Perez-Stable E, Caralis P V
Am Heart J. 1983 Jul;106(1 Pt 2):245-51. doi: 10.1016/0002-8703(83)90124-2.
Long-term thiazide diuretic therapy for hypertension is associated with disturbances in carbohydrate, lipid, and potassium metabolism that theoretically may have serious adverse effects. It appears that diuretic-induced hypokalemia interferes with production of insulin, producing mild elevations of blood glucose in nondiabetic patients. The insulinopenia worsens glucose metabolism in prediabetic and type II diabetic patients. Increases in low-density lipoprotein cholesterol, triglycerides, and the low-density lipoprotein/high-density lipoprotein cholesterol ratio are frequently seen following thiazide treatment of hypertension. These changes are more pronounced in younger patients. Decrements of serum potassium of 0.6 mEq/L are commonly observed with diuretic therapy. Usually, patients remain asymptomatic and no potassium replacement is necessary. In patients with underlying heart disease, however, alterations in potassium metabolism may produce increased frequency and complexity of ventricular ectopic activity. All these metabolic disturbances appear to be, in part, dose related, and there is currently no evidence that they have clinical significance.
长期使用噻嗪类利尿剂治疗高血压与碳水化合物、脂质和钾代谢紊乱有关，理论上可能会产生严重的不良反应。利尿剂引起的低钾血症似乎会干扰胰岛素的产生，导致非糖尿病患者血糖轻度升高。胰岛素缺乏会使糖尿病前期和II型糖尿病患者的葡萄糖代谢恶化。噻嗪类药物治疗高血压后，低密度脂蛋白胆固醇、甘油三酯以及低密度脂蛋白/高密度脂蛋白胆固醇比值经常升高。这些变化在年轻患者中更为明显。利尿剂治疗通常会使血清钾降低0.6 mEq/L。通常，患者无症状，无需补钾。然而，在患有基础心脏病的患者中，钾代谢的改变可能会使室性异位活动的频率增加且情况更为复杂。所有这些代谢紊乱似乎在一定程度上与剂量有关，目前尚无证据表明它们具有临床意义。
