《国际循环》：以往的研究引发了人们的一些担忧，即应用利尿剂治疗高血压会对其他心血管危险因素有不良影响。哪些患者适合应用利尿剂作为起始治疗？
    Luis Kuritsky教授：利尿剂仍然是高血压的重要治疗药物。但是，医生仍需要给予个体化的治疗。从整个人群的角度来讲，利尿剂对血糖、甘油三酯和LDL-C的影响较小。我们应当监测患者的上述心血管危险因素水平。如果患者的尿酸、甘油三酯或血糖明显控制不好的话，那么利尿剂就不是最适合的药物，应考虑换药。基于ALLHAT试验大型人群的数据，我们知道利尿剂对患者平均血糖水平的影响非常小。因此，我们只要注意监测患者就可以了。   

     <International Circulation>: Previous studies have raised concerns that antihypertensive therapy with diuretics adversely alters levels of other cardiovascular disease risk factors. For what type of patients should we choose diuretics as initial therapy？

    Prof. Kuritsky: Diuretics are still an important choice for any patients with hypertension but individualization comes into play here because on a population wide basis the change in glucose， triglycerides， and LDL are small. Therefore， what you should do is monitor your patient for all of those risk factors and if your patient is having a dramatic departure from good control in their uric acid level， triglycerides， or glucose， then this is not the best drug for them and you should consider another drug. We know based upon large population data from the ALLHAT trial that the mean change in glucose is very small so it is just a matter of monitoring your patient.

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