Preuss H G, Burris J F
Department of Medicine, Georgetown University Medical Center, Washington DC, USA.
Drug Saf. 1996 Jun;14(6):355-64. doi: 10.2165/00002018-199614060-00001.
Adverse metabolic effects have been associated with drugs used in the therapy of hypertension, especially diuretics and beta-blockers. These effects include electrolyte, glucose/insulin, lipid and uric acid disturbances. This may explain, at least in part, why early trials examining the impact of antihypertensive pharmacotherapy with diuretics and beta-blockers showed beneficial effects on coronary artery disease that fell disappointingly short of the predicted effect. Among therapeutic drugs, diuretics cause disturbances in electrolyte homeostasis, e.g. hypokalaemia, hypomagnesaemia, and hyponatraemia. In contrast, ACE inhibitors cause hyperkalaemia under certain circumstances. Both diuretics and beta-blockers, especially nonselective beta-blockers that lack intrinsic sympathomimetic capabilities, have been associated with disturbances in glucose/insulin metabolism and can cause deleterious alterations in the profile of circulating plasma lipids. Hyperuricaemia, associated with diuretic use, appears to be a problem only in those patients who are predisposed to high circulating levels of uric acid.
不良代谢效应与用于治疗高血压的药物有关，尤其是利尿剂和β受体阻滞剂。这些效应包括电解质、葡萄糖/胰岛素、脂质和尿酸紊乱。这至少可以部分解释为什么早期研究利尿剂和β受体阻滞剂的抗高血压药物治疗对冠状动脉疾病影响的试验显示出对冠状动脉疾病的有益作用，但令人失望地未达到预期效果。在治疗药物中，利尿剂会导致电解质稳态紊乱，例如低钾血症、低镁血症和低钠血症。相比之下，血管紧张素转换酶抑制剂在某些情况下会导致高钾血症。利尿剂和β受体阻滞剂，尤其是缺乏内在拟交感神经活性的非选择性β受体阻滞剂，都与葡萄糖/胰岛素代谢紊乱有关，并且会导致循环血浆脂质谱的有害改变。与使用利尿剂相关的高尿酸血症似乎仅在那些易发生高循环尿酸水平的患者中才是一个问题。
