氢氯噻嗪所致血糖升高对心脑血管事件的影响  

Effects of hydrochlorothiazide-induced hyperglycemia on cardio-cerbrovascular events

作　　者：孙丽霞[1] 刘继强[2] 吴寿岭[3] 李金峰[3] 桑大森[3] 王丽晔[3] 李冬青[3] 郑维国[1] 佟秀梅[1] 

机构地区：[1]河北联合大学附属医院急诊科,唐山063000 [2]秦皇岛市北戴河医院内科 [3]河北联合大学附属开滦医院

出　　处：《中华高血压杂志》2011年第11期1055-1060,共6页Chinese Journal of Hypertension

摘　　要：目的探讨以氢氯噻嗪为基础的降压治疗期间,血糖升高对原发性高血压患者心脑血管事件的影响。方法选择轻中度原发性高血压患者829例,入选患者经安慰剂洗脱2周和氢氯噻嗪导入6周后随机给予氢氯噻嗪12.5mg/d或(氢氯噻嗪12.5mg/d+螺内酯20mg/d)或(氢氯噻嗪12.5mg/d+卡托普利25mg两次/d)治疗。依据患者随访期内各次空腹血糖水平,血糖值≥7mmol/L的患者为暴露组,血糖值<7mmol/L者为对照组。治疗期间每月随访1次,监测血压,记录终点事件,每年进行一次血生化指标检测。随访7年。结果暴露组与对照组基线资料的比较:暴露组91例,对照组486例,暴露组年龄、体质量指数(BMI)、收缩压、空腹血糖均高于对照组(P<0.05)。终点事件比较:随访结束时共计发生心脑血管事件76例,暴露组发生心脑血管事件12例(13.2%),对照组发生心脑血管事件64例(13.2%),两组心脑血管事件发生率的差异无统计学意义(P>0.05)。结论以小剂量噻嗪类利尿剂作为基础降压药物长期降压治疗中所致的血糖升高不会引起心脑血管事件发生率的增加。Objective investigate the effects of hyperglycemia due to hydrochlorothiazide-based antihypertensive treatment on cardiovascular and cerebrovascular events. Methods A total of 829 patients with mild to moderate hypertension were recruited. After 2-week placebo elution period and 6-week hydrochlorothiazide（ HCTZ） initiation period, the patients were randomly given HCTZ 12.5 mg qd or HCTZ 12.5 mg qd plus spironolactone 20 mg qd or HCTZ 12.5 mg qd plus captopril 25 mg bid. According to the levels of fasting plasma glucose, the patients were divided into exposed group （blood glucose level〈7 mmol/L} and control group （blood glucose level 〈7 mmol/L）. During the 7-year follow-up, blood pressure and endpoint events were recorded monthly, and blood biochemical detection was performed once a year. Results Baseline data were analyzed bwtween the two groups. The eases in exposed group and and control group were 91 and 486 respectively. Age, body mass index（BMI）, systolic blood pressure（SBP）, fasting plasma glucose in exposed group were higher than those in control group （P〈0.05）. During the period of follow-up, eardio-cerebrovascular events totalled 76 cases, of which 12 cases （13.2%） occurred in exposed group and 64 cases （ 13.2 % ） in control group. The incidence of cardio-cerebrovascular events between the two groups demonstrated no statistical difference（P〉0. 05）. Conclusion The incidence of cardio-cerebrovascular events did not correlate hyperglycemia induced by hydroehlorothiazide-based antihypertensive treatment.

关 键 词：血糖升高 原发性高血压 心脑血管事件 

分 类 号：R544.1[医药卫生—心血管疾病]