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首页> 美国卫生研究院文献>Diabetology international >Antihypertensive and metabolic effects of hydrochlorothiazide versus amlodipine when added to losartan in patients with type 2 diabetes
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Antihypertensive and metabolic effects of hydrochlorothiazide versus amlodipine when added to losartan in patients with type 2 diabetes

机译：氯沙坦与氨氯地平联合氯沙坦治疗2型糖尿病患者的降压和代谢作用

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We performed a prospective, randomized, multicenter, parallel-group, per-protocol study to compare the effects of hydrochlorothiazide (HCTZ) and amlodipine as add-on to losartan treatment in hypertensive type 2 diabetic patients. A total of 49 Japanese type 2 diabetic patients with inadequate control of blood pressure while receiving losartan 50 mg were randomly allocated to receive a fixed-dose single-pill combination of HCTZ 12.5 mg plus losartan (N = 26) or a free combination of amlodipine 5 mg plus losartan (N = 23). During 8 weeks of follow-up, changes in blood pressure and laboratory data including HbA1c, uric acid, and potassium were compared between the groups using analysis of covariance. Systolic and diastolic blood pressure decreased in both groups, the reductions of which were greater in the amlodipine group. However, the least square mean (95 % CI) differences between groups were not statistically significant [2.3 (−6.8 to 11.4) mmHg, p = 0.618 and 2.7 (−2.4–7.9) mmHg, p = 0.293, respectively]. HbA1c increased in patients receiving HCTZ but not in the amlodipine group. Uric acid also increased in patients receiving HCTZ but decreased in patients receiving amlodipine, yielding a significant between-group difference of 1.0 (0.5–1.5) mg/dl (p < 0.001). No intra- or intergroup change was observed in serum potassium levels. This pilot study suggests that HCTZ and amlodipine result in nonsignificant effects on systolic and diastolic blood pressure reduction when administrated as add-on therapy to losartan in hypertensive patients with type 2 diabetes; however, addition of HCTZ may be associated with less favorable effects on metabolic profiles than amlodipine.
机译：我们进行了一项前瞻性，随机，多中心，平行组，每方案研究，以比较氢氯噻嗪（HCTZ）和氨氯地平作为氯沙坦治疗高血压2型糖尿病患者的附加药物的作用。总共49名日本2型糖尿病患者在接受氯沙坦50 mg的同时血压控制不佳，被随机分配接受HCTZ 12.5 mg加氯沙坦的固定剂量单药组合（N = 26）或氨氯地平的免费组合5毫克加氯沙坦（N = 23）。在8周的随访中，使用协方差分析比较了两组之间的血压变化和实验室数据，包括HbA1c，尿酸和钾。两组的收缩压和舒张压均下降，氨氯地平组的下降幅度更大。然而，两组之间的最小二乘均方差（95％CI）差异无统计学意义[分别为2.3（-6.8至11.4）mmHg，p = 0.618和2.7（-2.4-7.9）mmHg，p = 0.293]。接受HCTZ的患者中HbA1c升高，但氨氯地平组则没有。接受HCTZ的患者尿酸也增加，但接受氨氯地平的患者尿酸减少，组间差异显着1.0（0.5-1.5）mg / dl（p <0.001）。血清钾水平未观察到组内或组间变化。这项前瞻性研究表明，将HCTZ和氨氯地平作为氯沙坦的补充疗法与2型糖尿病高血压患者合用时，对收缩压和舒张压的降低没有明显影响。然而，与氨氯地平相比，添加HCTZ可能对代谢谱的不良影响更大。

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