{"id":11651,"date":"2023-09-15T14:58:52","date_gmt":"2023-09-15T06:58:52","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=11651"},"modified":"2025-02-11T13:36:57","modified_gmt":"2025-02-11T05:36:57","slug":"esh-2023-huong-dan-kiem-soat-tang-huyet-ap","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/esh-2023-huong-dan-kiem-soat-tang-huyet-ap\/","title":{"rendered":"ESH 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p"},"content":{"rendered":"\n

M\u1ede \u0110\u1ea6U<\/strong><\/p>\n\n\n\n

H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p c\u1ee7a Hi\u1ec7p h\u1ed9i T\u0103ng huy\u1ebft \u00e1p Ch\u00e2u \u00c2u (European society of hypertension \u2013 ESH) bao g\u1ed3m nh\u1eefng c\u1eadp nh\u1eadt c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh sau h\u01b0\u1edbng d\u1eabn n\u0103m 2018. H\u01b0\u1edbng d\u1eabn n\u0103m 2023 c\u0169ng \u0111\u00e0o s\u00e2u h\u01a1n nh\u1eefng ch\u1ee7 \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn t\u0103ng huy\u1ebft \u00e1p v\u00e0 bi\u1ec7n ph\u00e1p ki\u1ec3m so\u00e1t li\u00ean quan \u0111\u1ebfn nh\u1eefng v\u1ea5n \u0111\u1ec1 n\u00e0y. B\u00e0i vi\u1ebft l\u01b0\u1ee3c d\u1ecbch nh\u1eefng \u0111i\u1ec3m ch\u00ednh c\u1ee7a h\u01b0\u1edbng d\u1eabn v\u1ec1 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p, b\u1eb1ng vi\u1ec7c th\u1ec3 hi\u1ec7n n\u1ed9i dung qua h\u00ecnh \u1ea3nh v\u00e0 b\u1ea3ng bi\u1ec3u, \u0111\u1ed9i ng\u0169 Docquity hy v\u1ecdng qu\u00fd b\u1ea1n \u0111\u1ecdc d\u1ec5 d\u00e0ng n\u1eafm b\u1eaft c\u00e1c khuy\u1ebfn c\u00e1o. B\u00e0i vi\u1ebft \u0111\u1ec1 c\u1eadp \u0111\u1ebfn nh\u1eefng \u0111i\u1ec3m quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb sau:<\/p>\n\n\n\n

    \n
  1. \u0110\u1ecbnh ngh\u0129a v\u00e0 ph\u00e2n lo\u1ea1i t\u0103ng huy\u1ebft \u00e1p<\/li>\n\n\n\n
  2. T\u0103ng huy\u1ebft \u00e1p v\u00e0 nguy c\u01a1 tim m\u1ea1ch<\/li>\n\n\n\n
  3. Can thi\u1ec7p l\u1ed1i s\u1ed1ng<\/li>\n\n\n\n
  4. Kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p<\/li>\n\n\n\n
  5. Huy\u1ebft \u00e1p m\u1ee5c ti\u00eau trong \u0111i\u1ec1u tr\u1ecb<\/li>\n\n\n\n
  6. Thu\u1ed1c h\u1ea1 \u00e1p trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/li>\n\n\n\n
  7. Theo d\u00f5i<\/li>\n<\/ol>\n\n\n\n

    1. \u0110\u1ecaNH NGH\u0128A V\u00c0 PH\u00c2N LO\u1ea0I T\u0102NG HUY\u1ebeT \u00c1P<\/strong><\/p>\n\n\n\n

    D\u1ef1a theo \u0111\u1ecbnh ngh\u0129a c\u1ee7a Ch\u00e2u \u00c2u n\u0103m 2018 v\u00e0 nh\u1eefng h\u01b0\u1edbng d\u1eabn qu\u1ed1c t\u1ebf, t\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a d\u1ef1a tr\u00ean gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p t\u00e2m thu (SBP) \u0111o t\u1ea1i ph\u00f2ng kh\u00e1m \u2265 140 mmHg v\u00e0\/ho\u1eb7c huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng (DBP) \u0111o t\u1ea1i ph\u00f2ng kh\u00e1m \u2265 90 mmHg. Tuy nhi\u00ean, m\u1ed1i quan h\u1ec7 gi\u1eefa nhi\u1ec1u bi\u1ebfn c\u1ed1 tim m\u1ea1ch, bi\u1ebfn c\u1ed1 tr\u00ean th\u1eadn v\u00e0 nh\u1eefng bi\u1ebfn c\u1ed1 g\u00e2y nguy hi\u1ec3m \u0111\u1ebfn t\u00ednh m\u1ea1ng kh\u00e1c v\u00e0 SBP > 115 mmHg v\u00e0 DBP > 75 mmHg \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn. Do v\u1eady, \u0111\u1ecbnh ngh\u0129a n\u00f3i tr\u00ean kh\u00e1 ng\u1eabu nhi\u00ean v\u00e0 \u0111\u01b0\u1ee3c \u0111\u01b0a ra ch\u1ee7 y\u1ebfu \u0111\u1ec3 \u0111\u01a1n gi\u1ea3n h\u00f3a ch\u1ea9n \u0111o\u00e1n v\u00e0 quy\u1ebft \u0111\u1ecbnh ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p tr\u00ean th\u1ef1c h\u00e0nh. H\u01b0\u1edbng d\u1eabn n\u0103m 2023 kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 \u0111\u1ecbnh ngh\u0129a c\u0169ng nh\u01b0 c\u00e1ch ph\u00e2n lo\u1ea1i huy\u1ebft \u00e1p (b\u1ea3ng 1).<\/p>\n\n\n\n

    B\u1ea3ng 1.<\/strong> Ph\u00e2n lo\u1ea1i huy\u1ebft \u00e1p d\u1ef1a tr\u00ean gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p t\u00e2m thu v\u00e0 t\u00e2m tr\u01b0\u01a1ng<\/p>\n\n\n\n

    \"\"Ngo\u00e0i ph\u00e2n lo\u1ea1i huy\u1ebft \u00e1p d\u1ef1a tr\u00ean gi\u00e1 tr\u1ecb SBP v\u00e0 DBP, t\u0103ng huy\u1ebft \u00e1p c\u0169ng \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i d\u1ef1a tr\u00ean nh\u1eefng b\u1ec7nh l\u00fd\/bi\u1ebfn ch\u1ee9ng \u0111i k\u00e8m (b\u1ea3ng 2).<\/p>\n\n\n\n

    B\u1ea3ng 2.<\/strong> Ph\u00e2n lo\u1ea1i huy\u1ebft \u00e1p d\u1ef1a tr\u00ean c\u00e1c t\u00ecnh tr\u1ea1ng b\u1ec7nh l\u00fd m\u1eafc k\u00e8m<\/p>\n\n\n\n

    \"\"2. <\/strong>T\u0102NG HUY\u1ebeT \u00c1P V\u00c0 NGUY C\u01a0 TIM M\u1ea0CH<\/strong><\/p>\n\n\n\n

    T\u0103ng huy\u1ebft \u00e1p th\u01b0\u1eddng li\u00ean quan \u0111\u1ebfn nh\u1eefng y\u1ebfu t\u1ed1 nguy c\u01a1 kh\u00e1c, bao g\u1ed3m r\u1ed1i lo\u1ea1n lipid m\u00e1u, k\u00e9m dung n\u1ea1p glucose v\u00e0 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. Nguy c\u01a1 tim m\u1ea1ch ph\u00e2n lo\u1ea1i theo ph\u00e2n \u0111\u1ed9 huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong h\u00ecnh 1.<\/p>\n\n\n\n

    \"\"H\u00ecnh 1.<\/strong> Nguy c\u01a1 tim m\u1ea1ch theo ph\u00e2n \u0111\u1ed9 huy\u1ebft \u00e1p<\/p>\n\n\n\n

    3. CAN THI\u1ec6P L\u1ed0I S\u1ed0NG<\/strong><\/p>\n\n\n\n

    C\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 can thi\u1ec7p l\u1ed1i s\u1ed1ng \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong b\u1ea3ng 3 v\u00e0 h\u00ecnh 2.<\/p>\n\n\n\n

    \"\"H\u00ecnh 2.<\/strong> C\u00e1c y\u1ebfu t\u1ed1 c\u1ea7n c\u00e2n nh\u1eafc trong can thi\u1ec7p l\u1ed1i s\u1ed1ng<\/p>\n\n\n\n

    B\u1ea3ng 3.<\/strong> Khuy\u1ebfn c\u00e1o can thi\u1ec7p l\u1ed1i s\u1ed1ng<\/p>\n\n\n\n

    \"\"4. KH\u1edeI \u0110\u1ea6U \u0110I\u1ec0U TR\u1eca B\u1eb0NG THU\u1ed0C H\u1ea0 \u00c1P<\/strong><\/p>\n\n\n\n

    4.1. C\u00f3 n\u00ean kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb d\u1ef1a tr\u00ean nguy c\u01a1 tim m\u1ea1ch t\u1ed5ng th\u1ec3?<\/strong><\/p>\n\n\n\n

    K\u1ebft qu\u1ea3 m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p cho th\u1ea5y n\u00ean kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb h\u1ea1 \u00e1p d\u1ef1a theo m\u1ee9c \u0111\u1ed9 nguy c\u01a1 tim m\u1ea1ch \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao c\u00f3 huy\u1ebft \u00e1p b\u1ea5t k\u1ef3. Tuy nhi\u00ean, h\u01b0\u1edbng d\u1eabn c\u1ee7a ESH ch\u01b0a \u1ee7ng h\u1ed9 k\u1ebft lu\u1eadn n\u00e0y. B\u1eb3ng ch\u1ee9ng \u1ee7ng h\u1ed9 vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p s\u1edbm v\u1eabn n\u1eb1m \u1edf m\u1ee9c th\u1ea5p \u2013 trung b\u00ecnh. M\u1eb7c d\u00f9 nguy c\u01a1 tim m\u1ea1ch l\u00e0 m\u1ed9t th\u00f4ng tin quan tr\u1ecdng v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng, nh\u01b0ng c\u0169ng c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb h\u1ea1 \u00e1p d\u1ef1a tr\u00ean gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p trong ph\u00f2ng kh\u00e1m.<\/p>\n\n\n\n

    4.2. Ng\u01b0\u1ee1ng huy\u1ebft \u00e1p ph\u00f2ng kh\u00e1m \u0111\u1ec3 kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c<\/strong><\/p>\n\n\n\n

    T\u1ea5t c\u1ea3 c\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb \u0111\u1ec1u \u0111\u1ed3ng thu\u1eadn n\u00ean kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p cho b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 2 v\u00e0 \u0111\u1ed9 3, ph\u1ed1i h\u1ee3p v\u1edbi can thi\u1ec7p l\u1ed1i s\u1ed1ng. B\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 1 k\u00e8m nguy c\u01a1 tim m\u1ea1ch cao c\u0169ng n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p ph\u1ed1i h\u1ee3p v\u1edbi can thi\u1ec7p l\u1ed1i s\u1ed1ng. \u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 1 k\u00e8m nguy c\u01a1 tim m\u1ea1ch th\u1ea5p \u2013 trung b\u00ecnh, vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00f4ng \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 trong nh\u1eefng khuy\u1ebfn c\u00e1o tr\u01b0\u1edbc \u0111\u00e2y v\u00e0 hi\u1ec7n nay v\u1eabn \u0111ang l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 g\u00e2y tranh c\u00e3i. Trong h\u01b0\u1edbng d\u1eabn n\u00e0y, sau khi c\u00e2n nh\u1eafc c\u00e1c b\u1eb1ng ch\u1ee9ng, ESH cho r\u1eb1ng \u0111\u1ed1i v\u1edbi m\u1ecdi b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p, bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb n\u00ean bao g\u1ed3m can thi\u1ec7p l\u1ed1i s\u1ed1ng v\u00e0 thu\u1ed1c h\u1ea1 \u00e1p (b\u1ea5t k\u1ec3 nguy c\u01a1 tim m\u1ea1ch) (h\u00ecnh 3). Tuy nhi\u00ean, ri\u00eang \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p \u0111\u1ed9 1 c\u00f3 gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p ti\u1ec7m c\u1eadn kho\u1ea3ng gi\u1edbi h\u1ea1n d\u01b0\u1edbi m\u00e0 kh\u00f4ng b\u1ecb t\u1ed5n th\u01b0\u01a1ng c\u01a1 quan do t\u0103ng huy\u1ebft \u00e1p v\u00e0 c\u00f3 nguy c\u01a1 tim m\u1ea1ch th\u1ea5p, \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 n\u00ean kh\u1edfi \u0111\u1ea7u ch\u1ec9 b\u1eb1ng thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng. Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb ch\u1ec9 b\u1eb1ng can thi\u1ec7p l\u1ed1i s\u1ed1ng c\u00f3 th\u1ec3 l\u00e0 v\u00e0i th\u00e1ng (ch\u1eb1ng h\u1ea1n 6 th\u00e1ng) v\u00e0 ph\u1ee5 thu\u1ed9c v\u00e0o gi\u00e1 tr\u1ecb huy\u1ebft \u00e1p (huy\u1ebft \u00e1p t\u00e2m thu ti\u1ec7m c\u1eadn gi\u1edbi h\u1ea1n d\u01b0\u1edbi \u2013 140 mmHg). N\u1ebfu kh\u00f4ng \u0111\u1ea1t huy\u1ebft \u00e1p m\u1ee5c ti\u00eau sau v\u00e0i th\u00e1ng th\u00ec c\u00f3 th\u1ec3 c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p (h\u00ecnh 3).<\/p>\n\n\n\n

    \"\"H\u00ecnh 3.<\/strong> Kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p<\/p>\n\n\n\n

    B\u1ea3ng 4.<\/strong> Khuy\u1ebfn c\u00e1o kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u00e1p<\/p>\n\n\n\n

    \"\"<\/figure>\n\n\n\n

    5. HUY\u1ebeT \u00c1P M\u1ee4C TI\u00caU TRONG \u0110I\u1ec0U TR\u1eca<\/strong><\/p>\n\n\n\n

    Khuy\u1ebfn c\u00e1o v\u1ec1 huy\u1ebft \u00e1p m\u1ee5c ti\u00eau \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong b\u1ea3ng 5.<\/p>\n\n\n\n

    B\u1ea3ng 5.<\/strong> Huy\u1ebft \u00e1p m\u1ee5c ti\u00eau<\/p>\n\n\n\n

    \"\"<\/figure>\n\n\n\n

    6. THU\u1ed0C H\u1ea0 \u00c1P TRONG \u0110I\u1ec0U TR\u1eca T\u0102NG HUY\u1ebeT \u00c1P<\/strong><\/p>\n\n\n\n

    Trong h\u01b0\u1edbng d\u1eabn n\u0103m 2018 c\u1ee7a ESH\/ESC, 5 nh\u00f3m thu\u1ed1c h\u1ea1 \u00e1p ch\u00ednh \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay cho b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p bao g\u1ed3m: thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (ACEi); thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin (ARB); thu\u1ed1c ch\u1eb9n k\u00eanh calci (CCB); thu\u1ed1c l\u1ee3i ti\u1ec3u thiazide\/gi\u1ed1ng thiazide v\u00e0 ch\u1eb9n beta (BB) (h\u00ecnh 4). Trong c\u00e1c khuy\u1ebfn c\u00e1o v\u1ec1 vi\u1ec7c l\u1ef1a ch\u1ecdn nh\u00f3m thu\u1ed1c ph\u00f9 h\u1ee3p, ch\u1ea5t \u1ee9c ch\u1ebf h\u1ec7 renin \u2013 angiotensin (ACEi v\u00e0 ARB) \u0111\u01b0\u1ee3c xem l\u00e0 th\u00e0nh ph\u1ea7n ph\u1ed5 bi\u1ebfn nh\u1ea5t trong c\u00e1c chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p (n\u1ebfu kh\u00f4ng b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh). Vi\u1ec7c s\u1eed d\u1ee5ng BB c\u0169ng h\u1ea1n ch\u1ebf \u1edf m\u1ed9t s\u1ed1 nh\u00f3m b\u1ec7nh nh\u00e2n (b\u1ea3ng 7). Khuy\u1ebfn c\u00e1o v\u1ec1 c\u00e1c thu\u1ed1c h\u1ea1 \u00e1p \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong b\u1ea3ng 6. Vi\u1ec7c l\u1ef1a ch\u1ecdn nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb  \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean c\u00e1c y\u1ebfu t\u1ed1:<\/p>\n\n\n\n

      \n
    1. Kh\u1ea3 n\u0103ng h\u1ea1 \u00e1p khi \u0111\u01a1n tr\u1ecb<\/li>\n\n\n\n
    2. B\u1eb1ng ch\u1ee9ng t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1ec1 hi\u1ec7u l\u1ef1c \u0111i\u1ec1u tr\u1ecb v\u00e0 gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong<\/li>\n\n\n\n
    3. S\u1ef1 dung n\u1ea1p c\u1ee7a b\u1ec7nh nh\u00e2n v\u00e0 t\u00ednh an to\u00e0n c\u1ee7a thu\u1ed1c<\/li>\n<\/ol>\n\n\n\n

      \"\"H\u00ecnh 4.<\/strong> C\u00e1c nh\u00f3m thu\u1ed1c h\u1ea1 \u00e1p.<\/p>\n\n\n\n

      a<\/sup>C\u00e2n nh\u1eafc chuy\u1ec3n sang l\u1ee3i ti\u1ec3u quai n\u1ebfu eGFR n\u1eb1m trong kho\u1ea3ng 30 \u2013 45 mml\/ph\u00fat\/1.73 m2<\/sup>. N\u1ebfu eGFR < 30 ml\/ph\u00fat\/1.73m2<\/sup>, l\u1ef1a ch\u1ecdn l\u1ee3i ti\u1ec3u quai
      b<\/sup>CCB non-dihypropyridine kh\u00f4ng n\u00ean ph\u1ed1i h\u1ee3p v\u1edbi BB
      C<\/sup>BB n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn cho m\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh trong b\u1ea3ng 7<\/em><\/p>\n\n\n\n

      B\u1ea3ng 6.<\/strong> Khuy\u1ebfn c\u00e1o v\u1ec1 c\u00e1c thu\u1ed1c h\u1ea1 \u00e1p<\/p>\n\n\n\n

      \"\"B\u1ea3ng 7.<\/strong> C\u00e1c b\u1ec7nh l\u00fd m\u1eafc k\u00e8m \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p n\u00ean l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ch\u1eb9n beta<\/p>\n\n\n\n

      \"\"<\/figure>\n\n\n\n

      6. Ph\u1ed1i h\u1ee3p thu\u1ed1c h\u1ea1 \u00e1p<\/strong><\/p>\n\n\n\n

      Chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p d\u1ef1a tr\u00ean b\u1eb1ng ch\u1ee9ng hi\u1ec7u qu\u1ea3 l\u00e0 chi\u1ebfn l\u01b0\u1ee3c th\u1ecfa m\u00e3n c\u00e1c y\u1ebfu t\u1ed1:<\/p>\n\n\n\n

      1. Khuy\u1ebfn kh\u00edch ph\u1ed1i h\u1ee3p thu\u1ed1c \u1edf \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n, \u0111\u1eb7c bi\u1ec7t l\u00e0 \u0111\u1ec3 h\u1ea1 \u00e1p
      2. T\u0103ng c\u01b0\u1eddng ph\u1ed1i h\u1ee3p thu\u1ed1c trong 1 vi\u00ean \u0111\u1ec3 h\u1ed7 tr\u1ee3 s\u1ef1 ki\u00ean tr\u00ec khi \u0111i\u1ec1u tr\u1ecb d\u00e0i h\u1ea1n
      3. Khuy\u1ebfn c\u00e1o ph\u1ed1i h\u1ee3p h\u1ea1 \u00e1p khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u1edf \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p<\/p>\n\n\n\n

      Ch\u00ednh v\u00ec v\u1eady, khuy\u1ebfn c\u00e1o c\u1ee7a ESH\/ESC n\u0103m 2018 \u0111\u00e3 khuy\u1ebfn c\u00e1o chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n gi\u1ea3n h\u00f3a, s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p thu\u1ed1c trong 1 vi\u00ean nh\u01b0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay cho h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n, ngo\u1ea1i tr\u1eeb b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5ng tr\u1ea1ng y\u1ebfu v\u00e0 b\u1ec7nh nh\u00e2n cao tu\u1ed5i (do nguy c\u01a1 suy gi\u1ea3m ph\u1ea3n x\u1ea1 \u00e1p th\u1ee5 quan v\u00e0 t\u0103ng nguy c\u01a1 h\u1ea1 huy\u1ebft \u00e1p qu\u00e1 m\u1ee9c), b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 r\u1ea5t cao c\u00f3 huy\u1ebft \u00e1p b\u00ecnh th\u01b0\u1eddng cao, b\u1ec7nh nh\u00e2n gi\u1ea3m huy\u1ebft \u00e1p nh\u1ecf c\u00f3 th\u1ec3 \u0111\u1ea1t huy\u1ebft \u00e1p m\u1ee5c ti\u00eau khi \u0111\u01a1n tr\u1ecb. Kh\u1edfi tr\u1ecb \u0111\u01a1n tr\u1ecb c\u0169ng c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p ph\u00e2n \u0111\u1ed9 1 c\u00f3 nguy c\u01a1 th\u1ea5p.<\/p>\n\n\n\n

      Kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p b\u1eb1ng chi\u1ebfn l\u01b0\u1ee3c ph\u1ed1i h\u1ee3p thu\u1ed1c \u0111\u01b0\u1ee3c \u1ee7ng h\u1ed9 b\u1edfi nhi\u1ec1u lu\u1eadn \u0111i\u1ec3m:<\/p>\n\n\n\n

      1. Kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p thu\u1ed1c h\u1ea1 \u00e1p hi\u1ec7u l\u1ef1c h\u01a1n \u0111\u01a1n tr\u1ecb, ph\u1ed1i h\u1ee3p thu\u1ed1c \u1edf li\u1ec1u th\u1ea5p c\u0169ng hi\u1ec7u l\u1ef1c h\u01a1n \u0111\u01a1n tr\u1ecb \u1edf li\u1ec1u t\u1ed1i \u0111a
      2. Ph\u1ed1i h\u1ee3p thu\u1ed1c h\u1ea1 \u00e1p t\u00e1c \u0111\u1ed9ng qua nhi\u1ec1u c\u01a1 ch\u1ebf: (i) gi\u1ea3m b\u1edbt s\u1ef1 ph\u1ee9c t\u1ea1p c\u1ee7a \u0111\u00e1p \u1ee9ng huy\u1ebft \u00e1p khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb; (ii) mang \u0111\u1ebfn t\u00e1c \u0111\u1ed9ng li\u1ec1u \u2013 \u0111\u00e1p \u1ee9ng t\u1ed1t h\u01a1n so v\u1edbi li\u1ec7u ph\u00e1p \u0111\u01a1n tr\u1ecb khi t\u0103ng li\u1ec1u v\u00e0 (iii) an to\u00e0n v\u00e0 dung n\u1ea1p t\u1ed1t h\u01a1n
      3. H\u1ea1 \u00e1p nhanh h\u01a1n
      4. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u1ed1t h\u01a1n sau 1 n\u0103m \u0111i\u1ec1u tr\u1ecb<\/p>\n\n\n\n

      Khuy\u1ebfn c\u00e1o ph\u1ed1i h\u1ee3p thu\u1ed1c h\u1ea1 \u00e1p \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong h\u00ecnh 5.<\/p>\n\n\n\n

      \"\"H\u00ecnh 5.<\/strong> Chi\u1ebfn l\u01b0\u1ee3c h\u1ea1 \u00e1p \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p<\/p>\n\n\n\n

      a<\/sup>C\u00e2n nh\u1eafc chuy\u1ec3n sang l\u1ee3i ti\u1ec3u quai n\u1ebfu eGFR n\u1eb1m trong kho\u1ea3ng 30 \u2013 45 mml\/ph\u00fat\/1.73 m2<\/sup>. N\u1ebfu eGFR < 30 ml\/ph\u00fat\/1.73m2<\/sup>, l\u1ef1a ch\u1ecdn l\u1ee3i ti\u1ec3u quai
      b<\/sup>BB n\u00ean \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb theo h\u01b0\u1edbng d\u1eabn cho m\u1ed9t s\u1ed1 ch\u1ec9 \u0111\u1ecbnh trong b\u1ea3ng 7
      c<\/sup>\u0110\u01b0\u1ee3c ki\u1ec3m so\u00e1t < 140\/90 mmHg
      d<\/sup>Khi SBP \u2265 140 mmHg ho\u1eb7c DBP \u2265 90 mmHg v\u1edbi \u0111i\u1ec1u ki\u1ec7n: li\u1ec1u c\u1ee7a 3 thu\u1ed1c trong ph\u1ed1i h\u1ee3p (ACEi ho\u1eb7c ARB, CCB v\u00e0 l\u1ee3i ti\u1ec3u thiazide\/gi\u1ed1ng thiazide) \u0111\u00e3 \u0111\u1ea1t m\u1ee9c t\u1ed1i \u0111a c\u00f3 th\u1ec3 dung n\u1ea1p; ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c x\u00e1c nh\u1eadn b\u1eb1ng k\u1ebft qu\u1ea3 \u0111o huy\u1ebft \u00e1p l\u01b0u \u0111\u1ed9ng ho\u1eb7c huy\u1ebft \u00e1p \u0111o t\u1ea1i nh\u00e0; nhi\u1ec1u nguy\u00ean nh\u00e2n kh\u00e1c nhau d\u1eabn \u0111\u1ebfn gi\u1ea3 t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb (\u0111\u1eb7c bi\u1ec7t l\u00e0 do k\u00e9m tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb) v\u00e0 t\u0103ng huy\u1ebft \u00e1p th\u1ee9 ph\u00e1t \u0111\u00e3 \u0111\u01b0\u1ee3c lo\u1ea1i tr\u1eeb.<\/em><\/p>\n\n\n\n

      7. <\/em>THEO D\u00d5I<\/strong><\/p>\n\n\n\n

      Theo d\u00f5i b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p l\u00e0 y\u1ebfu t\u1ed1 quan tr\u1ecdng \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb, h\u1ed7 tr\u1ee3 b\u1ec7nh nh\u00e2n can thi\u1ec7p l\u1ed1i s\u1ed1ng, theo d\u00f5i tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u00e1c t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i c\u1ee7a thu\u1ed1c. \u0110\u1ed1i v\u1edbi theo d\u00f5i b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p, c\u00f3 3 c\u00e2u h\u1ecfi c\u1ea7n \u0111\u01b0\u1ee3c gi\u1ea3i quy\u1ebft:<\/p>\n\n\n\n

      1. B\u1ec7nh nh\u00e2n n\u00ean t\u00e1i kh\u00e1m v\u1edbi t\u1ea7n su\u1ea5t ra sao?
      2. Nh\u1eefng y\u1ebfu t\u1ed1 n\u00e0o c\u1ea7n \u0111\u01b0\u1ee3c ki\u1ec3m tra?
      3. N\u00ean tham v\u1ea5n nh\u1eefng ai\/khoa ph\u00f2ng n\u00e0o m\u1ed7i l\u1ea7n b\u1ec7nh nh\u00e2n t\u00e1i kh\u00e1m?<\/p>\n\n\n\n

      Chi\u1ebfn l\u01b0\u1ee3c theo d\u00f5i b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb trong h\u00ecnh 6.<\/p>\n\n\n\n

      \"\"
      H\u00ecnh 6.<\/strong> Chi\u1ebfn l\u01b0\u1ee3c theo d\u00f5i b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p<\/p>\n\n\n\n

      Ph\u1ea7n ti\u1ebfp theo ch\u00fang t\u00f4i s\u1ebd \u0111\u1ec1 c\u1eadp \u0111\u1ebfn b\u1ea1n \u0111\u1ecdc c\u00e1c khuy\u1ebfn c\u00e1o ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t, bao g\u1ed3m ph\u1ee5 n\u1eef mang thai.<\/p>\n\n\n\n

      \n\n\n\n

      T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n

        \n
      1. Mancia Chairperson G, Kreutz Co-Chair R, Brunstr\u00f6m M et al; Authors\/Task Force Members:. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023 Jun 21. doi: 10.1097\/HJH.0000000000003480.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

        M\u1ede \u0110\u1ea6U H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p c\u1ee7a Hi\u1ec7p h\u1ed9i T\u0103ng huy\u1ebft \u00e1p Ch\u00e2u \u00c2u (European society of hypertension \u2013 ESH) bao g\u1ed3m nh\u1eefng c\u1eadp nh\u1eadt c\u1ee7a c\u00e1c nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh sau h\u01b0\u1edbng d\u1eabn n\u0103m 2018. H\u01b0\u1edbng d\u1eabn n\u0103m 2023 c\u0169ng \u0111\u00e0o s\u00e2u h\u01a1n nh\u1eefng ch\u1ee7 \u0111\u1ec1 li\u00ean quan \u0111\u1ebfn t\u0103ng …<\/p>\n

        ESH 2023: H\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p<\/span> Read More »<\/a><\/p>\n","protected":false},"author":123,"featured_media":11652,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1436],"articles_languages":[1375],"articles_filters":[],"class_list":["post-11651","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/11651","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=11651"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/11651\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/11652"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=11651"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=11651"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=11651"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=11651"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=11651"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=11651"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}