Winchester J F, Kellett R J, Boddy K, Boyle P, Dargie H J, Mahaffey M E, Ward D M, Kennedy A C
Clin Pharmacol Ther. 1980 Nov;28(5):611-8. doi: 10.1038/clpt.1980.211.
A double-blind crossover comparison was made in 18 nonedematous hypertensive subjects with glomerular filtration rates exceeding 70 ml/min/1.73 m2 of the effects of 5 mg metolazone and 5 mg bendroflumethiazide on blood pressure and metabolic parameters. After a 4-wk run-in placebo period, patients received either metolazone or bendroflumethiazide for 6 wk in a crossover fashion with an intervening washout period of 4 wk. Metolazone induced a more sustained and greater blood pressure response than bendroflumethiazide. Changes in plasma potassium, urate, bicarbonate, renin, and angiotensin II occurred during treatment with both metolazone and bendroflumethiazide; the only significant difference, however, was in changes in plasma bicarbonate. Total body potassium (TBK), measured by whole-body monitor, did not fall outside the normal range with either metolazone or bendroflumethiazide, although metolazone induced a greater reduction in TBK (6.2 gm, 5.5% of TBK) than bendroflumethiazide (1.2 gm, 1.1% of TBK, p < 0.05). Our results suggest that metolazone is a more effective antihypertensive and induces similar but greater metabolic changes than bendroflumethiazide. The results of our comparison suggest that although changes in plasma potassium and TBK are minor, they are greater with metolazone, and potassium supplements may not be necessary in nonedematous hypertensive patients with normal renal function.
对18名肾小球滤过率超过70 ml/min/1.73 m²的非水肿性高血压患者进行了双盲交叉比较，观察5 mg美托拉宗和5 mg苄氟噻嗪对血压和代谢参数的影响。在为期4周的导入安慰剂期后，患者以交叉方式接受美托拉宗或苄氟噻嗪治疗6周，中间有4周的洗脱期。美托拉宗比苄氟噻嗪引起更持久、更大的血压反应。在美托拉宗和苄氟噻嗪治疗期间，血浆钾、尿酸盐、碳酸氢盐、肾素和血管紧张素II均发生变化；然而，唯一显著的差异在于血浆碳酸氢盐的变化。通过全身监测仪测量的全身钾（TBK），使用美托拉宗或苄氟噻嗪时均未超出正常范围，尽管美托拉宗导致的TBK降低幅度（6.2 g，占TBK的5.5%）大于苄氟噻嗪（1.2 g，占TBK的1.1%，p < 0.05）。我们的结果表明，美托拉宗是一种更有效的抗高血压药物，与苄氟噻嗪相比，可引起相似但更大的代谢变化。我们的比较结果表明，尽管血浆钾和TBK的变化较小，但美托拉宗导致的变化更大，对于肾功能正常的非水肿性高血压患者，可能无需补充钾。
