尿剂的有效性和安全性。结果噻嗪类利尿剂氢氯噻嗪对收缩压的影响具有明显剂量依赖性,氯噻酮和吲达帕胺对舒张压影响小,且某些药物对血压的影响及其不良反应都存在剂量依赖性。噻嗪类利尿剂不同药物间存在差异性,多数文献支持噻嗪样利尿剂取代噻嗪型利尿剂,但噻嗪型利尿剂中的氢氯噻嗪在临床最常用。低剂量使用噻嗪类利尿剂可在保留大部分有效性的同时大幅降低不良反应发生率。结论噻嗪类利尿剂存在诸多临床应用问题未解决,不同噻嗪类利尿剂药物间的直接对比研究尚需进行。

Objective To introcluce the application progress of thiazide diuretics as antihypertensive drugs.Methods The″thiazides″″diuretic″″hypertension″″hydrochlorothiazide″″indapamide″and″chlorthalidone″were taken as keywords,t he relevant literature in CNKI,VIP,PubMed,ScienceDirect and other databases were searched from October 2015 to October 2020 to summarize the role of diuretics in antihypertension,the characteristics of thiazide diuretics and the application of low-dose diuretics,and to compare the effectiveness and safety of commonly used thiazide diuretics.Results Hydrochlorothiazide,a thiazide diuretic,had a significant dose-dependent influence on systolic blood pressure(SBP),chlorothiazide and indapamide had little influence on diastolic blood pressure,and some drugs had a dose-dependent effect on blood pressure and adverse reactions.There were differences among different thiazide diuretics.Most literature supported that thiazide-like diuretics should replace thiazide-type diuretics,but hydrochlorothiazide was the most commonly thiazide diuretics used in clinic.Low-dose use of thiazide diuretics could retain most of the effectiveness while significantly reduce the incidence of adverse reactions.Conclusion There are many unsolved problems in the clinical use of thiazide diuretics,and the head-to-head comparative study of different thiazide diuretics needs to be carried out.