Roush George C, Kaur Ramdeep, Ernst Michael E
1UCONN School of Medicine and St Vincent's Medical Center, Bridgeport, CT, USA.
J Cardiovasc Pharmacol Ther. 2014 Jan;19(1):5-13. doi: 10.1177/1074248413497257. Epub 2013 Nov 15.
Diuretics have been recommended as first-line treatment of hypertension and are also valuable in the management of hypervolemia and electrolyte disorders. This review summarizes the key features of the most commonly used diuretics. We then provide an update of clinical trials for diuretics during the past 5 years. Compared to other classes of medications, thiazide diuretics are at least as effective in reducing cardiovascular events (CVEs) in patients with hypertension and are more effective than β-blockers and angiotensin-converting enzyme inhibitors in reducing stroke. Observational cohort data and a network analysis have shown that CVEs are lowered by one-fifth from chlorthalidone when compared to the commonly used thiazide, hydrochlorothiazide. Relative to placebo, chlorthalidone increases life expectancy. In those aged 80 years and older, the diuretic, indapamide, lowers CVEs relative to placebo. The aldosterone antagonist, eplerenone, lowers total mortality in early congestive heart failure. The benefit of eplerenone following acute myocardial infarction (MI) is limited to administration within 3 to 6 days post-MI. Aldosterone antagonists have been shown to lower the incidence of sudden cardiac death and to reduce proteinuria. In the setting of heart failure, long acting loop diuretics azosemide and torasemide are more effective in improving heart failure outcomes than the far more commonly used short acting furosemide. Evening dosing of diuretics appears to lower CVEs relative to morning dosing. In conclusion, diuretics are a diverse class of drugs that remain extremely important in the management of hypertension and hypervolemic states.
利尿剂已被推荐作为高血压的一线治疗药物，在治疗血容量过多和电解质紊乱方面也很有价值。本综述总结了最常用利尿剂的关键特性。然后，我们提供了过去5年利尿剂临床试验的最新情况。与其他类别的药物相比，噻嗪类利尿剂在降低高血压患者心血管事件（CVE）方面至少同样有效，且在降低中风发生率方面比β受体阻滞剂和血管紧张素转换酶抑制剂更有效。观察性队列数据和网络分析表明，与常用的噻嗪类药物氢氯噻嗪相比，氯噻酮可使CVE降低五分之一。相对于安慰剂，氯噻酮可延长预期寿命。在80岁及以上的人群中，利尿剂吲达帕胺相对于安慰剂可降低CVE。醛固酮拮抗剂依普利酮可降低早期充血性心力衰竭的总死亡率。依普利酮在急性心肌梗死（MI）后的益处仅限于在MI后3至6天内给药。醛固酮拮抗剂已被证明可降低心源性猝死的发生率并减少蛋白尿。在心力衰竭的情况下，长效襻利尿剂阿佐塞米和托拉塞米在改善心力衰竭结局方面比更常用的短效呋塞米更有效。相对于早晨给药，晚上给药利尿剂似乎可降低CVE。总之，利尿剂是一类多样的药物，在高血压和血容量过多状态的管理中仍然极为重要。
