Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Clin Ther. 2013 Sep;35(9):1423-30. doi: 10.1016/j.clinthera.2013.07.430. Epub 2013 Aug 29.
There are few data available examining the clinical impact of switching patients from hydrochlorothiazide (HCTZ) to chlorthalidone for blood pressure management.
The goal of this study was to compare within-patient clinic blood pressure readings, serum electrolyte levels, and renal function markers before and after a medication change from HCTZ to chlorthalidone in a veteran population.
This was a retrospective, pre- and postmeasure, self-controlled study. Veterans Affairs Ann Arbor Healthcare System patients switched from HCTZ to chlorthalidone between January 1, 2001, and January 31, 2012, who had at least 1 follow-up clinic blood pressure reading recorded between 2 and 8 weeks from the date of the medication change were included in the study. Mean pre- and postmeasure values for systolic and diastolic clinic blood pressures, serum potassium, serum sodium, serum calcium, serum creatinine, and blood urea nitrogen were compared by using a 2-tailed, paired t test with a significance level (α) of 0.05.
Of the 40 patients included in the study 95% were male, 65% were white, and the mean age was 64.9 (10.8) years. Both mean systolic (-15.8 mm Hg [95% CI, 8.9 to 22.6], P < 0.0001) and mean diastolic (-4.2 mm Hg [95% CI, 1.5 to 6.9], P = 0.0035) blood pressures showed statistically and clinically significant reductions after the medication change. A statistically significant decrease in mean sodium (-1.1 mmol/L [95% CI, 0.4 to 1.9], P = 0.003) and an increase in mean serum creatinine (0.06 mg/dL [95% CI, -0.09 to -0.02], P = 0.002) was observed; however, these changes may not be viewed as clinically significant by many practitioners. No statistically significant changes were observed in any of the other outcomes examined. Most patients (38 of 40) were taking at least 1 additional antihypertensive agent; 73% of patients were using ≥ 3 antihypertensive agents at the time of the medication change.
In patients with hypertension already taking HCTZ, switching to chlorthalidone seems to further reduce systolic and diastolic blood pressures without any clinically significant changes in renal function or electrolyte levels.
目前仅有少量数据可用于评估将患者的降压治疗方案由氢氯噻嗪（HCTZ）转换为氯噻酮所产生的临床影响。
本研究旨在比较退伍军人人群中，将降压治疗方案由 HCTZ 转换为氯噻酮前后，患者的门诊血压读数、血清电解质水平和肾功能标志物的变化。
这是一项回顾性、前后自身对照研究。2001 年 1 月 1 日至 2012 年 1 月 31 日期间，退伍军人事务部安阿伯医疗保健系统的患者将 HCTZ 转换为氯噻酮，且在药物转换日期后 2 至 8 周内至少有 1 次门诊血压记录，将其纳入研究。采用双侧配对 t 检验比较收缩压和舒张压的门诊血压、血清钾、血清钠、血清钙、血清肌酐和血尿素氮的治疗前后平均值，检验水准（α）为 0.05。
在纳入的 40 例患者中，95%为男性，65%为白人，平均年龄为 64.9（10.8）岁。药物转换后，平均收缩压（-15.8mmHg [95%置信区间，8.9 至 22.6]，P<0.0001）和平均舒张压（-4.2mmHg [95%置信区间，1.5 至 6.9]，P=0.0035）均显著下降，且具有统计学意义。同时，观察到平均血清钠（-1.1mmol/L [95%置信区间，0.4 至 1.9]，P=0.003）显著降低，血清肌酐（0.06mg/dL [95%置信区间，-0.09 至 -0.02]，P=0.002）轻度升高，但许多医生可能并不认为这些变化具有临床意义。在其他检测的结果中，未观察到有统计学意义的变化。大多数患者（40 例中的 38 例）至少服用了 1 种其他降压药物；药物转换时，73%的患者使用≥3 种降压药物。
对于已经服用 HCTZ 的高血压患者，转换为氯噻酮似乎可进一步降低收缩压和舒张压，而肾功能或电解质水平无任何临床意义的变化。
