Creighton University School of Medicine, Omaha, Nebraska, USA.
Mary Lanning Healthcare, Hastings, Nebraska, USA.
J Clin Hypertens (Greenwich). 2022 Oct;24(10):1310-1315. doi: 10.1111/jch.14564. Epub 2022 Sep 6.
Chlorthalidone (CTD) may be superior to hydrochlorothiazide (HCTZ) in the reduction of adverse cardiovascular events in hypertensive patients. The mechanism of the potential benefit of CTD could be related to antiplatelet effects. The objective of this study was to determine if CTD or HCTZ have antiplatelet effects. This study was a prospective, double-blind, randomized, three-way crossover comparison evaluating the antiplatelet effects of CTD, HCTZ, and aspirin (ASA) in healthy volunteers. The effects of these treatments on platelet activation and aggregation were assessed using a well-established method with five standard platelet agonists. Thirty-four patients completed the three-way crossover comparing pre- and post-treatment changes in platelet activation and aggregation studies. There were statistically significant antiplatelet effects with ASA but not with CTD or HCTZ. Hypokalemia occurred in 0 (0%), 10 (30%), and 6 (18%) of the ASA, CTD, and HCTZ patients, respectively. The results of our study suggest that the benefits of CTD and HCTZ in reducing adverse cardiovascular events in patients with hypertension is not a result of an antiplatelet effect. In our study, hypokalemia with CTD was more prevalent than that reported in a large outcome trial in patients with hypertension. The clinical relevance of this finding is uncertain.
氯噻酮（CTD）在降低高血压患者不良心血管事件方面可能优于氢氯噻嗪（HCTZ）。CTD 潜在益处的机制可能与抗血小板作用有关。本研究旨在确定 CTD 或 HCTZ 是否具有抗血小板作用。这是一项前瞻性、双盲、随机、三向交叉比较研究，评估 CTD、HCTZ 和阿司匹林（ASA）对健康志愿者的抗血小板作用。使用五种标准血小板激动剂建立的成熟方法评估这些治疗对血小板激活和聚集的影响。34 名患者完成了三向交叉比较，比较了血小板激活和聚集研究前后的变化。ASA 具有统计学显著的抗血小板作用，但 CTD 或 HCTZ 没有。低血钾分别发生在 0（0%）、10（30%）和 6（18%）例 ASA、CTD 和 HCTZ 患者中。我们的研究结果表明，CTD 和 HCTZ 在降低高血压患者不良心血管事件方面的益处不是抗血小板作用的结果。在我们的研究中，与高血压患者的大型结局试验报道相比，CTD 引起的低血钾更为常见。这一发现的临床意义尚不确定。
