chau ngoc hoa dieutri

Điều trị Tăng huyết áp bệnh nhân Bệnh thận mạn PGS TS BS CHÂU NGỌC HOA BỘ MÔN NỘI - ĐHYD Hypertension remains the first cause of death Attributable mortality (in percent) of 56 000 000 deaths in year 2000 Série High blood pressure Smoking million deaths High cholesterol High BMI Physical inactivity Alcohol 3.25 6.5 9.75 Adapted from Ezzati et al Lancet 2002;360:1347-1360 13 Relationship of Hypertension to Its Comorbidities Comorbidity Relationship to Hypertension Coronary artery disease 50% of patients with coronary artery disease have hypertension Left ventricular hypertrophy 15% to 20% of hypertensive adults have an increased left ventricular mass Ischemic stroke 77% of patients who have a first stroke have a blood pressure >140/90 mm Hg Chronic kidney disease 8% to 15% of hypertensive adults have decreased renal function Diabetes 75% of added cardiovascular risk in diabetic patients is attributable to hypertension Peripheral artery disease 74% of patients with peripheral artery disease have hypertension Diamond JA, Phillips RA Hypertens Res 2005;28:191-202;El-Atat F, et al Curr Hypertens Rep 2004;6:215-223; Pepine CJ Am J Cardiol 1998;82(3A):21H-24H; Rosamond W, et al Circulation 2007;115:69-171; Segura J, et al Curr Opin Nephrol Hypertens 2004;13:495-500; Selvin E, Erlinger P Circulation 2004;110:738-743 TĂNG HUYẾT ÁP- BỆNH THẬN MẠN Chronic Kidney Disease in the US Over 20 Million Americans have some degree of renal insufficiency….1 in people 20 million others are at risk Hypertension & Diabetes are the leading causes of kidney failure • 23% of all Americans have hypertension • 16 million Americans have diabetes Both are independent risk factors for cardiovascular disease Incidence by Race 2008 Incidence of ESRD per 100,000 PersonYears (%) Incidence of ESRD by Systolic Blood Pressure: Multiple Risk Factor Intervention Trial* 100 83.1 White Men (n = 300,645) 80 Black Men (n = 20,222) 60 37.2 40 27.3 26.2 15.8 20 5.4 140 Systolic Blood Pressure (mm Hg) *The original cohort of 332,544 men included 11,677 men in other ethnic groupswhose data are excluded from this comparison Klag MJ, et al JAMA 1997;277:1293-1298 Lifestyle Measures: KDIGO Weight: Achieve or maintain a normal weight (BMI 20-25 kg/m²) Salt: < g sodium (5 g salt) per day unless contraindicated Exercise: At least 30 minutes times per week Alcohol: Limit to maximum of standard drinks per day Smoking: No direct effect on long-term BP but cessation reduces CV risk KDIGO Blood Pressure Work Group Kidney Int Suppl 2012 JNC CKD SBP