Semenkin A A
Ter Arkh. 2007;79(4):31-8.
To evaluate the influence of antihypertensive and metabolic effects of thiazide diuretics on vascular endothelial function and coronary risk (CR) in patients with essential hypertension (EH). Materials and methods. The study included 50 EH patients treated with indapamide retard (n = 25) or hydrochlorothiazide (n=25) during 12 weeks. Changes in blood pressure, blood lipid and glucose levels, Framingham algorithm-calculated coronary risk (CR), the brachial response to endothelium-dependent and endothelium-independent stimuli, studied by high-resolution ultrasound, were evaluated. Results. Indapamide retard (1.5 mg/day) and hydrochlorothiazide (25 mg/day) showed the similar antihypertensive effect. Indapamide retard was metabolically neutral whereas hydrochlorothiazide increased the blood levels of triglycerides and glucose by 15.3% (p < 0.05) and 12.2% (p < 0.05), respectively. The calculated CR decreased by 21.3% (p < 0.01) on indapamide retard treatment and practically unchanged on hydrochlorothiazide. There were significant group differences in the effects of the drugs on endothelium-dependent vasodilatation. The latter tended to improve by indapamide retard (+8.9%; p = 0.10) and to significantly worse by hydrochlorothiazide (-17.0%; p < 0.05). Hydrochlorothiazide-induced changes in total cholesterol, triglycerides, and low-density lipoprotein cholesterol were directly related to calculated CR changes (r = 0.69, r = 0.58, and r = 0.57, respectively; p < 0.01) and the changes in blood glucose levels were inversely related to those in vascular endothelial function (r = -0.52; p < 0.01). Such relations were not observed on indapamide retard. Conclusion. The negative metabolic effects of hydrochlorothiazide induce negative changes in vascular endothelial function just at early stages of therapy. These changes may be used as a predictor of a coronary risk during thiazide diuretic treatment in patients with EH.
评估噻嗪类利尿剂的降压及代谢作用对原发性高血压（EH）患者血管内皮功能和冠状动脉风险（CR）的影响。材料与方法。本研究纳入50例EH患者，分别接受缓释吲达帕胺治疗（n = 25）或氢氯噻嗪治疗（n = 25），为期12周。评估血压、血脂和血糖水平的变化、采用弗明汉算法计算的冠状动脉风险（CR），以及通过高分辨率超声研究的肱动脉对内皮依赖性和非内皮依赖性刺激的反应。结果。缓释吲达帕胺（1.5毫克/天）和氢氯噻嗪（25毫克/天）显示出相似的降压效果。缓释吲达帕胺对代谢无不良影响，而氢氯噻嗪使甘油三酯和血糖水平分别升高15.3%（p < 0.05）和12.2%（p < 0.05）。接受缓释吲达帕胺治疗时，计算得出的CR下降了21.3%（p < 0.01），而接受氢氯噻嗪治疗时CR几乎无变化。药物对内皮依赖性血管舒张的作用存在显著的组间差异。缓释吲达帕胺使内皮依赖性血管舒张有改善趋势（+8.9%；p = 0.10），而氢氯噻嗪使其显著恶化（-17.0%；p < 0.05）。氢氯噻嗪引起的总胆固醇、甘油三酯和低密度脂蛋白胆固醇的变化与计算得出的CR变化直接相关（分别为r = 0.69、r = 0.58和r = 0.57；p < 0.01），血糖水平的变化与血管内皮功能的变化呈负相关（r = -0.52；p < 0.01）。在缓释吲达帕胺治疗中未观察到此类关系。结论。氢氯噻嗪的负面代谢作用在治疗早期就会引起血管内皮功能的负面变化。这些变化可作为EH患者噻嗪类利尿剂治疗期间冠状动脉风险的预测指标。
