Brass E P
Drugs. 1984 May;27(5):447-58. doi: 10.2165/00003495-198427050-00004.
Pharmacological treatment of hypertension can cause clinically significant alterations in endocrine function through effects on glucose homeostasis, thyroid and parathyroid hormones, adrenal steroid metabolism and reproductive/pituitary physiology. Long term use of thiazide diuretics causes deterioration in glucose tolerance, probably secondary to potassium depletion. Hypoglycaemic complications of beta-blockers (mainly the non-selective compounds) can be dramatic, especially in type I diabetics. Clonidine, diazoxide and calcium antagonists have all been associated with deterioration in glucose tolerance and their long term use should be avoided in type II diabetics if possible. Propranolol lowers T3 levels by decreasing the conversion of T4 to T3. Prazosin causes elevations in T4 and thyroid-stimulating hormone, while sodium nitroprusside use may result in hypothyroidism. Numerous agents are associated with sexual dysfunction, including methyldopa, reserpine, clonidine and spironolactone. Thiazide diuretics may cause hypercalcaemia, particularly in patients with hyperparathyroidism, by decreasing urinary calcium as well as directly influencing bone and gut calcium handling. Conversely, propranolol may decrease circulating parathyroid hormone levels and correct the hypercalcaemia seen in hyperparathyroidism. Awareness of drug-induced changes in endocrine function will facilitate the rational management of the hypertensive patient.
高血压的药物治疗可通过影响葡萄糖稳态、甲状腺和甲状旁腺激素、肾上腺类固醇代谢以及生殖/垂体生理功能，导致临床上显著的内分泌功能改变。长期使用噻嗪类利尿剂会导致糖耐量恶化，可能继发于钾缺乏。β受体阻滞剂（主要是非选择性化合物）的低血糖并发症可能很严重，尤其是在I型糖尿病患者中。可乐定、二氮嗪和钙拮抗剂都与糖耐量恶化有关，如果可能，II型糖尿病患者应避免长期使用。普萘洛尔通过减少T4向T3的转化来降低T3水平。哌唑嗪会导致T4和促甲状腺激素升高，而使用硝普钠可能会导致甲状腺功能减退。许多药物与性功能障碍有关，包括甲基多巴、利血平、可乐定和螺内酯。噻嗪类利尿剂可能会导致高钙血症，特别是在甲状旁腺功能亢进患者中，这是通过减少尿钙以及直接影响骨骼和肠道对钙的处理来实现的。相反，普萘洛尔可能会降低循环中的甲状旁腺激素水平，并纠正甲状旁腺功能亢进中出现的高钙血症。了解药物引起的内分泌功能变化将有助于对高血压患者进行合理管理。
