小剂量氢氯噻嗪和螺内酯在难治性高血压治疗中的联合应用  

Combination Application of Low-Dose Hydrochlorothiazide and Spironolactone in the Treatment of Refractory Hypertension

作　　者：李丹 LI Dan(Department of Cardiology,Liaoyang Central Hospital,Liaoyang 111000,Liaoning Province,China)

机构地区：[1]辽阳市中心医院心内科,辽宁辽阳111000

出　　处：《中国实用乡村医生杂志》2024年第4期17-20,共4页Chinese Practical Journal of Rural Doctor

摘　　要：目的探讨小剂量氢氯噻嗪和螺内酯对难治性高血压(resistant hypertension,RH)患者的治疗效果。方法选择辽阳市中心医院2021年1月—2022年12月收治的RH患者80例,随机分为对照组和观察组各40例。两组患者基础治疗药物为硝苯地平、厄贝沙坦和哌唑嗪,对照组利尿剂选择小剂量氢氯噻嗪;而观察组则在其基础上加用小剂量螺内酯。比较两组治疗后心脏负荷、心脏结构及实验室指标变化情况。结果治疗2周后,观察组收缩压、舒张压低于对照组,差异有统计学意义(P<0.05);而两组心率差异无统计学意义(P>0.05)。治疗12周后,观察组左心房内径小于对照组,差异有统计学意义(P<0.05);而两组左心室内径、室间隔厚度差异无统计学意义(P>0.05)。治疗4周后,两组谷丙转氨酶、谷草转氨酶、尿素氮、肌酐、血钾、甘油三酯和总胆固醇差异无统计学意义(P>0.05)。结论小剂量氢氯噻嗪和螺内酯用于RH患者的治疗,可以进一步降低心脏负荷,改善心肌重塑,并且未对肝功、肾功、血脂造成明显的影响。Objective To explore the therapeutic effect of low-dose hydrochlorothiazide and spironolactone on patients with refractory hypertension(RH).Methods A total of 80 RH patients admitted to Liaoyang Central Hospital from January 2021 to December 2022 were randomly divided into a control group and an observation group,with 40 cases in each group.The basic treatment drugs for all patients were nifedipine,irbesartan,and prazosin.The control group chose low-dose hydrochlorothiazide as the diuretic,while the observation group added a small dose of spironolactone on top of it.The changes in cardiac load,cardiac structure,and laboratory indicators between two groups after treatment were compared.Results After 2 weeks of treatment,the systolic and diastolic blood pressure in the observation group were significantly lower than those in the control group(P<0.05).However,there was no significant difference in heart rate between the two groups(P>0.05).After 12 weeks of treatment,the left atrial diameter in the observation group was significantly smaller than that in the control group(P<0.05).However,there was no significant difference in left ventricular diameter and interventricular septum thickness between the two groups(P>0.05).After 4 weeks of treatment,there was no significant difference in the levels of alanine aminotransferase,aspartate aminotransferase,urea nitrogen,creatinine,blood potassium,triglycerides,and total cholesterol between the two groups(P>0.05).Conclusion Low dose hydrochlorothiazide and spironolactone can further reduce cardiac compliance,improve myocardial remodeling,and have no significant impact on liver function,kidney function,and blood lipids in the treatment of RH patients.

关 键 词：难治性高血压 氢氯噻嗪 螺内酯 联合 治疗 应用 

分 类 号：R544.1[医药卫生—心血管疾病]