Điều trị tăng huyết áp yếu tố nguy cơ cao cập nhật từ các khuyến cáo - Châu Ngọc Hoa

 ĐIỀU TRỊ TĂNG HUYẾT ÁP 
YẾU TỐ NGUY CƠ CAO 
 CẬP NHẬT TỪ CÁC KHUYẾN CÁO 
PGS. TS. BS. CHÂU NGỌC HOA 
ĐHYD – TP HCM 
Nội dung 
 CẬP NHẬT DỊCH TỄ HỌC 
 ESC 2013 –JNC 8 
 ĐIỀU TRỊ THA- NGUY CƠ CAO 
Prevalence of raised blood pressure 
World Health Organization 2011, Map Production: Public Health Information 
and Geographic Information Systems (GIS) 
The NHLBI Division for the Application 
of Research Discoveries (DARD): 
Translating Science into Practice 
Karen A. Donato, S.M. 
Acting Deputy Director, Division for the Application of 
Research Discoveries 
National Heart, Lung, and Blood Institute 
July 8, 2011 
Filippino Cardiovascular Summit 
Hypertension Treatment Options 
2013 ESH / ESC Hypertension Guidelines 
21 
130 
140 
150 
160 
170 
180 
190 
200 
mmHg mmHg 
FACE
T 
Micro HOPE 
CAPPP 
INSIGHT 
HOT 
VALUE 
STOP-2 
UKPDS 
LIFE 
RENAAL 
IDNT 
IRMA 
ABCD 
120 
Mancia G., Grassi G., J Hypertension 2002 
70 
80 
90 
100 
110 
120 
60 
SBP DBP 
1186 G 
Systolic vs Diastolic BP Control in Trials on Diabetic Hypertensives 
B T B T 
CÁC NGHIÊN CỨU ĐIỀU TRỊ TĂNG HUYẾT ÁP/ ĐTĐ 
1 2 3 4 
ASCOT-BPLA (136.9 mmHg) 
ALLHAT (138 mmHg) 
IDNT (138 mmHg) 
RENAAL (141 mmHg) 
UKPDS (144 mmHg) 
ABCD (132 mmHg) 
MDRD (132 mmHg) 
HOT (138 mmHg) 
AASK (128 mmHg) 
ACCOMPLISH (132 mmHg) 
Average Nr. of Antihypertensive Drugs 
Study (syst. BP achieved) 
Number of antihypertensive drugs in 
intervention studies 
1/3 normalized with 1 agent 
1/3 normalized with 2 agents 
1/3 normalized with ≥3 agents* 
Düsing, Vasc Health Risk Manag 6: 1, 2010 
*32,3% in ACCOMPLISH 
Antihypertensive combinations: 
what do the guidelines tell us? 
 ; 
Hypertension Treatment Options 
2013 ESH / ESC Hypertension Guidelines 
Rationale: ARB/ACE-I + HCTZ + CCB 
combination 
Stanton et al., J Hum Hypertens 2002;16:75–8 
 Jamerson et al., Am J Hypertens 2004;17:793–801 RAS = Renin-Angiotensin System 
CCB Diuretic 
Na+-loss and volume 
contraction 
Vasodilatation 
Activation of RAS 
Increased BP Lowering 
Addition of RAS Blocker 
RAS-blocker 
RAS-blocker 
+ diuretic 
RAS-blocker 
+ CCB 
Treatment algorithm 
 Heart 
Failure/impaired 
ventricular 
function, Stroke 
 Edema 
All others, 
especially 
metabolic, 
high risk 
patients 
RAS-blocker 
RAS-blocker 
+ diuretic 
RAS-blocker 
+ CCB 
RAS-blocker 
+ diuretic 
+ CCB 
Step 1 
Step 2 
Step 3 
Treatment algorithm 
Phối hợp điều trị - Phòng biến cố tim mạch 
29 
Edward D. Freis, MD 
We are not treating numbers, we are treating patients!