Lemieux G, Beauchemin M, Vinay P, Gougoux A
Can Med Assoc J. 1980 Apr 19;122(8):905-7.
In a study of 50 patients with uncomplicated arterial hypertension the administration of hydrochlorothiazide, 50 to 100 mg daily or every other day, with or without reserpine, 0.25 mg daily, resulted in a fall in the mean blood pressure from 182/113 to 144/92 mm Hg. The mean duration of therapy was 19 months. The mean serum potassium concentration was 4.3 mmol/l before the onset of therapy. It fell during the first 6 weeks of treatment, but seldom below 3.5 mmol/l, then rose gradually and spontaneously to 4.1 mmol/l after 19 months of therapy. All the patients remained asymptomatic. These findings bring into question the routine use of potassium supplements or a potassium-sparing diuretic, such as spironolactone or triamterene, during the treatment of hypertension with diuretics such as the thiazides. The use of potassium supplements or a potassium-sparing agent may induce hyperkalemia in spite of the simultaneous administration of a diuretic that acts more proximally. Since hyperkalemia is potentially lethal, the serum potassium concentration should be carefully monitored in any patient receiving potassium supplements or a potassium-sparing agent.
在一项针对50例单纯性动脉高血压患者的研究中，每日或隔日给予50至100毫克氢氯噻嗪，无论是否联用每日0.25毫克利血平，患者平均血压从182/113毫米汞柱降至144/92毫米汞柱。平均治疗时长为19个月。治疗开始前平均血清钾浓度为4.3毫摩尔/升。治疗前6周血清钾浓度下降，但很少低于3.5毫摩尔/升，之后逐渐自发上升，治疗19个月后升至4.1毫摩尔/升。所有患者均无相关症状。这些发现对使用噻嗪类利尿剂治疗高血压时常规补充钾剂或使用保钾利尿剂（如螺内酯或氨苯蝶啶）提出了质疑。尽管同时使用了作用于更近端的利尿剂，但补充钾剂或使用保钾药物仍可能诱发高钾血症。由于高钾血症有潜在致死风险，对于任何接受钾剂补充或保钾药物治疗的患者，都应密切监测血清钾浓度。
