Licht J H, Haley R J, Pugh B, Lewis S B
Arch Intern Med. 1983 Sep;143(9):1694-9. doi: 10.1001/archinte.143.9.1694.
Intolerable side effects and hypokalemia during thiazide treatment of hypertension frequently necessitate a change in diuretic regimen. The hypokalemic effects, effectiveness in controlling BP, and cost of several alternate diuretic regimens were evaluated. Prevalences of serum K+ values less than 3.5 mEq/L were as follows for the various regimens: hydrochlorothiazide, 50 mg daily, 11.0% (n = 500); chlorthalidone, 25 mg daily, 8.1% (n = 37); triamterene, 100 mg, plus hydrochlorothiazide, 50 mg daily, 5.3% (n = 357); hydrochlorothiazide, 25 mg daily, 2.2% (n = 183); and furosemide, 40 mg daily, 3.5% (n = 284). In paired studies comparing hydrochlorothiazide with alternate diuretic regimens, potassium conservation was comparable with furosemide, the triamterene/hydrochlorothiazide combination, the spironolactone/hydrochlorothiazide combination, and adding potassium, 37 mEq daily. All alternate diuretic regimens were as effective as hydrochlorothiazide in controlling BP. Furosemide reduced serum glucose and calcium levels compared with hydrochlorothiazide. When these factors and costs are considered, furosemide appears to be the most cost-effective alternative in patients with hypertension in whom intolerable side effects or hypokalemia develops while taking hydrochlorothiazide.
噻嗪类药物治疗高血压期间出现难以耐受的副作用和低钾血症时，常常需要改变利尿剂治疗方案。我们评估了几种替代利尿剂方案的低钾血症效应、控制血压的有效性以及成本。各种方案血清钾离子浓度低于3.5 mEq/L的发生率如下：氢氯噻嗪每日50 mg，为11.0%（n = 500）；氯噻酮每日25 mg，为8.1%（n = 37）；氨苯蝶啶100 mg加氢氯噻嗪每日50 mg，为5.3%（n = 357）；氢氯噻嗪每日25 mg，为2.2%（n = 183）；以及呋塞米每日40 mg，为3.5%（n = 284）。在比较氢氯噻嗪与替代利尿剂方案的配对研究中，保钾效果与呋塞米、氨苯蝶啶/氢氯噻嗪联合用药、螺内酯/氢氯噻嗪联合用药以及每日补充37 mEq钾相当。所有替代利尿剂方案在控制血压方面与氢氯噻嗪同样有效。与氢氯噻嗪相比，呋塞米可降低血清葡萄糖和钙水平。综合考虑这些因素和成本，对于服用氢氯噻嗪时出现难以耐受的副作用或低钾血症的高血压患者，呋塞米似乎是最具成本效益的替代药物。
