Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L
Acta Med Scand Suppl. 1983;672:79-83. doi: 10.1111/j.0954-6820.1983.tb01617.x.
Three long-term, randomised trials examining antihypertensive treatment with either diuretics or beta-blockers are in progress. On the basis of these, the following conclusions may be drawn regarding metabolic side-effects. Diuretics decrease whereas beta-blockers increase serum potassium. Neither drug has any obvious influence on total body potassium. Serum urate increases on both drugs but more so in those taking diuretics. Serum triglycerides increase while total serum cholesterol is unchanged in both treatments. It is still a matter of controversy whether there is a decrease in glucose tolerance and an increase in the incidence of diabetes in patients on diuretics. The possible negative influence of metabolic side-effects on morbidity and mortality may limit the beneficial effects of blood pressure reduction, especially in patients with low pressures before treatment. Thus, it seems crucial to minimise theses side-effects. Since they are dose-related for both diuretics and beta-blockers, the use of low doses and, if needed, combination treatment is preferable.
三项关于使用利尿剂或β受体阻滞剂进行抗高血压治疗的长期随机试验正在进行中。基于这些试验，关于代谢副作用可得出以下结论。利尿剂会降低血清钾水平，而β受体阻滞剂会升高血清钾水平。两种药物对总体钾含量均无明显影响。两种药物都会使血清尿酸盐升高，但服用利尿剂的患者升高得更多。两种治疗方法都会使血清甘油三酯升高，而总血清胆固醇不变。利尿剂治疗的患者糖耐量是否降低以及糖尿病发病率是否增加仍存在争议。代谢副作用对发病率和死亡率可能产生的负面影响可能会限制血压降低的有益效果，尤其是在治疗前血压较低的患者中。因此，尽量减少这些副作用似乎至关重要。由于利尿剂和β受体阻滞剂的副作用都与剂量相关，因此使用低剂量药物，如有必要，联合治疗更为可取。
