TĂNG HUYẾT ÁP

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TNG HUYT P. I CNG. T 65 tui tr ln: 2/3 c THA (USA). T 60 tui tr ln 1/2 b THA (BV Lo Khoa trung ng) Ngi gi THA: tai bin tim mch tng gp 3 ngi gi, HA tm thu l yu t nguy c quan trng hn HA tm trng - PowerPoint PPT Presentation

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  • *TNG HUYT P

  • *I CNGT 65 tui tr ln: 2/3 c THA (USA). T 60 tui tr ln 1/2 b THA (BV Lo Khoa trung ng)Ngi gi THA: tai bin tim mch tng gp 3 ngi gi, HA tm thu l yu t nguy c quan trng hn HA tm trngiu tr h HA lm gim 30-40% t qu, 20-25% NMCT v 50% suy timiu tr h HA c li NCT cho n tui 80. Sau tui ny cha c kt lun

  • T L THA THEO TUI

  • *KIM SOT TNG HUYT P TI HOA KT l THA khng c kim sot ngi gi : 75%

    1976-19801988-19911991-19941900-2000c chn on THAc iu trKim sot c HA51%31%10%73%55%29%68%54%27%70%59%34%

  • THAY I HUYT P THEO TUI*

  • TNG TNH CNG M V VN TC LAN TRUYN SNG MCH*

  • LOI THA THEO TUI*

  • *NH NGHA, PHN LOI TNG HUYT P

    ESH/ESC - 2007HA (mmHg)JNC 7 - 2003Ti u< 120/80Bnh thngBnh thng120-129/80-84Tin THABnh thng cao130-139/85-89Tng huyt p 140/90Tng huyt pGiai on 1140-159/90-99Giai on 1Giai on 2160-179/100-109Giai on 2Giai on 3 180/110

  • *YU T NGUY C TIM MCH TNG QUTYu t nguy c chuyn ha v tn thng c quan ch tin lm sng rt hay gp BN THAPhi phn loi bnh nhn theo s o HA v yu t nguy c tim mch tng qut da vo yu t nguy c km theo v tn thng c quan chChin lc iu tr ty thuc vo yu t nguy c tim mch tng qut (chia thnh 4 mc: thp, trung bnh, cao v rt cao)

  • *YU T NGUY C TIM MCH TNG QUT

  • *O HUYT Po t nht 2 ln, mi ln cch nhau t nht l 2 pht, nu chnh nhau 5 mmHg phi o ln th 3, ly trung bnh cng. T th nm hoc ngi.My o HA thu ngn, ng h.o hai tay: Khi nghi ng (mch 2 tay khng u, chng mt). Chnh lch khi HA ti a 20 mmHg/ ti thiu 10 mmHg

  • *HI CHNG N CP MU DI N

  • * NGI GI CN LU Hi chng o chong trng: THA trong mi trng bnh vinTHA gi to do thnh mch qu cng: NF Osler, du hiu git chung...Tt HA t th: do cc baroreceptor km nhy cm, do suy tnh mch mn tnh, do tc dng ph ca cc thuc, do mt nc...Khong trng HA do nhp tim khng u

  • *THEO DI HA LIN TCTheo di HA lin tc cho php nh gi tinh trng THA o trng (white-coat HTN) HA khi theo di bng my o HA lin tc thng thp hn HA o ti bnh vin.Nu trung bnh, HA > 135/85 (khi thc) v >120/75 (khi ng) thi coi nh THA. Trong m HA gim t 10 - 20%. Nu khng gim, bnh nhn c tng nguy c b cc tai bin tim mch.

  • *T O HUYT PCung cp thng tin v:p ng vi iu tr bng thuc h pCi thin tun th iu tr nh gi cc trng hp THA o trngKhi t o HA ti nh, nu HA >135/85 ni chung coi l THA.My o HA phi c kim tra thng xuyn.Khng khuyn khch nu:BN lo lngBN t thay i ch iu tr

  • *THAY I HUYT P TRONG NGY

    Hot ngHA tm thu mmHgHA tm trng mmHgHpLm vici bGi in thoinNi chuync schXem TVNgh ngiNg+20,2+16,0+12,0+ 9,5+ 8,8+ 6,7+ 1,9+ 0,3 0,0-10,0+15,0+13,0+ 5,5+ 7,2+ 9,6+ 6,7+ 2,2+ 1,1 0,0- 7,6

  • *KHM BNH NHN TNG HUYT PTm hiu li sng v xc nh cc yu t nguy c mch vnh khc hoc cc bnh km theo c nh hng n tin lng v iu tr bnh nhn. Tm cc nguyn nhn c th xc nh c gy THA.nh gi cc tn thng c quan ch v bnh mch vnh.

  • *YU T NGUY C HA tm thu v tm trng Chnh lch HA ( ngi gi) Tui: nam>55, n>65 Ht thuc l Ri lon lipid mu: TC>5mmol/L, LDL>3mmol/L, HDL: nam102cm, n>88cm TS gia nh cht sm v tim mch: nam
  • *YU T NGUY C Hi chng chuyn ha, 3 trong 5 tiu chun sau: Bo bng: Vng bng nam>102cm, n>88cm (Chu l 90 v 80 cm) ng huyt i 5,6-6,9mmol/L HA130/85mmHg HDL: nam
  • *TN THNG C QUAN CH TIN LM SNGDTT trn T (Sokolov-Lyon>38) hocDTT trn siu m: Khi c tht tri nam>125g/m2, n>110g/m2NTM M cnh >0,9mm hoc c MVXTc lan truyn sng mch cnh-i>12m/sCh s p lc c chn-cnh tay
  • *BNH KM THEOi tho ngng huyt i >7mmol/L, nhiu lnng huyt sau n >11mmol/LBnh mch no: NMN, XHN, TIABnh tim: NMCT, au tht ngc, ti thng mch vnh, suy timBnh thn: Bnh thn do T, suy thn (cre ht nam>133, n>124mmol/L; protein niu>300mg/24hBnh mch ngoi viBnh vng mc tin trin: xut huyt, xut tit, ph gai

  • *NGUY C CAO, RT CAOHATT 180 mmHg v /hoc HATTr 110 mmHgHATT > 160 mmHg v HATTr < 70 mmHgi tho ngHi chng chuyn ha> 3 yu t nguy c tim mchC mt hoc nhiu tn thng c quan ch tin lm sngDTT trn T hoc S timDy NTM hoc MVX M cnhTng tnh cng ng mchCreatinin huyt thanh tng mc vaGim mc lc cu thn hoc thanh thi creatininMicroalbumin niu hoc protein niuBnh tim mch hoc bnh thn

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  • *MNG X VA

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  • *MC LC CU THNCockcroft-Gault GFR = (140-tui) x (cn nng kg) x (1,23 nu l nam, 1,04 nu l n) / (Cr)

    MDRD GFR = 32788 x Cr -1.154 x Tui - 0.203 x 0.742 (nu l n)

  • *CC THM D V XT NGHIMXt nghim thng quy in tm Phn tch nc tiu ng mu v hematocrit Kali, creatinine huyt thanh, mc lc cu thn, calcium nh lng lipid mu, sau nhn n t 9 - 12 gi, bao gm LDL, HDL v Triglyceride Cc xt nghim b xung nh lng albumin niu hoc ch s albumin/creatinine Cc xt nghim su tm nguyn nhn THA ch c ch nh khi khng th kim sot c HA

  • *HUYT P MC TIU NGI GI Ngi gi (60 79 tui): HA =80 tui):HA
  • *THAY I LI SNGTt c BN, k c HA bnh thng cao, nhm:H HAKim sot cc YTNC khcGim liu thuc h pB thuc lGim cn nng, BMI 20 25 kg/m2Hot ng th lc (75 150/ tun)Hn ch mui ( < 6g NaCl)n nhiu rau, hoa qu, gim m Hn ch ung ru

  • *THAY I LI SNG

    Thay iHA tm thu gimGim cn nng520mmHg/10 kg cn nngTheo ch DASH 814 mmHgHn ch mn 28 mmHgVn ng49 mmHgHn ch ru 24 mmHg

  • *KHI NO BT U IU TR BNG THUC

  • *PHN LOI THUC HUYT PLi tiu Thiazide: Benzthiazide, Hydrochlorothiazide, Indapamide Li tiu quai: Furosemide, Ethacrynic acid Li tiu gi kali: Amiloride, Triamterene i khng aldosterone: Spironolactone, EplerenoneTc dng giao cm Ngoi vi: Reserpine Trung ng: Clonidine, Methyldopa Chn bta giao cm: Atenolol, Metoprolol Chn alpha: Doxazosin, Prazosin, Terazosin Chn alpha v bta: Labetalol, Carvedilol

  • *PHN LOI THUC HUYT PChn knh can xi Nifedipine, Amlopidine, Nicardipinec ch men chuyn Benazepril, Captopril, Enalapril, quinaprili khng th th angiotensin II Candesartan, Irbesartan, Losartan, Telmisartan, ValsartanGin mch trc tip Hydralazine, Minoxidil

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  • *IU TR THUC: ESH/EHC 2007

    Tn thng c quan ch tin LSiu trDy tht triCMC, Chn knh canxi, i khng ATVXM khng triu chngChn knh canxi, CMC,

    Microalbumin niuCMC, i khng AT

    Suy thnCMC, i khng AT

  • *IU TR THUC: ESH/EHC 2007

    Biu hin lm sngiu trTin s t quBt c thuc h HA noTin s nhi mu c timChn bta, CMC, i khng ATau tht ngcChn bta, chn canxiSuy timLi tiu, chn bta, CMC, i khng AT, khng Aldosterone

  • *IU TR THUC: ESH/EHC 2007

    Biu hin lm sngiu trRung nh ti phtRung nh tn tii khng AT, CMCChn bta, Chn canxi non-dihydropiridineSuy thn/protein niuCMC, i khng AT, li tiu quaiBnh mch ngoi viChn canxi

  • *IU TR THUC: ESH/EHC 2007

    Tnh trng bnh nhniu trTHA tm thu n c (ngi gi)Li tiu, chn knh canxiHi chng chuyn haCMC, i khng AT, chn knh canxii tho ngCMC, i khng ATC thaiChn knh canxi, methyldopa, chn btaDa enLi tiu, chn knh canxi

  • *IU TR THUC: ESH/EHC 2007

    ThucCh nhLi tiu ThiazideTHA tm thu n c (ngi gi)Suy timCMCSuy tim, suy chc nng tht tri, sau NMCT, bnh thn do T, bnh thn khng do T, dy tht tri, VXM cnh, protein niu/microalbumine niu, rung nh, hi chng chuyn ha

  • *IU TR THUC: ESH/EHC 2007

    ThucCh nhChn btaau tht ngc, sau NMCT, suy tim, lon nhp nhanh, glaucoma, c thaii khng th th angiotensinSuy tim, sau NMCT, bnh thn do T, protein niu/microalbumine niu, dy tht tri, rung nh, hi chng chuyn ha, ho khi dng CMC

  • *IU TR THUC: ESH/EHC 2007

    ThucCh nhChn knh canxi (dihydro-pyridine)THA tm thu n c (ngi gi), au tht ngc, dy tht tri, VXM cnh/vnh, thai nghnLi tiu (khng aldosterone)Suy tim, sau NMCTChn knh canxi (verapamil/diltiazemau tht ngc, VXM cnh, nhp nhanh trn thtLi tiu quaiSuy thn giai on cui, suy tim

  • *CHNG CH NH : ESH/EHC 2007

    ThucCC bt bucCC c thLi tiu thiazideGoutHi chng chuyn ha, khng dung np glucose, c thai Chn btaHen ph qunBlock nh tht (cp 2 hoc 3)Bnh ng mch ngoi vi, hi chng chuyn ha, khng dung np glucose, vn ng vin, COPD

  • *CHNG CH NH : ESH/EHC 2007

    ThucCC Tuyt iCC c thChn knh canxi (dihydropiridine)Lon nhp nhanh, suy timChn knh canxi (verapamil diltiazem) Block nh tht (cp 2 hoc 3), suy timCMCC thai, ph mch-TK, tng kali mu, hp ng mch thn hai bn

  • *CHNG CH NH : ESH/EHC 2007

    ThucCC Tuyt iCC c thi khng th th angiotensinC thai, tng kali mu, hp ng mch thn 2 bnLi tiu (khng aldosterone)Suy thn, tng kali mu

  • *Li tiu ThiazideChn btaCMCi khng ATChn knh canxiChn alpha

  • Kt lunT l THA ngy cng gia tng trong cng ng nc ta v trn th gii.

    2. T l nhng ngi b THA c iu tr v t HA mc tiu cn thp.

    3. iu chnh li sng tch cc v phi hp thuc iu tr lu di.

    4. THA khng tr cn tm nguyn nhn, phi hp nhiu thuc h p hn ch ti a cc bin chng.

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    *Lowest rates of BP control