Bhigjee A I, Seedat Y K, Hoosen S, Neerahoo R M, Naidoo K
S Afr Med J. 1983 Dec 10;64(25):969-72.
Thirty-seven patients (19 Blacks and 18 Indians) suffering from mild hypertension were given each of five diuretics separately for 4 weeks after a 'washout' period on placebo of the same duration. The diuretics used were hydrochlorothiazide 25 mg/d (Dichlotride; Frosst MSD), hydrochlorothiazide 25 mg plus triamterene 50 mg (Dyazide; SKF) 1 tablet per day, amiloride hydrochloride 5 mg plus hydrochlorothiazide 50 mg (Moduretic; MSD) 1 tablet per day, chlorthalidone (Hygroton; Geigy) 50 mg/d and indapamide (Natrilix; Servier) 2.5 mg/d. The study showed that during the acute phase of diuretic therapy for the treatment of hypertension plasma potassium levels were decreased by thiazide and thiazide-like diuretics and increased by potassium-sparing diuretics. However, despite the decrease in plasma potassium levels produced by thiazide diuretics and indapamide these levels did not fall to 3.0 mmol/l or less. All the diuretics were effective in lowering the standing mean arterial pressure when compared with placebo values. In the absence of significant hypokalaemia, the choice of a diuretic for the Black hypertensive patient should therefore be determined by its cost.
37名患有轻度高血压的患者（19名黑人、18名印第安人）在经过为期相同的安慰剂“洗脱期”后，分别服用5种利尿剂，每种服用4周。所使用的利尿剂分别为氢氯噻嗪25毫克/天（双氢克尿噻；弗罗斯特·默克）、氢氯噻嗪25毫克加氨苯蝶啶50毫克（复方盐酸阿米洛利；史克必成）每日1片、盐酸阿米洛利5毫克加氢氯噻嗪50毫克（莫雷西嗪；默克）每日1片、氯噻酮（海吉妥；汽巴嘉基）50毫克/天和吲达帕胺（钠催离；施维雅）2.5毫克/天。研究表明，在利尿剂治疗高血压的急性期，噻嗪类和类噻嗪类利尿剂会使血浆钾水平降低，而保钾利尿剂会使其升高。然而，尽管噻嗪类利尿剂和吲达帕胺使血浆钾水平有所下降，但这些水平并未降至3.0毫摩尔/升或更低。与安慰剂值相比，所有利尿剂在降低静息平均动脉压方面均有效。因此，在没有明显低钾血症的情况下，黑人高血压患者利尿剂的选择应取决于其成本。
