Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Swiss National Centre of Competence in Research (NCCR) Kidney.CH, University of Zürich, Zürich, Switzerland.
Acta Physiol (Oxf). 2024 Jul;240(7):e14155. doi: 10.1111/apha.14155. Epub 2024 May 3.
Thiazide and thiazide-like diuretics (thiazides) belong to the most frequently prescribed drugs worldwide. By virtue of their natriuretic and vasodilating properties, thiazides effectively lower blood pressure and prevent adverse cardiovascular outcomes. In addition, through their unique characteristic of reducing urine calcium, thiazides are also widely employed for the prevention of kidney stone recurrence and reduction of bone fracture risk. Since their introduction into clinical medicine in the early 1960s, thiazides have been recognized for their association with metabolic side effects, particularly impaired glucose tolerance, and new-onset diabetes mellitus. Numerous hypotheses have been advanced to explain thiazide-induced glucose intolerance, yet underlying mechanisms remain poorly defined. Regrettably, the lack of understanding and unpredictability of these side effects has prompted numerous physicians to refrain from prescribing these effective, inexpensive, and widely accessible drugs. In this review, we outline the pharmacology and mechanism of action of thiazides, highlight recent advances in the understanding of thiazide-induced glucose intolerance, and provide an up-to-date discussion on the role of thiazides in kidney stone prevention.
噻嗪类和噻嗪样利尿剂（噻嗪类药物）属于全球最常开处方的药物。由于其具有利钠和血管扩张作用，噻嗪类药物可有效降低血压并预防不良心血管结局。此外，通过其独特的降低尿钙特性，噻嗪类药物也广泛用于预防肾结石复发和降低骨折风险。自 20 世纪 60 年代初引入临床医学以来，噻嗪类药物已被认为与代谢副作用有关，特别是糖耐量受损和新发糖尿病。已经提出了许多假设来解释噻嗪类药物引起的葡萄糖不耐受，但潜在机制仍未明确定义。遗憾的是，对这些副作用缺乏了解和不可预测性促使许多医生避免开这些有效、廉价且广泛可用的药物。在这篇综述中，我们概述了噻嗪类药物的药理学和作用机制，强调了对噻嗪类药物引起的葡萄糖不耐受的理解的最新进展，并对噻嗪类药物在预防肾结石中的作用进行了最新讨论。
