Ramsay L E, Silas J H, Freestone S
Br Med J. 1980 Oct 25;281(6248):1101-3. doi: 10.1136/bmj.281.6248.1101.
In patients with hypertension resistant to three or four drugs including a thiazide diuretic substitution of frusemide for the thiazide, or the addition of spironolactone, produced significant reductions in blood pressure and body weight. The response did not depend on the presence of overt fluid retention, renal impairment, or the use of antihypertensive drugs of high potency. Women had larger responses than men. Expansion of the plasma or extracellular fluid volume is an important cause of resistance to treatment even when a thiazide diuretic is used. An increase in diuretic treatment should be tried before using the postganglionic adrenergic blockers or minoxidil in resistant hypertension.
在使用包括噻嗪类利尿剂在内的三到四种药物治疗仍耐药的高血压患者中，用呋塞米替代噻嗪类利尿剂，或加用螺内酯，可使血压和体重显著降低。这种反应不取决于是否存在明显的液体潴留、肾功能损害或使用高效能抗高血压药物。女性的反应比男性更明显。即使使用噻嗪类利尿剂，血浆或细胞外液容量的增加也是治疗耐药的一个重要原因。在耐药性高血压中，在使用节后肾上腺素能阻滞剂或米诺地尔之前，应尝试增加利尿剂治疗。
