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KINH NGHIỆM VỚI VIÊN KẾT HỢP TỪ PHÂN TÍCH GỘP ĐẾN HỒ SƠ BỆNH NHÂN Ts Bs Ngô Minh Hùng Tim mạch Can thiệp – Bệnh Viện Chợ Rẫy CVRFS AND HEART DISEASE Framingham Nguy tim mạch tảng: • • • • Cholesterol Hút thuốc Tăng huyết áp Đái tháo đường Chuỗi bệnh lý tim mạch Expert Rev Cardiovasc Ther 2007;5(2):177-193 Am J Cardiol 1998;82:3Q-12Q Lancet 2004;364:685-696 NEJM 2004;350:1495-1504 JAMA 2005;294:2437-2445 Lancet 2005;366:1267-1278 Expert Rev Cardiovasc Ther 2004;2(3):431-449 World Health Organization Integrated management of cardiovascular risk – report of a WHO meeting, Geneva, 9–12 July 2002 Available at: http://whqlibdoc.who.int/publications/9241562242.pdf Accessed: Oct 2009 CVRFS AND HEART DISEASE 11/3/2020 TOTAL CV RISK (1) No risk estimation models are needed for persons with: Documented CVD DM2 Very high levels of individual risk factors CKD (2) For all other people, the use of a risk estimation system such as SCORE is recommended to estimate total CV risk European Heart Journal (2016) 37, 2999–3058 CVRF: HYPERTENSION Phân tích gộp 61 nghiên cứu tiền cứu, quan sát - triệu người lớn - 12,7 triệu bệnh nhân - năm Giảm thêm 10% tử vong bệnh mạch vành Giảm 10 mmHg HATh trung bình Giảm thêm 40% tử vong đột quỵ1 Điều trị THA cần thiết Lewington S et al Lancet 2002;360:1903-1913 STUDIES ON SINGLE PILL COMBINATION (SPC) ◼All 29 studies reported on adherence and/or persistence in patients taking SPC therapy for hypertension 756 04 RCTs (14%) 25 Observational Studies (86%) ◼Sample sizes 75 to 79,958 for SPC therapy 645 111 29 RCTs 25 Obs 73 to 383,269 for Free Dose Combination Therapy Mancia G, et al J Hypertens 2015; 33:401–411 Mourad JJ, et al J Hypertens 2017; 35: 1481–1495 edogoda SV, et al Cardiol Ther 2017; 6:91–104 Webster R, et al JAMA 2018; 320:566–579 RCTS ON SINGLE PILL COMBINATION Mancia G, et al J Hypertens 2015; 33:401–411 Mourad JJ, et al J Hypertens 2017; 35: 1481–1495 edogoda SV, et al Cardiol Ther 2017; 6:91–104 Webster R, et al JAMA 2018; 320:566–579 OBSERVATIONAL STUDIES ON SPC Fleig SV, et al Adv Ther 2018; 35:353–366 Jadhav U, et al PLoS One 2014; 9:e92955 Jung HW, et al Clin Exp Hypertens 2015; 37:482–489 Liakos CI, et al Am J Cardiovasc Drugs 2017;17:391–398 COMBINATIONS CHANGE IN BP AND BP CONTROL ◼Only 14 studies (48%) reported the number of patients reaching their target BP (