使用噻嗪类药物治疗高血压和晚期慢性肾脏病。
Use of Thiazides to Treat Hypertension and Advanced CKD.
作者信息
Priamvada Gargi Sharma, Divyadarshini Divya Sharma, Voora Raven
机构信息
Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA.
Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India.
出版信息
Curr Cardiol Rep. 2022 Dec;24(12):2131-2137. doi: 10.1007/s11886-022-01817-y. Epub 2022 Oct 27.
PURPOSE OF REVIEW
Hypertension is often difficult to control in patients with CKD as manifested by suboptimal control rates in this population. Use of thiazides in CKD patients has been limited as these agents are thought to be ineffective in reducing blood pressure in people with advanced CKD. This review summarizes recent studies impacting indications and safety of use of thiazide in patients with CKD and discusses the mechanism of how thiazides reduce blood pressure.
RECENT FINDINGS
Chlorthalidone reduces blood pressure compared to placebo in patients with advanced CKD, challenging the belief that thiazide diuretics lose efficacy at lower levels of GFR. Recent clinical trial data indicate that thiazides are effective in patients with advanced kidney disease for blood pressure lowering. However, monitoring of electrolytes and kidney function is important to ensure patient safety when prescribing these agents in patients with CKD.
综述目的
慢性肾脏病（CKD）患者的高血压往往难以控制，这一人群的血压控制率不理想就体现了这一点。噻嗪类药物在CKD患者中的使用一直受到限制，因为人们认为这些药物对晚期CKD患者降低血压无效。本综述总结了近期影响噻嗪类药物在CKD患者中应用指征和安全性的研究，并讨论了噻嗪类药物降低血压的机制。
最新发现
与安慰剂相比，氯噻酮可降低晚期CKD患者的血压，这对噻嗪类利尿剂在较低肾小球滤过率（GFR）水平时失去疗效的观点提出了挑战。近期临床试验数据表明，噻嗪类药物对晚期肾病患者降低血压有效。然而，在给CKD患者开这些药物时，监测电解质和肾功能对于确保患者安全很重要。
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