Spinar J, Spinarová L, Vítovec J
Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice.
Vnitr Lek. 2013 Jun;59(6):486-94.
Diuretics belong to the basic group of medicines for the treatment of hypertension and heart failure. In the case of hypertension treatment, their main indication is higher age and isolated systolic hypertension. In the case of heart failure they are used for the treatment of swellings and shortness of breath. The most frequently prescribed group of diuretics is thiazides and similar products. In patients with renal insufficiency, loop diuretics are administered. In the case of hypertension, diuretics are mainly used in the combination treatment. The most frequently used diuretic in combination is again hydrochlorothiazide, which is combined with reninangiotensin system blockers. It is mainly the combination of an ACE inhibitor + indapamide that seems to be modern and promising, and it is, on the basis of large clinical trials, recommended also for diabetics (ADVANCE) or for secondary prevention following a cerebrovascular accident (PROGRESS) or for the elderly (HYVET). Also a combination of two diuretics is popular - mainly hydrochlorothiazide + amiloride. A combination of a betablocker and diuretic is less suitable.
利尿剂属于治疗高血压和心力衰竭的基本药物类别。在治疗高血压时,其主要适应症为高龄和单纯收缩期高血压。在治疗心力衰竭时,它们用于治疗水肿和呼吸急促。最常处方的利尿剂类别是噻嗪类及类似产品。对于肾功能不全的患者,使用袢利尿剂。在高血压治疗中,利尿剂主要用于联合治疗。联合治疗中最常用的利尿剂仍是氢氯噻嗪,它与肾素 - 血管紧张素系统阻滞剂联合使用。主要是ACE抑制剂 + 吲达帕胺的联合似乎既现代又有前景,并且基于大型临床试验,也推荐用于糖尿病患者(ADVANCE研究)、脑血管意外后的二级预防(PROGRESS研究)或老年人(HYVET研究)。两种利尿剂的联合也很常见——主要是氢氯噻嗪 + 阿米洛利。β受体阻滞剂和利尿剂的联合不太合适。