Department of Clinical Pharmacology, King's College London British Heart Foundation Centre, London, UK.
Br J Clin Pharmacol. 2022 May;88(5):1964-1977. doi: 10.1111/bcp.15156. Epub 2021 Dec 23.
By contrast with drugs inhibiting the renin-angiotensin-aldosterone system (RAAS), diuretics stimulate renin release by the kidneys. Although plasma aldosterone (PA) is thought to be mainly regulated by RAAS activity, serum potassium has been shown to be an important factor in animal models and humans. Here we perform a systematic review and meta-analysis of randomised controlled trials (RCT) in hypertension investigating the effects of diuretic therapy on PA and the correlation of change in PA with that of potassium and blood pressure (BP).
Three databases were searched: MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Titles were first screened by title and abstract for relevance before full-text articles were assessed for eligibility according to a predefined inclusion/exclusion criteria.
A total of 1139 articles were retrieved, of which 42 met the prespecified inclusion/exclusion criteria. The average standardised difference in mean PA was similar for all classes of diuretic: thiazide/thiazide-like 0.299 (95% confidence interval [CI] 0.150, 0.447), loop 0.927 (0.37, 1.49), MRA/potassium-sparing 0.265 (0.173, 0.357) and combination 0.466 (0.137, 0.796), Q = 6.33, P = .097. In subjects untreated with another antihypertensive, there was a significant relationship between change in PA and change in systolic BP but no relationship with the change in potassium.
In RCTs of diuretic therapy in hypertension, there is an increase in PA with all classes of diuretic and no significant between-class heterogeneity. Change in PA is not related with potassium but correlates with the change in BP in subjects untreated with another antihypertensive medication.
与抑制肾素-血管紧张素-醛固酮系统（RAAS）的药物相比，利尿剂通过肾脏刺激肾素的释放。虽然认为血浆醛固酮（PA）主要受 RAAS 活性调节，但在动物模型和人类中已表明血清钾是一个重要因素。在此，我们对高血压中利尿剂治疗对 PA 的影响以及 PA 变化与钾和血压（BP）变化相关性的随机对照试验（RCT）进行了系统评价和荟萃分析。
我们在 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库（CENTRAL）这三个数据库中进行了搜索。首先通过标题和摘要筛选标题，然后根据预先确定的纳入/排除标准评估全文文章的资格。
共检索到 1139 篇文章，其中 42 篇符合预定的纳入/排除标准。所有类别的利尿剂的平均 PA 标准化差异相似：噻嗪类/噻嗪样物 0.299（95%置信区间 [CI] 0.150，0.447）、袢利尿剂 0.927（0.37，1.49）、MRA/保钾利尿剂 0.265（0.173，0.357）和联合用药 0.466（0.137，0.796），Q = 6.33，P = 0.097。在未接受另一种抗高血压药物治疗的受试者中，PA 变化与收缩压变化之间存在显著关系，但与钾变化之间无关系。
在高血压利尿剂治疗的 RCT 中，所有类型的利尿剂均可使 PA 升高，且无显著的类别间异质性。PA 的变化与钾无关，但与未接受另一种降压药物治疗的受试者的 BP 变化相关。
