Flack J M, Cushman W C
Department of Surgical Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157, USA.
Am J Med. 1996 Sep 30;101(3A):53S-60S. doi: 10.1016/s0002-9343(96)00268-9.
Diuretic monotherapy has been recommended by the fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC-V) as a preferred initial treatment for hypertension. Thiazide diuretics are commonly used to treat hypertension because of their demonstrated efficacy, favorable safety profile, low acquisition cost, and their proven ability to reduce blood pressure-related morbidity and mortality. Once-daily low-dose hydrochlorothiazide (12.5 mg/ day) or chlorthalidone (15 mg/day) effectively reduces blood pressure in patients with stage 1 or stage 2 hypertension in comparison with placebo. Blood pressure reductions with low-dose hydrochlorothiazide and chlorthalidone are comparable to that achieved with higher doses (25 and 50 mg/day). Additional blood pressure reductions can be attained with concomitant use of once-daily low-dose hydrochlorothiazide or chlorthalidone with an angiotensin-converting enzyme (ACE) inhibitor, a beta blocker, or a calcium antagonist. Once-daily low-dose hydrochlorothiazide provides clinically meaningful blood pressure lowering while minimizing adverse effects, such as electrolyte disturbances, cholesterol elevations, and increases in serum uric acid levels.
美国国家高血压检测、评估与治疗联合委员会（JNC-V）的第五次报告推荐将利尿剂单一疗法作为高血压的首选初始治疗方法。噻嗪类利尿剂因其已证实的疗效、良好的安全性、较低的购置成本以及已证实的降低与血压相关的发病率和死亡率的能力，常用于治疗高血压。与安慰剂相比，每日一次的低剂量氢氯噻嗪（12.5毫克/天）或氯噻酮（15毫克/天）能有效降低1期或2期高血压患者的血压。低剂量氢氯噻嗪和氯噻酮降低血压的效果与高剂量（25毫克/天和50毫克/天）相当。每日一次的低剂量氢氯噻嗪或氯噻酮与血管紧张素转换酶（ACE）抑制剂、β受体阻滞剂或钙拮抗剂联合使用，可进一步降低血压。每日一次的低剂量氢氯噻嗪能在降低不良反应（如电解质紊乱、胆固醇升高和血清尿酸水平升高）的同时，实现具有临床意义的血压降低。
