Lacourcière Y, Gagné C
Hypertension Unit, Université Laval, Québec, Canada.
J Hum Hypertens. 1993 Apr;7(2):149-52.
The effects of the combination of captopril and hydrochlorothiazide at modest doses of plasma lipids, lipoproteins and apolipoproteins were investigated in 139 patients with mild to moderate primary hypertension. Following an eight week wash-out period and a 4 week period of monotherapy with either captopril or hydrochlorothiazide, the combination of captopril 50 mg and hydrochlorothiazide 25 mg daily was given for 16 weeks. All factors known to affect plasma lipids were held constant throughout the study (i.e. diet, weight, exercise, caffeine, tobacco). There were significant reductions in total and low density lipoprotein-cholesterol (P < 0.01), total cholesterol/high density lipoprotein-cholesterol (P < 0.001) and low density lipoprotein/high density lipoprotein-cholesterol (P < 0.01) ratios. These favourable changes were significant only in patients whose baseline values were above the 90th centile adjusted for age and sex. The combination had a neutral effect on plasma lipids in patients with normal values. The data suggest that the combination of captopril and hydrochlorothiazide at modest doses does not induce deleterious changes in lipid profile and warrant further long-term controlled studies. This antihypertensive regimen may thus represent an advantageous alternative in subjects with a potentially atherogenic lipoprotein profile.
在139例轻至中度原发性高血压患者中，研究了中等剂量的卡托普利和氢氯噻嗪联合用药对血浆脂质、脂蛋白和载脂蛋白的影响。经过8周的洗脱期和4周单用卡托普利或氢氯噻嗪的治疗期后，给予患者每日50 mg卡托普利和25 mg氢氯噻嗪联合用药16周。在整个研究过程中，所有已知影响血浆脂质的因素均保持恒定（即饮食、体重、运动、咖啡因、烟草）。总胆固醇和低密度脂蛋白胆固醇显著降低（P<0.01），总胆固醇/高密度脂蛋白胆固醇（P<0.001）和低密度脂蛋白/高密度脂蛋白胆固醇（P<0.01）比值也显著降低。这些有利变化仅在基线值高于根据年龄和性别调整后的第90百分位数的患者中显著。该联合用药对血脂正常的患者血脂无影响。数据表明，中等剂量的卡托普利和氢氯噻嗪联合用药不会引起血脂谱的有害变化，值得进一步进行长期对照研究。因此，这种抗高血压方案可能是具有潜在致动脉粥样硬化脂蛋白谱的患者的一个有利选择。
