Garcá Puig J, Miranda M E, Mateos F, Herrero E, Lavilla P, Gil A
Department of Internal Medicine and Clinical Biochemistry, La Paz Hospital, Universidad Autónoma, Madrid, Spain.
J Clin Pharmacol. 1991 May;31(5):455-61. doi: 10.1002/j.1552-4604.1991.tb01903.x.
The metabolic side effects of thiazide diuretics are believed to be responsible for the failure of thiazide diuretics to reduce cardiovascular morbidity in patients with hypertension. However, the decrease in the incidence of osteoporotic fractures that are associated with thiazide administration may be relevant in elderly patients with arterial hypertension. Spironolactone (SP) appears not to influence the metabolic risk profile of the patient with hypertension, and no studies have examined its effect on calcium metabolism. Therefore, in 22 patients with mild to moderate essential hypertension, the authors performed a parallel, randomized, double-blind, placebo-controlled study that compared the effects on serum urate and lipid, potassium, magnesium, and calcium metabolism of hydrochlorothiazide (HC) (mean [+/- SD] dose, 72 +/- 26 mg/d) and SP (144 +/- 53 mg/d) during a 52-week period. As compared with placebo, HC significantly increased serum urate and total cholesterol concentrations, and decreased serum potassium levels. SP did not affect serum urate or cholesterol levels but increased serum potassium concentrations. Neither diuretic significantly modified magnesium metabolism. Little changes were seen in serum calcium levels during HC or SP treatment, whereas urinary calcium excretion was significantly decreased by HC (mean decrease, 45%; P less than .01) or SP (40%; P less than .01). The authors conclude that SP, in addition to its potassium-sparing properties, has a calcium-sparing effect that may be beneficial for patients in whom reduction of urinary calcium excretion has a therapeutic value.
噻嗪类利尿剂的代谢副作用被认为是其未能降低高血压患者心血管疾病发病率的原因。然而，噻嗪类药物给药相关的骨质疏松性骨折发生率的降低可能与老年高血压患者相关。螺内酯（SP）似乎不影响高血压患者的代谢风险状况，且尚无研究考察其对钙代谢的影响。因此，作者对22例轻度至中度原发性高血压患者进行了一项平行、随机、双盲、安慰剂对照研究，比较了在52周期间氢氯噻嗪（HC）（平均[±标准差]剂量，72±26mg/d）和SP（144±53mg/d）对血清尿酸、脂质、钾、镁和钙代谢的影响。与安慰剂相比，HC显著升高血清尿酸和总胆固醇浓度，并降低血清钾水平。SP不影响血清尿酸或胆固醇水平，但升高血清钾浓度。两种利尿剂均未显著改变镁代谢。在HC或SP治疗期间，血清钙水平变化不大，而HC（平均降低45%；P<0.01）或SP（40%；P<0.01）使尿钙排泄显著减少。作者得出结论，SP除了具有保钾特性外，还具有保钙作用，这可能对尿钙排泄减少具有治疗价值的患者有益。
