Kooter Albertus J, Smulders Yvo M
VU Medisch Centrum, Amsterdam, Afd. Interne Geneeskunde, Amsterdam, The Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A1608.
Thiazide diuretics have been the cornerstone in the pharmacological treatment of hypertension for more than 5 decades. Hydrochlorothiazide and chlorthalidone have been the 2 most commonly used diuretics in major clinical trials and are considered interchangeable. Nonetheless, hydrochlorothiazide has been much more widely prescribed than chlorthalidone, especially since nearly all available combinations with other antihypertensive drugs contain hydrochlorothiazide. However, whereas chlorthalidone at low doses has been shown repeatedly to reduce cardiovascular morbidity and mortality, such low doses of hydrochlorothiazide have never been shown to do this. Moreover, in direct comparison, chlorthalidone has a more sustained antihypertensive effect than hydrochlorothiazide, probably due to its very long half-life. These beneficial effects on blood pressure and cardiovascular events make chlorthalidone a tenable choice for the treatment of hypertension.
五十多年来，噻嗪类利尿剂一直是高血压药物治疗的基石。在主要临床试验中，氢氯噻嗪和氯噻酮是最常用的两种利尿剂，被认为可以相互替代。尽管如此，氢氯噻嗪的处方量比氯噻酮广泛得多，特别是因为几乎所有与其他降压药物的复方制剂都含有氢氯噻嗪。然而，虽然低剂量氯噻酮已被反复证明可降低心血管发病率和死亡率，但低剂量氢氯噻嗪从未被证明有此效果。此外，直接比较显示，氯噻酮的降压作用比氢氯噻嗪更持久，这可能归因于其极长的半衰期。这些对血压和心血管事件的有益作用使氯噻酮成为治疗高血压的合理选择。
