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A pilot study comparing furosemide and hydrochlorothiazide in patients with hypertension and stage 4 or 5 chronic kidney disease

机译:一项初步研究比较了速尿和氢氯噻嗪在高血压和4或5期慢性肾脏病患者中的作用

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摘要

Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double-blind, cross-over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long-acting furosemide (60mg) and hydrochlorothiazide (25mg) for 3months and then both diuretics for 3months. Sodium and chloride fractional excretions were measured after 3months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the two diuretics increased the fractional excretions of sodium and chloride from 3.4±1.8 to 4.9±2.8 and from 3.8±2.0 to 6.0±3.1, respectively (P < .05). Furosemide and hydrochlorothiazide decreased mean blood pressure by the same extent. The association of the two diuretics was more efficient on blood pressure. There were no differences between furosemide and hydrochlorothiazide with respect to natriuresis and blood pressure control in patients with hypertension and chronic kidney disease.
机译:速尿是治疗慢性肾脏疾病高血压的首选利尿剂,但远端肾单位的适应性改变可能会降低其疗效。人们认为氢氯噻嗪在这种情况下无效。在一项随机,双盲,交叉试验中,有23位高血压和4或5期慢性肾脏病患者接受了长效速尿(60mg)和氢氯噻嗪(25mg)治疗3个月,然后两种利尿剂治疗3个月。每种利尿剂3个月后,再测定它们的缔合后,测量钠和氯化物的排泄分数。使用速尿和氢氯噻嗪观察到钠和氯的分数排泄增加的趋势(P =不显着)。两种利尿剂的结合使钠和氯化物的排泄分数分别从3.4±1.8增加到4.9±2.8和从3.8±2.0增加到6.0±3.1(P <.05)。速尿和氢氯噻嗪的平均血压降低幅度相同。两种利尿剂的结合对血压更有效。高血压和慢性肾脏病患者在尿钠排泄和血压控制方面,速尿和氢氯噻嗪之间无差异。

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