Điều trị tăng huyết áp yếu tố nguy cơ cao PGS 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  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) Hypertension Treatment Options 2013 ESH / ESC Hypertension Guidelines CÁC NGHIÊN CỨU ĐIỀU TRỊ TĂNG HUYẾT ÁP/ ĐTĐ 200 mmHg SBP Systolic vs Diastolic BP Control in Trials on Diabetic Hypertensives 120 mmHg DBP Micro HOPE 190 CAPPP 110 INSIGHT 180 VALUE HOT 100 170 UKPDS 160 STOP-2 150 FACE T LIFE RENAAL 90 80 IDNT 140 IRMA 70 130 ABCD 120 1186 G 21 B T 60 B T Mancia G., Grassi G., J Hypertension 2002 Number of antihypertensive drugs in intervention studies Study (syst BP achieved) MDRD (132 mmHg) HOT (138 mmHg) RENAAL (141 mmHg) normalized with agent AASK (1281/3 mmHg) normalized with agents ABCD (1321/3 mmHg) IDNT (1381/3 mmHg)normalized with ≥3 agents* UKPDS (144 mmHg) ASCOT-BPLA (136.9 mmHg) ALLHAT (138 mmHg) ACCOMPLISH (132 mmHg) *32,3% in ACCOMPLISH Average Nr of Antihypertensive Drugs Düsing, Vasc Health Risk Manag 6: 1, 2010 Antihypertensive combinations: what the guidelines tell us? ; Hypertension Treatment Options 2013 ESH / ESC Hypertension Guidelines Rationale: ARB/ACE-I + HCTZ + CCB combination Diuretic CCB Na+-loss and volume contraction Vasodilatation Activation of RAS Addition of RAS Blocker Increased BP Lowering RAS = Renin-Angiotensin System Stanton et al., J Hum Hypertens 2002;16:75–8 Jamerson et al., Am J Hypertens 2004;17:793–801 Treatment algorithm   Heart Failure/impaired ventricular function, Stroke Edema RAS-blocker RAS-blocker + diuretic All others, especially metabolic, high risk patients RAS-blocker + CCB Treatment algorithm Step Step Step RAS-blocker RAS-blocker + diuretic RAS-blocker + CCB RAS-blocker + diuretic + CCB Phối hợp điều trị - Phòng biến cố tim mạch 29 We are not treating numbers, we are treating patients! Edward D Freis, MD [...]... Division for the Application of Research Discoveries National Heart, Lung, and Blood Institute July 8, 2011 Hypertension Treatment Options 2013 ESH / ESC Hypertension Guidelines CÁC NGHIÊN CỨU ĐIỀU TRỊ TĂNG HUYẾT ÁP/ ĐTĐ 200 mmHg SBP Systolic vs Diastolic BP Control in Trials on Diabetic Hypertensives 120 mmHg DBP Micro HOPE 190 CAPPP 110 INSIGHT 180 VALUE HOT 100 170 UKPDS 160 STOP-2 150 FACE T LIFE... others, especially metabolic, high risk patients RAS-blocker + CCB Treatment algorithm Step 1 Step 2 Step 3 RAS-blocker RAS-blocker + diuretic RAS-blocker + CCB RAS-blocker + diuretic + CCB Phối hợp điều trị - Phòng biến cố tim mạch 29 We are not treating numbers, we are treating patients! Edward D Freis, MD