Chen Peng, Chaugai Sandip, Zhao Fujie, Wang Dao Wen
Departments of Internal Medicine and Institute of Hypertension, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. of China.
Am J Hypertens. 2015 Dec;28(12):1453-63. doi: 10.1093/ajh/hpv050. Epub 2015 Apr 29.
Thiazide diuretics (TD), including thiazide-type (chlorothiazide and hydrochlorothiazide) and thiazide-like diuretics (indapamide and chlorthalidone), have been used for the treatment of hypertension for more than 5 decades. This meta-analysis aimed to evaluate whether TD, including thiazide-type and thiazide-like diuretics have additional cardioprotective effects.
We performed a pooled study of 19 randomized clinical trials (RCTs). PubMed and EMBASE databases were searched for RCTs assessing TD treatment in patients with hypertension.
Nineteen RCTs involving 112,113 patients (56,802 in TD; 55,311 in control) were included. The incidence ratio of cardiac events (CVs) was 34.3 vs. 37.8 per 1,000 patient-years in patients randomized to TD and controls, respectively. TD treatment was associated with reductions in the risks of CVs (odds ratio (OR): 0.86, P = 0.007) and heart failure (OR: 0.62, P < 0.001), but not different in stroke (OR: 0.92, P = 0.438) or CHD (OR: 0.95, P = 0.378) between diuretics and controls. Further analysis showed that the observed benefits were mainly confined to thiazide-like diuretic therapy rather than thiazide-type diuretics with a significant reduction in the risk of CVs (OR: 0.78, P < 0.001), heart failure (OR: 0.57, P < 0.001) and stroke (OR: 0.82, P = 0.016).
This study suggests that use of TD in hypertensive patients results in a reduction in the risk of CVs. Moreover, thiazide-like diuretics have greater protective effect against CVs than thiazide-type diuretics, especially on heart failure, suggesting that preferential use of thiazide-like diuretics over thiazide-type diuretics may result in greater cardiovascular benefits in hypertensive patients.
噻嗪类利尿剂（TD），包括噻嗪型（氯噻嗪和氢氯噻嗪）和类噻嗪型利尿剂（吲达帕胺和氯噻酮），已用于治疗高血压五十多年。本荟萃分析旨在评估TD，包括噻嗪型和类噻嗪型利尿剂是否具有额外的心脏保护作用。
我们对19项随机临床试验（RCT）进行了汇总研究。在PubMed和EMBASE数据库中检索评估TD治疗高血压患者的RCT。
纳入了19项RCT，涉及112113例患者（TD组56802例；对照组55311例）。随机分配到TD组和对照组的患者，心脏事件（CVs）的发生率分别为每1000患者年34.3例和37.8例。TD治疗与CVs风险降低（比值比（OR）：0.86，P = 0.007）和心力衰竭风险降低（OR：0.62，P < 0.001）相关，但利尿剂组和对照组在中风（OR：0.92，P = 0.438）或冠心病（OR：0.95，P = 0.378）方面无差异。进一步分析表明，观察到的益处主要局限于类噻嗪型利尿剂治疗，而非噻嗪型利尿剂，其CVs风险（OR：0.78，P < 0.001）、心力衰竭风险（OR：0.57，P < 0.001）和中风风险（OR：0.82，P = 0.016）显著降低。
本研究表明，高血压患者使用TD可降低CVs风险。此外，类噻嗪型利尿剂对CVs的保护作用大于噻嗪型利尿剂，尤其是对心力衰竭，这表明在高血压患者中优先使用类噻嗪型利尿剂而非噻嗪型利尿剂可能会带来更大的心血管益处。
