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TĂNG HUYẾT ÁP Ở NGƯỜI CAO TUỔI & KHUYẾN CÁO VNHA/VSH 2021-2022 PGS TS TRẦN VĂN HUY FACC FESC PCT VSH ĐIỀU PHỐI Ban Soạn Thảo KC Prospective Studies Collaboration Lancet 2002;360:1903-1913 Ranh Giới Đích Điều Trị Theo HAPK Của ESC/ESH 2018 ESC/ESC  guideline EHJ (2018) 00, 1–98 ; Ranh Giới Đích Điều Trị Theo HAPK Của ESC/ESH 2018 ESC/ESC  guideline EHJ (2018) 00, 1–98 ; Tuổi sinh học & Tuổi đời (năm sinh) Essential standards with an evidence‐based simplified treatment algorithm BP > 130/85 mmHg  in adults > 18 years Examination for  diagnosis of HNBP , HTN and the risk stratifications ESSENTI AL HNBP + Low or moderate risk factor* Lifestyle changes + individualized drug therapy HNBP + high‐risk patient or + ASCVD, + CKD, + DM, or HTN ≥140/90mmHg A , B, C, D* * Lifestyle changes from 3 to 6 months patients if BP not to 80 years) or frailer patients use monotherapy •* HNBP=High normal BP • B: Consider beta‐blockers at any treatment step, when there is a specific indication for their use, e.g heart failure, angina, post‐MI, atrial fibrillation, or younger women with, or planning, pregnancy ** Use whatever drugs are available, Low dose= ½ standard dose Use whatever drug are available with free dual combination (if possible use A + C or D)** Initial from low doses to full doses Free triple combination, but priority A + C + D** Uncontrolled Hypertension Transfer to CV centre, experts & Management HTN with expert opinion via telemedicine A: ACEi = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; B: Beta blocker; D: diuretic; BP = blood pressure; CCB = calcium channel blocker; CVD = cardiovascular CKD = chronic kidney disease; DM: = diabetic mellitus; DBP = diastolic blood pressure; SBP = systolic blood pressure; ASCVD: atherosclerotic cardiovascular disease HTN; hypertension d Optimal standards with an evidence‐based simplified treatment algorithm PreHTN=HNBP > 130-139/85-89 mmHg ; HTN> 140/90 mmHg in adults > 18 years Examination  for diagnosis of HTN and the risk stratification OPTIMAL Lifestyle changes + individualized drug therapy HNBP + Low, moderate risk factor* A , B, C, D* HNBP: High Risk patients, ASCVD, CKD, DM, or HTN ≥140/90 mmHg 1PILL Dual Pill combinations A + C or D From low dose to full dose** PILL Triple Pill Combination: A + C + D PILL PILL RESISTANT HTN: + Spironolactone or other D, block alpha or B Consider referral to a specialist centre HTN with the compelling indications CAD: A+B or C HF: A (ACEi, ARB, ARNI) + B + MRA + SGLT2i + D (loop if congestACEion) Stroke TIA: A+ D CKD: A+ C DM: A+C or D, SGLT2i or GLP 1 RA * Lifestyle changes from 3 to 6 months patients if BP not to 80 years) or frailer patients use monotherapy B: Consider beta‐blockers at any treatment step, when there is a specific indication for their use, e.g heart failure, angina, post‐MI, atrial fibrillation, or younger women with, or planning, pregnancy ** Use whatever drugs are available, Low dose= ½ standard dose A: ACEi = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; B: Beta blocker; D: diuretic; BP = blood pressure; CCB = calcium channel blocker; CVD = cardiovascular disease, CKD = chronic kidney disease; DM: = diabetic mellitus; DBP = diastolic blood pressure; SBP = systolic blood pressure; ASCVD: atherosclerotic cardiovascular disease HTN; hypertension, HNBP=High normal B Optimal standards with an evidence‐based simplified treatment algorithm PreHTN=HNBP > 130-139/85-89 mmHg ; HTN> 140/90 mmHg in adults > 18 years Examination  for diagnosis of HTN and the risk stratification OPTIMAL Lifestyle changes + individualized drug therapy HNBP + Low, moderate risk factor* A , B, C, D* 1PILL PILL HNBP: High Risk patients, ASCVD, CKD, DM, or HTN ≥140/90 mmHgy Monotherapy use in very old (> 80 years) or frailer Triple Pill Combination: A + C + D patients Dual Pill combinations A + C or D From low dose to full dose**p HTN with the compelling indications CAD: A+B or C HF: A (ARNI) + B + MRA + SGLT2i + D (loop if congestion) Stroke TIA: A+ D CKD: A+ C DM: A+C or D, SGLT2i or GLP 1 RA * Lifestyle changes from 3 to 6 months patients if BP not to 80 RESISTANT HTN: + Spironolactone or other D, block PILL years) or frailer patients use monotherapy B: Consider beta‐blockers at any treatment step, when alpha or B PILL there is a specific indication for their use, e.g heart failure, angina, post‐MI, atrial fibrillation, or younger women with, or planning, pregnancy Consider referral to a specialist centre ** Use whatever drugs are available, Low dose= ½ standard dose A: ACEi = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker; B: Beta blocker; D: diuretic; BP = blood pressure; CCB = calcium channel blocker; CVD = cardiovascular disease, CKD = chronic kidney disease; DM: = diabetic mellitus; DBP = diastolic blood pressure; SBP = systolic blood pressure; ASCVD: atherosclerotic cardiovascular disease HTN; hypertension, HNBP=High normal BP THA NGƯỜI CAO TUỔI Khuyến Cáo Loại MCC Ngưỡng HA người cao tuổi cần điều trị thuốc hạ áp tùy theo tình trạng bệnh nhân, chung 70-80 tuổi ≥ 140/90mmHg Ngưỡng già >80 tuổi >160/90mmHg I B Đích hạ HA người cao tuổi chung HATT 160/90mmHg I B Đích hạ HA người cao tuổi chung HATT < 140 mmHg , hạ thấp 80 tuổi >160/90mmHg I B Đích hạ HA người cao tuổi chung HATT < 140 mmHg , hạ thấp