PGS. TS. PHAM XUAN SINH CMiex* c© raa m m t An g h u y e t Ap NHA XUAT BAN Y HOC THUOC CO TRUYEN PHONG, TRIBENH TANG HUYET AP PGS. TS PHAM XUAN SINH THUOC CO TRUYEN PHONG, TRI BENH TANG HUYET AP • • NHA XUAT BAN Y HOC HA NQI • 2001 L0(I NOI DAU Tang huyet ap la chtfng benh thudng gSp, benh mang trnh tong hap, phat trien cham va tCr tCf; ngay cang co xu the gia tang, dac biet a cdc nUdc co nen , r, 7, ’ a kinh te phat trien. O chau Au va Bac My, benh tang huyet dp chiem ty le cao, tori 15-20% trong so cac benh ve tim mach. d Hoa Ky nam 1998 co tdi 50 trieu ngi/di, d Phdp tdi 8 trieu ngUdi bi tSng huyet ap. O nUdc ta trong nhuTng nam gan day, benh tang huyet ap cung co ty le gia tang dang ke, chiem 11,75% trong so benh tim mach vao nam 1990. Theo so lieu dieu tra cua Vien tim mach Viet Nam, nam 1989, trong so 31,3 trieu ngtfdi tuf 15 tuoi trd len co 2 trieu ngUdi tang huyet ap chinh thiJc va 2,6 trieu ngUdi tang huyet ap gidi han, chiem ty le 6-12% dan so. Giao si/ Pham Khue va cong sir da tien hanh dieu tra tren 1329 cu tuoi tren 60 tuoi cho thay tan suat tang huyet ap la 9,23%. Rieng 364 cu d dong bang, tan suat la 16,7%. Ta biet rang benh tang huyet ap se la moi lo ngai neu khong duoc phat hien va dieu tri sdm vdi cac phitong phap thlch hop. Vi benh se lam ton thuong cac mach mau, anh hudng xau den hoat dong cua cac co quan nhu tim co the bi suy, vufa xo mach vanh, nguy co dan den nhoi mau co tim; dau that ngUc hoSc anh hudng true tiep den than, gay suy than cap. O giai doan nang co the gay xuat huyet a nhieu bo phan nhu xua't huyet vong mac, gay md mat hoac mu loa, dac biet la xuat huyet mach mau nao, gay liet 3 nufa ngUdi; de lai nhufng di chufng khong the hoi phuc duoc, anh hudng den sufc khoe va cuoc song. Trong trUdng hop qua nSng co the gay nguy hiem den tinh mang. Tren thi trUdng hien nay co nhieu loai thuoc tan duoc co the dung de tri benh t&ng huyet ap, tuy nhien khi suf dung thudng kem theo nhtfng tac dung khong mong muon, anh hudng den sure khoe cua ngtfoi benh. Chinh vi le do de phong tri benh tSng huyet ap hien nay tren the gidi; dSc biet cdc nUdc dang phat trien co xu hudng suf dung cac vi thuoc co nguon goc tCr duoc lieu trong thien nhien. Dung thuoc co truyen de phong tri cao huyet ap co nhieu UU diem: - Nguon duoc lieu phong phu, de kiem, gia thanh ha. - Phuong phap bao che don gian, de dang thuc hi^n ngay ca d nhufng noi co dieu kien kho khan. - Han che duoc nhufng tac dung khong mong muon. Sau khi uong thuoc dua lai cam giac de chiu cho ngudi benh. Tuy nhien, tuy theo tinh hinh cu the, co the tien hanh ket hop viec dieu tri benh t&ng huyet ap b&ng thuoc tan duoc va thuoc YHCT cho hop ly. Vdi cuon sach nho nay hy vong giup ban doc tim hieu sau them ve cdc vi thuoc va phi/cfng thuoc co truyen dung phong va tri benh tdng huyet ap. TAC GIA 4 Phan I MOT SO KHAI NIEM VE BENH • • • TANG HUYET AP (HA) I. NHLT THE NAO GOI LA BENH TANG HUYET AP Cf ngudi khoe manh, co HA toi da (HA tam thu) la 120mmHg vk HA toi thieu (HA tam trUOng) Id 80mmHg va thudng bieu thi bang chi so 120/80mmHg. Neu HA toi da 140mmHg va HA toi thieu 90mmHg duoc coi la t&ng huyet dp. Neu HA toi da n&m trong khoang 140- 160mmHg, v& HA toi thieu nfim trong khoang 90- 95mmHg, duoc coi la tang huyet Ap gidfi han. Tuy nhien HA con phu thuoc vao nhieu yeu to khac nhau. Vi du vao gioi tinh, o nam HA thudng cao hon nOr. Vao luTa tuoi ngUdi gia thudng co HA cao hon ngUcfi tre thudng tif 10- 20mmHg. Vao vi tri trong co the; HA toi da d chan thudng cao hon d tay 20mmHg con HA toi thieu thi khong chenh lech. NgUdi ta thudng chia benh tang huyet ap ra lam 2 loai: Loai tang huyet ap thudng xuyen co the lanh tinh va co the ac tinh; loai tang HA con tren co sd HA binh thudng, co nhOTng con cao vot, nhihig luc ndy thudng gay tai bien. Mac du vay d moi quoc gia, dUa vao dieu kien cu the, co cac quy dinh rieng ve chi so HA. O Trung Quoc c6 luc dUa vdo do tuoi de xac dinh tinh trang tang huyet dp. 5 Do tuoi HA toi da Ket luan 39 < >140 Tang HA 40-49 >150 Tang HA 50-59 >160 Tjing HA > 60 >170 T§ng HA j 0 Hoa Ky theo quy dinh cua Vien sure khoe JNC thi tinh trang HA duoc quy dinh thanh 4 giai doan: HA toi da (mmHg) HA toi thieu mmHg Tinh trang HA 130< 85< Binh thudng 130-139 85-89 Binh thudng cao 140-159 90-99 Tana HA nhe-aiai doan 1 160-179 100-109 Tang HA vua, giai doan 2 180-209 110-119 > 220 > 120 Tang HA nang-giai doan 3 Tang HA rat nanq-qiai doan 4 Theo OMS o ngudi ldn tuoi co HA binh thudng neu HA toi da dudi 140mmHg va HA toi thieu dudi 90mmHg. Neu HA toi da tren 160mmHg va HA toi thieu tren 95mmHg la tang huyet ap. Nam 1993, cung vdi Hoi tang huyet ap the gidi, OMS da quy dinh lai nhu sau: Tti 140/90 trcr len duoc coi la tang huyet ap Tang HA nhe, neu HA toi da 140-180mmHg HA toi thieu 90-105mmHg 6 Tang HA vira va nSng; HA toi da > 180mmHg HA toi thieu 105mmHg Theo con so dieu tra cua Vien tim mach Viet Nam HA binh thirdng cua ngirdi VN la 120/75mmHg a nam gidi thirdng 122/76mmHg, d nur gidi 119/75mmHg. Tuy nhien doi vdi ngtfdi tang huyet dp, cung co the chi tang HA toi da con HA toi thieu vdn binh thirdng; cung co the chi tang HA toi thieu con HA toi da van binh thirdng; cung co the tang ca HA toi da va HA toi thieu khi hieu so cua HA toi da va HA toi thieu nho, khoang 15-20mmHg; hodc HA toi thieu > 100, luc nay the rat m$t moi va kho chiu cung can noi them rang, doi vdi YHCT khong co khai niem benh tang huyet ap. Cac khai niem ve benh tang huyet ap nhu ta thudng hieu lai ndm trong khai niem ve chufng "huyen vyfng" cua YHCT. Trong nhufng nam gan day cac nha YHCT phirang Dong noi chung va YHCT Viet Nam noi rieng, qua nghien cufu tren thiTc nghiem cung nhi/ tren thiTc ti§n lam sang thay rang chufng huyet viTng cua YHCT noi chung co cac trieu chufng giong vdi cac trieu chufng cua benh tang huyet ap. Tuy nhien ve mat phan loai HA va ccf che tac dung cua thuoc lai co y nghla rieng se phan tlch d phan sau. Mac du vay nhufng vi thuoc va phi/cfng thuoc co truyen chufa chufng huyin viTng van diTcfc suf dung vdi tinh chat de chijfa benh tang huyet ap. 7 De xac dinh xem mot ngirdi co bi tang huyet dp hay khong, ngudi ta co the diia vao mot so dau hieu sau day: Benh nhan thudng co cac ccfn dau dau duf doi, cdng dau, hoa mat, chong mat, buon non mat thudng do, mdt do do sung huyet, mat md di. Tinh trang ndng hoi thd thudng gap tim dap nhanh; tham chi chan tay bi co qudp. Ve phia YHCT thudng ket hop giufa cdc trieu chufng lam sang vdi viec chan mach de xem xet tinh trang HA. Ve mdt chan mach, YHCT coi mach huyen la loai mach dien hinh cua chufng tang huyet ap; do Id loai mach dai suot 3 bo (thon quan xich) c6 do trU’cmg life ldn "cang nhu sai day dan". Tuy nhien dien bien nay cung kha phufc tap, se duoc bdn d muc sau. De- co ket luan chinh xac ve tinh trang tang huyet ap cua mot ngi/di, hien nay ngirdi ta thirdng tien hanh kiem tra HA bang cac may do HA. Cong viec kiem tra thi/dng tien hanh do it nhat 2 lan vdi nhufng dieu kien giong nhau, vao gid nhat dinh, thirdng tien hanh vao buoi sang co the tir 8-10 gid. Sau do lay gia tri trung binh cua cac lan do. Co the dung HA ke kieu dong ho hodc HA ke thuy ngan. Kieu HA ke dong ho tien lcfi, nhanh song do chinh xac doi khi khong cao vi the ngi/di ta khuyen cdo nen 3 thang kiem tra lai bang HA ke thuy ngan mot lan doi vdi nhufng ngirdi bi b<?nh tang huyet 8 ap. Khi tien hanh do HA benh nhan co the ngoi hodc nim de do. Can chu y them rdng khi tien hanh kiem tra HA ngirdi benh can d trang thai thoai mai tranh cac hoat dong ndng nhir chay nhay; can nghi ngoi 5-10 phut trUdc khi do va tranh cac thufc an mang tinh kich thich nhir riTOu, bia, ca phe, tranh hut thuoc la hodc uong cdc thuoc chufa hen suyen, tranh nhufng kich thich ve cam xuc vd cung khong do sau khi dn no. II. PHAN L0«l CHUNG BENH TANG HUYET AP 2.1. Y hoc hi$n dai Theo y hoc hien dai benh tdng huyet dp diroc chia lam 2 loai: - Nguyen phdt: Loai tdng huyet dp khong rd nguyen nhan; co the do bairn sinh, the loai nay chiem ty le cao tori 85-90% trong tong so ngirdi bi tang huyet ap. - Thur phdt: Loai tang huyet ap do sau mot chufng benh nao do. Vi du: Viem cau than, viem be than, u than, lao than, benh noi tiet, phi dai thifOng than bam sinh, hep dong mach chu, nhiem doc thai nghen, hodc tinh than cdng thdng 2.2. Y hoc co truyen Y hoc co truyen coi benh tang huyet dp la benh thuoc chufng huyen viTng, dau thdng, can difcfng thi/ang ci/dng. Cdn cur vdo chufng trang benh, ngifdi ta chia 1dm mot so loai hinh nhir sau: 9