• 四川大學華西醫(yī)院老年病科（成都，610041）;

利尿劑因降壓效果強，能顯著降低心血管事件且價格低廉，一直被各國高血壓指南和專家共識推薦為一線降壓藥物。在老年高血壓人群中尤是如此。長期使用利尿劑有一定的不良反應(yīng)，但合理的、小劑量的使用，能實現(xiàn)有效的降壓和靶器官保護作用，避免不良事件發(fā)生。

引用本文： 李君,張新軍. 利尿劑在老年高血壓治療中的應(yīng)用. 華西醫(yī)學, 2012, 27(12): 1902-1905. doi: 復制

1. 　張新軍. 利尿劑的合理應(yīng)用[M]// 張廷杰, 徐俊波. 社區(qū)常見慢性病常規(guī)防治手冊·心腦血管疾病分冊. 成都: 四川出版集團天地出版社，2010: 207-216.
2. 　Safar M, Laurent S, Safavian A, et al. Sodium and large arteries in hypertension. Effects of indapamide[J]. Am J Med, 1988, 84(1B): 15-19.
3. 　Safar ME, Asmar R, Benetos A, et al. Sodium, large arteries, and diuretic compounds in hypertension[J]. Am J Med Sci, 1994, 307( Suppl 1): 3-8.
4. 　Matrougui K, Lévy BI, Schiavi P, et al. Indapamide improves flow-induced dilation in hypertensive rats with a high salt intake[J]. J Hypertens, 1998, 16(10): 1485-1490.
5. 　Kool MJ, Lustermans FA, Breed JG, et al. The influence of perindopril and the diuretic combination amiloride + hydrochlorothiazide on the vessel wall properties of large arteries in hypertensive patients[J]. J Hypertens, 1995, 13(8): 839-848.
6. 　Girerd X, Giannattasio C, Moulin C, et al. Regression of radial artery wall hypertrophy and improvement of carotid artery compliance after long-term antihypertensive treatment in elderly patients[J]. J Am Coll Cardiol, 1998, 31(5): 1064-1073.
7. 　Kithas PA, Supiano MA. Spironolactone and hydrochlorothiazide decrease vascular stiffness and blood pressure in geriatric hypertension[J]. J Am Geriatr Soc, 2010, 58(7): 1327-1332.
8. 　Winer N, Weber MA, Sowers JR. The effect of antihypertensive drugs on vascular compliance[J]. Curr Hypertens Rep, 2001, 3(4): 297-304.
9. 　張新軍. 從老年高血壓病理生理特點看血管緊張素受體拮抗劑與噻嗪類利尿劑聯(lián)合治療的價值[J]. 中華高血壓雜志, 2012, 20(5): 414-418.
10. 　Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure:meta-analysis of 11000 participants from 42 trials[J]. Am J Med, 2009, 122(3): 290-300.
11. 　Kang S, Wu YF, An N, et al. A systematic review and Meta-analysis of the efficacy and safety of a fixed, low-dose perindopril-indapamide combination as first-line treatment of hypertension[J]. Clin Ther, 2004, 26(2): 257-270.
12. 　Heran BS, Chen JM, Wang JJ, et al. Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension[J]. Cochrane Database Syst Rev, 2010, 20(1): CD008167.
13. 　Sica DA, Carter B, Cushman W, et al. Thiazide and loop diuretics[J]. J Clin Hypertens, 2011, 13(9): 639-643.
14. 　Tropeano AI, Saleh N, Hawajri N, et al. Do all antihypertensive drugs improve carotid intima-media thickness? A network meta-analysis of randomized controlled trials[J]. Fundam Clin Pharmacol, 2011, 25(3): 395-404.
15. 　Cherchi A, Sau F, Seguro C. Possible regression of left ventricular hypertrophy during antihypertensive treatment with diuretics and/or beta blockers[J]. J Clin Hypertens, 1987, 3(2): 216-225.
16. 　Raki? D, Rumboldt Z, Bagatin J, et al. Effects of four antihypertensive monotherapies on cardiac mass and function in hypertensive patients with left ventricular hypertrophy: randomized prospective study[J]. Croat Med J, 2002, 43(6): 672-679.
17. 　Papademetriou V, Gottdiener JS, Narayan P, et al. Hydrochlorothiazide is superior to isradipine for reduction of left ventricular mass: results of a multicenter trial. The Isradipine Study Group[J]. J Am Coll Cardiol, 1997, 30(7): 1802-1808.
18. 　Mottram PM, Haluska B, Leano R, et al. Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure[J]. Circulation, 2004, 110(5): 558-565.
19. 　Mourad JJ, Le Jeune S. Evaluation of high dose of perindopril/indapamide fixed combination in reducing blood pressure and improving end-organ protection in hypertensive patients[J]. Curr Med Res Opin, 2009, 25(9): 2271-2280.
20. 　Bulpitt CJ, Beckett NS, Peters R, et al. Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET) [J]. J Hum Hypertens, 2012, 26(3): 157-163.
21. 　Beckett NS, Peters R, Flecher AE, et al. Treatment of hypertension in patients 80 years of age or older[J]. N Engl J Med, 2008, 358(18): 1887-1898.
22. 　SHEP Cooperative Reaserch Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension.Final results of the systolic hypertension in the elderly program (SHEP) [J]. JAMA, 1991, 265(24): 3255-3264.
23. 　Cushman WC, Davis BR, Pressel SL, et al. Mortality and morbidity during and after the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial[J]. J Clin Hypertens (Greenwich), 2012, 14(1): 20-31.
24. 　Wassertheil-Smoller S, Psaty B, Greenland P, et al. Association between cardiovascular outcomes and antihypertensive drug treatment in older women[J]. JAMA, 2004, 292(23): 2849-2859.
25. 　Yasar S, Lin FM, Fried LP, et al. Diuretic use is associated with better learning and memory in older adults in the Ginkgo Evaluation of Memory study[J]. Alzheimers Dement, 2012, 8(3): 188-195.
26. 　Kooter AJ, Smulders YM. Chlorthalidone better than hydrochlorothiazide in hypertension[J]. Ned Tijdschr Geneeskd, 2010, 154: A1608.
27. 　Dorsch MP, Gillespie BW, Erickson SR, et al. Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis[J]. Hypertension, 2011, 57(4): 689-694.
28. 　Chow KM, Szeto CC, Wong TY, et al. Risk factors for thiazide-induced hyponatremia[J]. Q J M, 2003, 96(12): 911-917.
29. 　Sharabi Y, Illan R, Kamari Y, et al. Diuretic induced hyponatraemia in elderly hypertensive women[J]. J Hum Hypertens, 2002, 16(9): 631-635.
30. 　Takahashi Y, Nishida Y, Nakayama T, et al. Adverse effect profile of trichlormethiazide: a retrospective observational study[J]. Cardiovascular Diabetology, 2011, 10: 45.
31. 　Choi HK, Soriano LC, Zhang Y, et al. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study[J]. BMJ, 2012, 344: d8190.
32. 　繆京莉, 侯曉平, 尹巧香, 等. 雙氫克脲噻對老年高血壓患者糖、脂代謝及腎功能的影響[J]. 中國臨床保健雜志, 2007, 10(6): 619-620.
33. 　裴星, 牛敏. 利尿劑治療老年高血壓對糖脂代謝及腎功能的影響[J]. 中國社區(qū)醫(yī)師, 2007, 17(9): 17-18.
34. 　Greenberg A. Diuretic complications[J]. Am J Med Sci, 2000, 319(1): 10-24.
35. 　Carter BL, Einhorn PT, Brands M, et al. Thiazide-induced dysglycemia : call for research from a working group from the national heart, lung, and blood institute[J]. Hypertension, 2008, 52(1): 30-36.
36. 　Helderman JH, Elahi D, Andersen DK, et al. Prevention of the glucose intolerance of thiazide diuretics by maintenance of body potassium[J]. Diabetes, 1983, 32(2): 106-111.
37. 　Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review[J]. Hypertension, 2006 , 48(2): 219-224.
38. 　Ellison DH, Loffing J. Thiazide effects and adverse effects : insights from molecular genetics[J]. Hypertension, 2009, 54(2): 196-202.
39. 　Ayvaz G, Balos Törüner F, Karakoc A, et al. Acute and chronic effects of different concentrations of free fatty acids on the insulin secreting function of islets[J]. Diabetes Metab, 2002, 28(6 Pt 2):3S7-12.
40. 　Fujiwara W, Izawa H, Ukai G, et al. Low dose of hydrochlorothiazide, in combination with angiotensin receptor blocker, reduces blood pressure effectively without adverse effect on glucose and lipid profiles[J]. Heart Vessels, 2012, Mar 25. [Epub ahead of print] DOI: 10.1007/s00380-012-0246-5.
  1. 1. 　張新軍. 利尿劑的合理應(yīng)用[M]// 張廷杰, 徐俊波. 社區(qū)常見慢性病常規(guī)防治手冊·心腦血管疾病分冊. 成都: 四川出版集團天地出版社，2010: 207-216.
  2. 2. 　Safar M, Laurent S, Safavian A, et al. Sodium and large arteries in hypertension. Effects of indapamide[J]. Am J Med, 1988, 84(1B): 15-19.
  3. 3. 　Safar ME, Asmar R, Benetos A, et al. Sodium, large arteries, and diuretic compounds in hypertension[J]. Am J Med Sci, 1994, 307( Suppl 1): 3-8.
  4. 4. 　Matrougui K, Lévy BI, Schiavi P, et al. Indapamide improves flow-induced dilation in hypertensive rats with a high salt intake[J]. J Hypertens, 1998, 16(10): 1485-1490.
  5. 5. 　Kool MJ, Lustermans FA, Breed JG, et al. The influence of perindopril and the diuretic combination amiloride + hydrochlorothiazide on the vessel wall properties of large arteries in hypertensive patients[J]. J Hypertens, 1995, 13(8): 839-848.
  6. 6. 　Girerd X, Giannattasio C, Moulin C, et al. Regression of radial artery wall hypertrophy and improvement of carotid artery compliance after long-term antihypertensive treatment in elderly patients[J]. J Am Coll Cardiol, 1998, 31(5): 1064-1073.
  7. 7. 　Kithas PA, Supiano MA. Spironolactone and hydrochlorothiazide decrease vascular stiffness and blood pressure in geriatric hypertension[J]. J Am Geriatr Soc, 2010, 58(7): 1327-1332.
  8. 8. 　Winer N, Weber MA, Sowers JR. The effect of antihypertensive drugs on vascular compliance[J]. Curr Hypertens Rep, 2001, 3(4): 297-304.
  9. 9. 　張新軍. 從老年高血壓病理生理特點看血管緊張素受體拮抗劑與噻嗪類利尿劑聯(lián)合治療的價值[J]. 中華高血壓雜志, 2012, 20(5): 414-418.
  10. 10. 　Wald DS, Law M, Morris JK, et al. Combination therapy versus monotherapy in reducing blood pressure:meta-analysis of 11000 participants from 42 trials[J]. Am J Med, 2009, 122(3): 290-300.
  11. 11. 　Kang S, Wu YF, An N, et al. A systematic review and Meta-analysis of the efficacy and safety of a fixed, low-dose perindopril-indapamide combination as first-line treatment of hypertension[J]. Clin Ther, 2004, 26(2): 257-270.
  12. 12. 　Heran BS, Chen JM, Wang JJ, et al. Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension[J]. Cochrane Database Syst Rev, 2010, 20(1): CD008167.
  13. 13. 　Sica DA, Carter B, Cushman W, et al. Thiazide and loop diuretics[J]. J Clin Hypertens, 2011, 13(9): 639-643.
  14. 14. 　Tropeano AI, Saleh N, Hawajri N, et al. Do all antihypertensive drugs improve carotid intima-media thickness? A network meta-analysis of randomized controlled trials[J]. Fundam Clin Pharmacol, 2011, 25(3): 395-404.
  15. 15. 　Cherchi A, Sau F, Seguro C. Possible regression of left ventricular hypertrophy during antihypertensive treatment with diuretics and/or beta blockers[J]. J Clin Hypertens, 1987, 3(2): 216-225.
  16. 16. 　Raki? D, Rumboldt Z, Bagatin J, et al. Effects of four antihypertensive monotherapies on cardiac mass and function in hypertensive patients with left ventricular hypertrophy: randomized prospective study[J]. Croat Med J, 2002, 43(6): 672-679.
  17. 17. 　Papademetriou V, Gottdiener JS, Narayan P, et al. Hydrochlorothiazide is superior to isradipine for reduction of left ventricular mass: results of a multicenter trial. The Isradipine Study Group[J]. J Am Coll Cardiol, 1997, 30(7): 1802-1808.
  18. 18. 　Mottram PM, Haluska B, Leano R, et al. Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure[J]. Circulation, 2004, 110(5): 558-565.
  19. 19. 　Mourad JJ, Le Jeune S. Evaluation of high dose of perindopril/indapamide fixed combination in reducing blood pressure and improving end-organ protection in hypertensive patients[J]. Curr Med Res Opin, 2009, 25(9): 2271-2280.
  20. 20. 　Bulpitt CJ, Beckett NS, Peters R, et al. Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET) [J]. J Hum Hypertens, 2012, 26(3): 157-163.
  21. 21. 　Beckett NS, Peters R, Flecher AE, et al. Treatment of hypertension in patients 80 years of age or older[J]. N Engl J Med, 2008, 358(18): 1887-1898.
  22. 22. 　SHEP Cooperative Reaserch Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension.Final results of the systolic hypertension in the elderly program (SHEP) [J]. JAMA, 1991, 265(24): 3255-3264.
  23. 23. 　Cushman WC, Davis BR, Pressel SL, et al. Mortality and morbidity during and after the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial[J]. J Clin Hypertens (Greenwich), 2012, 14(1): 20-31.
  24. 24. 　Wassertheil-Smoller S, Psaty B, Greenland P, et al. Association between cardiovascular outcomes and antihypertensive drug treatment in older women[J]. JAMA, 2004, 292(23): 2849-2859.
  25. 25. 　Yasar S, Lin FM, Fried LP, et al. Diuretic use is associated with better learning and memory in older adults in the Ginkgo Evaluation of Memory study[J]. Alzheimers Dement, 2012, 8(3): 188-195.
  26. 26. 　Kooter AJ, Smulders YM. Chlorthalidone better than hydrochlorothiazide in hypertension[J]. Ned Tijdschr Geneeskd, 2010, 154: A1608.
  27. 27. 　Dorsch MP, Gillespie BW, Erickson SR, et al. Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis[J]. Hypertension, 2011, 57(4): 689-694.
  28. 28. 　Chow KM, Szeto CC, Wong TY, et al. Risk factors for thiazide-induced hyponatremia[J]. Q J M, 2003, 96(12): 911-917.
  29. 29. 　Sharabi Y, Illan R, Kamari Y, et al. Diuretic induced hyponatraemia in elderly hypertensive women[J]. J Hum Hypertens, 2002, 16(9): 631-635.
  30. 30. 　Takahashi Y, Nishida Y, Nakayama T, et al. Adverse effect profile of trichlormethiazide: a retrospective observational study[J]. Cardiovascular Diabetology, 2011, 10: 45.
  31. 31. 　Choi HK, Soriano LC, Zhang Y, et al. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study[J]. BMJ, 2012, 344: d8190.
  32. 32. 　繆京莉, 侯曉平, 尹巧香, 等. 雙氫克脲噻對老年高血壓患者糖、脂代謝及腎功能的影響[J]. 中國臨床保健雜志, 2007, 10(6): 619-620.
  33. 33. 　裴星, 牛敏. 利尿劑治療老年高血壓對糖脂代謝及腎功能的影響[J]. 中國社區(qū)醫(yī)師, 2007, 17(9): 17-18.
  34. 34. 　Greenberg A. Diuretic complications[J]. Am J Med Sci, 2000, 319(1): 10-24.
  35. 35. 　Carter BL, Einhorn PT, Brands M, et al. Thiazide-induced dysglycemia : call for research from a working group from the national heart, lung, and blood institute[J]. Hypertension, 2008, 52(1): 30-36.
  36. 36. 　Helderman JH, Elahi D, Andersen DK, et al. Prevention of the glucose intolerance of thiazide diuretics by maintenance of body potassium[J]. Diabetes, 1983, 32(2): 106-111.
  37. 37. 　Zillich AJ, Garg J, Basu S, et al. Thiazide diuretics, potassium, and the development of diabetes: a quantitative review[J]. Hypertension, 2006 , 48(2): 219-224.
  38. 38. 　Ellison DH, Loffing J. Thiazide effects and adverse effects : insights from molecular genetics[J]. Hypertension, 2009, 54(2): 196-202.
  39. 39. 　Ayvaz G, Balos Törüner F, Karakoc A, et al. Acute and chronic effects of different concentrations of free fatty acids on the insulin secreting function of islets[J]. Diabetes Metab, 2002, 28(6 Pt 2):3S7-12.
  40. 40. 　Fujiwara W, Izawa H, Ukai G, et al. Low dose of hydrochlorothiazide, in combination with angiotensin receptor blocker, reduces blood pressure effectively without adverse effect on glucose and lipid profiles[J]. Heart Vessels, 2012, Mar 25. [Epub ahead of print] DOI: 10.1007/s00380-012-0246-5.