tình hình kiểm soát huyết áp, đường huyết và lipid máu trên bệnh nhân tăng huyết áp có đái tháo đường typ 2 mới mắc

BỘ Y TẾ ĐẠI HỌC Y DƯỢC THÀNH PHỐ HỒ CHÍ MINH ˜¯™ BÁO CÁO TỔNG KẾT ĐỀ TÀI KHOA HỌC VÀ CƠNG NGHỆ CẤP TRƯỜNG TÌNH HÌNH KIỂM SỐT HUYẾT ÁP, ĐƯỜNG HUYẾT VÀ LIPID MÁU TRÊN BỆNH NHÂN TĂNG HUYẾT ÁP CÓ ĐÁI THÁO ĐƯỜNG TYP MỚI MẮC Mã số: 16193 - ĐHYD Chủ nhiệm đề tài: PGS TS BS CHÂU NGỌC HOA ThS BS NGUYỄN NGỌC THANH VÂN THÀNH PHỐ HỒ CHÍ MINH, 04/2018 BỘ Y TẾ ĐẠI HỌC Y DƯỢC TP HỒ CHÍ MINH ˜¯™ BÁO CÁO TỔNG KẾT ĐỀ TÀI KHOA HỌC VÀ CÔNG NGHỆ CẤP TRƯỜNG TÌNH HÌNH KIỂM SỐT HUYẾT ÁP, ĐƯỜNG HUYẾT VÀ LIPID MÁU TRÊN BỆNH NHÂN TĂNG HUYẾT ÁP CÓ ĐÁI THÁO ĐƯỜNG TYP MỚI MẮC Mã số: 16193 - ĐHYD Chủ nhiệm đề tài PGS TS BS Châu Ngọc Hoa ThS BS Nguyễn Ngọc Thanh Vân Tp Hồ Chí Minh, 04/2018 DANH SÁCH THÀNH VIÊN THAM GIA NGHIÊN CỨU ĐỀ TÀI VÀ ĐƠN VỊ PHỐI HỢP CHÍNH Chủ nhiệm đề tài: PGS TS Châu Ngọc Hoa Đồng chủ nhiệm đề tài: ThS Nguyễn Ngọc Thanh Vân MỤC LỤC Trang DANH MỤC CÁC TỪ VIẾT TẮT DANH MỤC THUẬT NGỮ ANH – VIỆT DANH MỤC CÁC BẢNG DANH MỤC CÁC BIỂU ĐỒ MỞ ĐẦU CHƯƠNG - KẾT QUẢ NGHIÊN CỨU 1.1 ĐẶC ĐIỂM DÂN SỐ NGHIÊN CỨU 1.1.1 Tuổi 1.1.2 Giới 1.1.3 Nơi cư trú .7 1.1.4 Trình độ học vấn 1.1.5 Hút thuốc 1.1.6 Chỉ số khối thể 10 1.1.7 Tiền sử gia đình tăng huyết áp 11 1.1.8 Tiền sử gia đình đái tháo đường 11 1.1.9 Thời gian tăng huyết áp 12 1.1.10 Thời gian đái tháo đường 13 1.1.11 Thời gian từ lúc tăng huyết áp đến lúc đái tháo đường 14 1.1.12 Đái tháo đường mắc 15 1.1.13 Bệnh kèm 16 1.1.14 Thuốc điều trị tăng huyết áp 17 1.1.15 Thuốc điều trị đái tháo đường 18 1.1.16 Thuốc điều trị rối loạn chuyển hoá lipid 19 1.1.17 Thuốc kháng kết tập tiểu cầu 20 1.1.18 Số viên thuốc 21 1.1.19 Sự tuân trị 22 1.2 KIỂM SOÁT HUYẾT ÁP, ĐƯỜNG HUYẾT VÀ LIPID MÁU 22 1.2.1 Kiểm soát huyết áp 22 1.2.2 Kiểm soát đường huyết 23 1.2.3 Kiểm soát lipid máu 24 1.2.4 Kiểm soát đa yếu tố 25 1.3 MỘT SỐ YẾU TỐ LIÊN QUAN TÌNH TRẠNG KIỂM SỐT ĐỒNG THỜI HUYẾT ÁP, ĐƯỜNG HUYẾT VÀ LIPID MÁU 25 1.3.1 Phân tích đơn biến đặc điểm dân số kiểm soát đa yếu tố (huyết áp, đường huyết lipid máu) 25 1.3.2 Phân tích hồi quy đa biến đặc điểm dân số kiểm soát đa yếu tố (huyết áp, đường huyết lipid máu) 28 KẾT LUẬN 29 KIẾN NGHỊ 31 DANH MỤC CÁC CƠNG TRÌNH CƠNG BỐ CỦA TÁC GIẢ TÀI LIỆU THAM KHẢO PHỤ LỤC DANH MỤC CÁC TỪ VIẾT TẮT TIẾNG VIỆT BN ĐTĐ KS KKS KTC KTPV TIẾNG ANH 4S ACCOMPLISH ACCORD-BP ADVANCE CAD CARDS DCCT DECODA DEGS1 DPP-4 GLP-1 GNHIES98 HEART2D HOPE-3 HPS IGF-1 INTERHEART INVEST LIFE Hypertension Bệnh nhân Đái tháo đường Kiểm sốt Khơng kiểm sốt Khoảng tin cậy Khoảng tứ phân vị Scandinavian Simvastatin Survival Study The Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension The Action to Control Cardiovascular Risk in Diabetes Blood Pressure Trial Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation Canadian Dollar Collaborative Atorvastatin Diabetes Study Diabetes Control and Complications Trial Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Asia German National Health Interview and Examination Survey for adults Dipeptidyl peptidase-4 Glucagon-like peptide-1 German National Health Interview and Examination Survey 1998 Hyperglycemia and its effect after acute myocardial infarction on cardiovascular outcomes in patients with Typ diabetes mellitus Heart Outcomes Prevention Evaluation–3 Heart Protection Study Insulin-like growth factor-1 The Effect of Potentially Modifiable Risk Factors Associated with Myocardial Infarction International Verapamil SR-Trandolapril Study The Losartan Intervention For Endpoint reduction in MICRO-HOPE MRFIT NAVIGATOR ONTARGET SGLT2 SPRINT STENO-2 STOP-2 STOP- NIDDM TG UKPDS USD VADT VALUE MIcroalbuminuria, Cardiovascular, and Renal Outcomes in the HOPE trial Multiple Risk Factor Intervention Trial Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial Sodium Glucose Co-Transporter-2 The Systolic Blood Pressure Intervention Trial Effect of a Multifactorial Intervention on Mortality in Typ Diabetes Swedish Trial in Old Patients with Hypertension-2 Study to Prevent NIDDM Triglyceride United Kingdom Prospective Diabetes Study United States Dollar Veterans Affairs Diabetes Trial The Valsartan Antihypertensive Long-term Use Evaluation 2D ACC ACR ADA AGEs AHA ALA BMI CABG EHJ ESC HDL-c HR IDF JAMA JNC LDL-c MEMS DANH MỤC THUẬT NGỮ ANH – VIỆT Two dimensions chiều American College of Cardiology Trường môn Tim Hoa Kỳ Albumine to Creatinine Ratio Tỷ lệ Albumin/Creatinine niệu American Diabetes Association Hội Đái tháo Đường Hoa Kỳ Advanced glycation end-products Sản phẩm cuối đường hóa bậc cao American Heart Association Hội Tim Hoa Kỳ American Lung Association Hội Phổi Hoa Kỳ Body Mass Index Chỉ số khối thể Coronary artery bypass grafting Phẫu thuật bắc cầu động mạch vành European Heart Journal Tạp chí Tim Châu Âu European Society of Cardiology Hội Tim Châu Âu High Density Lipoprotein cholesterol Lipoprotein tỷ trọng cao Hazard ratio Tỷ số rủi ro International Diabetes Federation Liên đoàn Đái tháo đường Thế giới Journal of the American Medical Association Tạp chí Hội Y khoa Hoa Kỳ Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure Uỷ ban Liên Quốc gia Phòng ngừa, Phát hiện, Đánh giá Điều trị Tăng huyết áp Low Density Lipoprotein cholesterol Lipoprotein tỷ trọng thấp Medication Event Monitoring System MPR MMAS-8 NHANES NHBIL OR PSM RAAS ROS RR SNS TC TIA WHO Hệ thống giám sát hoạt động y khoa Medication Possession Ratio Tỷ số sở hữu thuốc 8-item Morisky Medication Adherence Scale Thang điểm Tuân thủ điều trị Thuốc Morisky thông số National Health and Nutrition Examination Survey Điều tra Dinh dưỡng Sức khoẻ Quốc gia National Heart, Lung, and Blood Institute Viện Tim, Phổi, Máu Quốc gia Odds ratio Tỷ số chênh Propensity Score Matching Ghép cặp điểm khuynh hướng Renin Angiotensin Aldosterone System Hệ Renin Angiotensin Aldosterone Reactive oxygen species Gốc oxy hóa tự Relative risk Nguy tương đối Sympathetic Nervous System Hệ thần kinh giao cảm Total Cholesterol Cholesterol toàn phần Transient Ischemic Attack Cơn thoáng thiếu máu não World Health Organization Tổ chức Y tế Thế giới DANH MỤC CÁC BẢNG Trang Bảng 1.1: Kiểm soát đường huyết 23 Bảng 1.2: Phân tích đơn biến đặc điểm dân số kiểm soát đa yếu tố 25 Bảng 1.3: Phân tích đa biến đặc điểm dân số kiểm soát đa yếu tố 28 century", Lancet, Vol 388 (10043), pp 530-2 26 Bruno R M., Taddei S (2016), "New-onset diabetes in hypertensive patients and mortality: timing is everything", Eur Heart J, Vol 37 (12), pp 975-7 27 Camm A J., Kirchhof P., Lip G Y., et al (2010), "Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)", Eur Heart J, Vol 31 (19), pp 2369-429 28 Carlsson A C., Ruge T., Sundstrom J., et al (2013), "Association between circulating endostatin, hypertension duration, and hypertensive targetorgan damage", 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THẬP SỐ LIỆU Số thứ tự Mã số bệnh nhân Tên đề tài: TÌNH HÌNH KIỂM SỐT HUYẾT ÁP, ĐƯỜNG HUYẾT, VÀ LIPID MÁU TRÊN BỆNH NHÂN TĂNG HUYẾT ÁP CÓ ĐÁI THÁO ĐƯỜNG TYP MỚI MẮC I Hành chính: -Họ Tên (viết tắt tên): Tuổi: Giới: Nam o/Nữ o -Tỉnh/Thành phố -Mã số nhập viện:………………… Ngày khám: II Tăng huyết áp đái tháo đường: -Trị số huyết áp: +Ngày khám: +Cao nhất: +Thường xuyên: -Thời gian Tăng huyết áp: -Thời gian Đái tháo đường: -Đặc điểm kèm: BMI: Hút thuốc o Có o Khơng o Ngưng Trình độ dân trí: Mù chữ o Cấp I o Cấp II o Cấp III trở lên o -Thời gian tái khám: -Bệnh kèm: Đã biết Chưa biết Đã biết Đột quỵ Hen phế quản Suy tim Bệnh thận mạn Bệnh TTMCB NMCT Stent CABG Bệnh MMNB RLCH Lipid Viêm dày Bệnh khớp Bệnh võng mạc Chưa biết Khác - Đái tháo đường Ngày Ngày Ngày ĐH đói ĐH sau ăn 2h HbA1c III IV Lipid máu - Cholesterol TP: - TG: - HDL-c: - LDL-c: Điều trị: Tăng huyết áp thuốc o thuốc o ≥3 thuốc o Thuốc dùng: Tên Liều Loại Lợi tiểu Chẹn β Chẹn kênh Canxi Ức chế men chuyển Chẹn TT Angiotensin II Thuốc khác Thuốc phối hợp: Tên Đái tháo đường Thuốc uống Thuốc dung Loại Sulfonylurea Metformin o Liều Insulin Tên o Liều Ức chế men alpha glucosidase Thiazolidinedione Ức chế men DPP4 Đồng vận thụ thể GLP-1 Ức chế kênh SGLT2 Thuốc phối hp Tờn Insulin Nn ă Hn hp Tờn Liu ă Basal bolus ă Liu Thuc khỏc Tờn V VI Liu S viờn thuc viờn ă 7-9 viờn ă 10 viờn ă Tuõn tr: Cú ă Khụng ă Ghi chỳ: ... sát tình hình kiểm sốt huyết áp, đường huyết, lipid máu bệnh nhân tăng huyết áp có đái tháo đường typ mắc 2. 2 Mục tiêu cụ thể Khảo sát đặc điểm dân số tăng huyết áp có đái tháo đường typ mắc. .. 20 1.1.18 Số viên thuốc 21 1.1.19 Sự tuân trị 22 1 .2 KIỂM SOÁT HUYẾT ÁP, ĐƯỜNG HUYẾT VÀ LIPID MÁU 22 1 .2. 1 Kiểm soát huyết áp 22 1 .2. 2 Kiểm soát đường huyết. .. 56,3% bệnh nhân tuân thủ điều trị 1 .2 KIỂM SOÁT HUYẾT ÁP, ĐƯỜNG HUYẾT VÀ LIPID MÁU 1 .2. 1 Kiểm soát huyết áp 13.8% 42 BN 86 .2% 26 2 BN Kiểm sốt Khơng kiểm soát Biểu đồ 1 .20 : Kiểm soát huyết áp Nhận