最新一期的爱思唯尔期刊《美国高血压学会杂志》(Journal of the American Society of Hypertension)刊登了美国范德比尔特大学医学中心的一项最新研究，研究发现高血压患者如果优化组合他们的药物治疗方案，会大大减少患心脏病突发死亡的危险。
高血压是冠心病的危险因素，积极控制高血压对于减少心脏病猝死有重要意义。目前，高血压治疗都会建议使用噻嗪利尿剂，这种药物可以作为那些开始治疗或已经应用降压药物治疗患者的一线药物，它们有非常显著的降低血压和减少高血压并发症的效果，另外费用较低，患者的治疗依从性好。但是，使用利尿剂降压药会导致低血钾，所以这种药物也被称为耗尽钾，研究已表明，钾的“耗尽”与心脏猝死有很大的关系。
在最新研究中，科学家发现，结合噻嗪利尿剂与留钾利尿剂药物治疗高血压病可以降低心脏性猝死和冠心病的死亡率约40%。保钾利尿剂不仅不会产生低钾，还可使血钾升高。因此，必要时两类利尿剂合用，也可减少血钾异常。研究人员将继续通过临床试验来进一步研究。
aSection of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
bDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
cDepartment of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
dDepartment of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
eDivision of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
fDivision of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
gHypertension and Cardiovascular Rehabilitation Unit, University of Leuven K. U. Leuven, Leuven, Belgium
Abstract
No reduction in either coronary mortality or sudden cardiac death (SCD) has been demonstrated in overviews of randomized trials of treatment of hypertension with diuretics. An overview was conducted of coronary mortality and SCD in randomized controlled antihypertensive trials in which an epithelial sodium channel (ENaC) inhibitor/hydrochlorothiazide (HCTZ) combination was used. Secondarily, an analogous overview in which thiazide diuretic was used alone was performed. Randomized trials that used an ENaC inhibitor/HCTZ combination (or, alternatively, thiazide diuretic alone) were identified from previous meta-analyses, searches of PubMed, search of the Cochrane Clinical Trials database, and review of publications that addressed the consequences of treating hypertension. Trials in which participants were randomized to either an ENaC inhibitor combined with a thiazide diuretic (or to a thiazide diuretic alone) or to control treatment for at least 1 year and in which coronary mortality was reported were included. Numbers of events in individual trials were abstracted independently by two authors. Significant reductions in both coronary mortality and SCD were observed in the overview of trials in which elderly patients received an ENaC inhibitor/HCTZ combination. The odds ratio (OR) for coronary mortality was 0.59 (95% confidence interval [CI], 0.44 to 0.78) and for SCD was 0.60 (95% CI, 0.38 to 0.94). In contrast, an overview of the trials using thiazide diuretics alone showed no significant reductions of either coronary mortality (OR, 0.94; 95% CI, 0.81 to 1.09) or SCD (OR, 1.27; 95% CI, 0.93 to 1.75). Use of an ENaC inhibitor combined with HCTZ for treatment of hypertension in the elderly results in favorable effects on coronary mortality and SCD.
Keywords: Potassium; ventricular tachyarrhythmia; inhibitor/hydrochlorothiazide; meta-analysis
