{"id":13156,"date":"2023-12-28T18:41:12","date_gmt":"2023-12-28T10:41:12","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=13156"},"modified":"2025-02-11T13:38:41","modified_gmt":"2025-02-11T05:38:41","slug":"hoi-nghi-aha-2022-phoi-hop-bon-thuoc-ha-ap-va-hieu-qua-dieu-tri","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/hoi-nghi-aha-2022-phoi-hop-bon-thuoc-ha-ap-va-hieu-qua-dieu-tri\/","title":{"rendered":"H\u1ed9i ngh\u1ecb AHA 2022: Ph\u1ed1i h\u1ee3p b\u1ed1n thu\u1ed1c h\u1ea1 \u00e1p v\u00e0 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb"},"content":{"rendered":"\n

K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u QUARTER-USA \u0111\u00e3 cho th\u1ea5y ph\u1ed1i h\u1ee3p 4 thu\u1ed1c v\u1edbi li\u1ec1u th\u1ea5p c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m nhi\u1ec1u h\u01a1n g\u1ea7n 5 mmHg so v\u1edbi bi\u1ec7n ph\u00e1p h\u1ea1 \u00e1p \u0111\u01a1n tr\u1ecb v\u1edbi li\u1ec1u c\u01a1 b\u1ea3n trong h\u01a1n 12 tu\u1ea7n theo d\u00f5i \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p nh\u1eb9 – trung b\u00ecnh. S\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p thu\u1ed1c h\u1ea1 \u00e1p ch\u1ee9a 4 thu\u1ed1c kh\u00e1c nhau c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p ch\u1ec9 qua m\u1ed9t b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u QUARTER \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y t\u1ea1i H\u1ed9i ngh\u1ecb th\u01b0\u1eddng ni\u00ean c\u1ee7a Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Hoa K\u1ef3 (American Heart Association \u2013 AHA) n\u0103m 2022 b\u1edfi GS. Mark Huffman, tr\u01b0\u1eddng \u0111\u1ea1i h\u1ecdc Washington.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u QUARTER \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n d\u1ef1a tr\u00ean m\u1ed9t m\u00f4 h\u00ecnh nghi\u00ean c\u1ee9u kh\u00e1c t\u1ea1i Australia (QUARTER-Australia). Nghi\u00ean c\u1ee9u n\u00e0y ti\u1ebfn h\u00e0nh so s\u00e1nh ph\u1ed1i h\u1ee3p 4 thu\u1ed1c (bao g\u1ed3m candesartan, amlodipine, indapamide v\u00e0 bisoprolol) v\u1edbi candesartan \u0111\u01a1n tr\u1ecb li\u1ec1u ti\u00eau chu\u1ea9n.<\/p>\n\n\n\n

Ph\u1ed1i h\u1ee3p 4 thu\u1ed1c g\u00e2y ra nhi\u1ec1u ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i h\u01a1n li\u1ec7u ph\u00e1p \u0111\u01a1n tr\u1ecb, nh\u01b0ng t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n ng\u01b0ng \u0111i\u1ec1u tr\u1ecb l\u1ea1i cao h\u01a1n \u1edf nh\u00f3m \u0111\u01a1n tr\u1ecb. Nghi\u00ean c\u1ee9u g\u1ea7n nh\u01b0 kh\u00f4ng c\u00f3 b\u00e1o c\u00e1o v\u1ec1 nh\u1eefng ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i nghi\u00eam tr\u1ecdng c\u1ee7a ph\u1ed1i h\u1ee3p 4 thu\u1ed1c.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u m\u1edbi QUARTER v\u00e0 nghi\u00ean c\u1ee9u tr\u01b0\u1edbc \u0111\u00f3 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u1edf Australia t\u01b0\u01a1ng t\u1ef1 nhau v\u1ec1 hi\u1ec7u qu\u1ea3 h\u1ea1 huy\u1ebft \u00e1p c\u1ee7a bi\u1ec7n ph\u00e1p ph\u1ed1i h\u1ee3p 4 thu\u1ed1c. Hai nghi\u00ean c\u1ee9u n\u00e0y cho th\u1ea5y vi\u1ec7c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p b\u1eb1ng ph\u1ed1i h\u1ee3p 4 thu\u1ed1c mang l\u1ea1i nhi\u1ec1u hi\u1ec7u qu\u1ea3 h\u01a1n bi\u1ec7n ph\u00e1p \u0111\u01a1n tr\u1ecb v\u00e0 kh\u00e1 an to\u00e0n.<\/p>\n\n\n\n

Ph\u1ed1i h\u1ee3p 4 thu\u1ed1c trong 1 vi\u00ean l\u00e0 m\u1ed9t bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 gi\u1ea3m thi\u1ec3u s\u1ed1 l\u1ea7n th\u0103m kh\u00e1m c\u1ee7a b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p, mang l\u1ea1i nhi\u1ec1u l\u1ee3i \u00edch v\u1ec1 kinh t\u1ebf v\u00e0 c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb. Ph\u1ed1i h\u1ee3p 4 thu\u1ed1c c\u00f3 th\u1ec3 l\u00e0m h\u1ea1 huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n m\u1ed9t c\u00e1ch hi\u1ec7u qu\u1ea3 \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau huy\u1ebft \u00e1p c\u1ee7a h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb m\u1edbi ch\u1ec9 sau 1 b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb. Tuy nhi\u00ean v\u1edbi k\u1ebft qu\u1ea3 c\u1ee7a th\u1eed nghi\u1ec7m SPRINT, \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c m\u1ee5c ti\u00eau huy\u1ebft \u00e1p n\u00e0y, b\u1ec7nh nh\u00e2n ph\u1ea3i tr\u1ea3i qua nhi\u1ec1u h\u01a1n 3 l\u1ea7n th\u0103m kh\u00e1m. Tr\u00ean th\u1ef1c t\u1ebf, nhi\u1ec1u b\u1ec7nh nh\u00e2n \u0111\u00e3 kh\u00f4ng quay l\u1ea1i ph\u00f2ng kh\u00e1m \u0111\u1ec3 \u0111i\u1ec1u ch\u1ec9nh chi\u1ebfn l\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u QUARTER-Australia<\/strong><\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u n\u00e0y \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh v\u00e0o n\u0103m 2021, tr\u00ean t\u1ed5ng c\u1ed9ng 591 b\u1ec7nh nh\u00e2n, so s\u00e1nh ph\u1ed1i h\u1ee3p 4 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u1edf li\u1ec1u th\u1ea5p (\u00bc li\u1ec1u ti\u00eau chu\u1ea9n): irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, bisoprolol 2.5 mg v\u1edbi irbesartan li\u1ec1u 150 mg\/ng\u00e0y trong v\u00f2ng 12 tu\u1ea7n. K\u1ebft qu\u1ea3 cho th\u1ea5y ph\u1ed1i h\u1ee3p 4 thu\u1ed1c \u1edf li\u1ec1u th\u1ea5p mang l\u1ea1i nhi\u1ec1u hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb h\u01a1n. Ph\u1ed1i h\u1ee3p 4 thu\u1ed1c l\u00e0m gi\u1ea3m nhi\u1ec1u h\u01a1n 6.9 mmHg huy\u1ebft \u00e1p t\u00e2m thu, 5.8 mmHg huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng so v\u1edbi irbesartan \u0111\u01a1n tr\u1ecb li\u1ec1u ti\u00eau chu\u1ea9n. S\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 hi\u1ec7u qu\u1ea3 gi\u1ea3m huy\u1ebft \u00e1p c\u1ee7a 2 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u QUARTER-Australia cho th\u1ea5y ph\u1ed1i h\u1ee3p 4 thu\u1ed1c v\u1edbi li\u1ec1u th\u1ea5p mang l\u1ea1i hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb nh\u01b0ng v\u1eabn duy tr\u00ec \u0111\u01b0\u1ee3c s\u1ef1 c\u00e2n b\u1eb1ng gi\u1eefa t\u00e1c d\u1ee5ng \u0111i\u1ec1u tr\u1ecb – s\u1ef1 dung n\u1ea1p thu\u1ed1c v\u00e0 t\u00ednh tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u QUARTER-USA<\/strong><\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u bao g\u1ed3m 62 b\u1ec7nh nh\u00e2n t\u1eeb Chicago. Nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u00f3 th\u1ec3 c\u00f3 huy\u1ebft \u00e1p > 140\/90 mmHg ch\u01b0a t\u1eebng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p > 130\/85 mmHg \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p. Huy\u1ebft \u00e1p t\u00e2m thu trung b\u00ecnh l\u00e0 138 mmHg v\u00e0 huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng trung b\u00ecnh l\u00e0 84 mmHg.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u ti\u1ebfn h\u00e0nh so s\u00e1nh gi\u1eefa 2 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb, ph\u1ed1i h\u1ee3p 4 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb v\u1edbi li\u1ec1u th\u1ea5p (\u00bc li\u1ec1u ti\u00eau chu\u1ea9n): candesartan 2 mg, amlodipine 1.25 mg, indapamide 0.625 mg, bisoprolol 2.5 mg v\u00e0 candesartan li\u1ec1u 8 mg. B\u1ec7nh nh\u00e2n tham gia nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o 2 nh\u00f3m \u0111i\u1ec1u tr\u1ecb n\u00e0y. Amlodipine li\u1ec1u 5 mg\/ng\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u1ed5 sung v\u00e0o ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb \u1edf c\u1ea3 2 nh\u00f3m b\u1ec7nh nh\u00e2n n\u1ebfu huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n duy tr\u00ec > 130\/80 mmHg sau 6 tu\u1ea7n \u0111i\u1ec1u tr\u1ecb. K\u1ebft qu\u1ea3 c\u00f3 18% b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m ph\u1ed1i h\u1ee3p 4 thu\u1ed1c v\u00e0 53% b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m \u0111\u01a1n tr\u1ecb ph\u1ea3i b\u1ed5 sung amlodipine 5 mg.<\/p>\n\n\n\n

K\u1ebft qu\u1ea3 cho th\u1ea5y ph\u1ed1i h\u1ee3p 4 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb l\u00e0m gi\u1ea3m nhi\u1ec1u h\u01a1n 4.8 mmHg huy\u1ebft \u00e1p t\u00e2m thu v\u00e0 4.9 mmHg huy\u1ebft \u00e1p t\u00e2m tr\u01b0\u01a1ng so v\u1edbi candesartan \u0111\u01a1n tr\u1ecb sau 12 tu\u1ea7n theo d\u00f5i. Tuy nhi\u00ean kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea v\u1ec1 hi\u1ec7u qu\u1ea3 h\u1ea1 \u00e1p gi\u1eefa 2 nh\u00f3m \u0111i\u1ec1u tr\u1ecb do c\u1ee1 m\u1eabu nghi\u00ean c\u1ee9u qu\u00e1 nh\u1ecf.<\/p>\n\n\n\n

Sau 12 tu\u1ea7n theo d\u00f5i, huy\u1ebft \u00e1p trung b\u00ecnh c\u1ee7a nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p 4 thu\u1ed1c l\u00e0 121\/73 mmHg, huy\u1ebft \u00e1p trung b\u00ecnh c\u1ee7a nh\u00f3m \u0111\u01a1n tr\u1ecb b\u1eb1ng candesartan l\u00e0 124\/77 mmHg.<\/p>\n\n\n\n

Ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c x\u1ea3y ra \u1edf 25% b\u1ec7nh nh\u00e2n nh\u00f3m ph\u1ed1i h\u1ee3p 4 thu\u1ed1c v\u00e0 10% b\u1ec7nh nh\u00e2n nh\u00f3m \u0111\u01a1n tr\u1ecb b\u1eb1ng candesartan. Tuy nhi\u00ean, ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c d\u1eabn \u0111\u1ebfn h\u1eadu qu\u1ea3 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb ch\u1ec9 x\u1ea3y ra \u1edf 6.3% b\u1ec7nh nh\u00e2n ph\u1ed1i h\u1ee3p 4 thu\u1ed1c, nh\u01b0ng c\u00f3 t\u1eadn 26.7% b\u1ec7nh nh\u00e2n \u0111\u01a1n tr\u1ecb b\u1eb1ng candesartan ph\u1ea3i ng\u01b0ng \u0111i\u1ec1u tr\u1ecb v\u00ec nh\u1eefng t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i.<\/p>\n\n\n\n

B\u00e0n lu\u1eadn<\/strong><\/p>\n\n\n\n

Trong s\u1ed1 nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 huy\u1ebft \u00e1p ch\u01b0a \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t \u1edf Hoa K\u1ef3, c\u00f3 40% b\u1ec7nh nh\u00e2n v\u1eabn ch\u1ec9 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb \u0111\u01a1n tr\u1ecb. K\u1ebft qu\u1ea3 nghi\u00ean c\u1ee9u QUARTER-USA cho th\u1ea5y nhi\u1ec1u h\u1ee9a h\u1eb9n v\u1ec1 hi\u1ec7u qu\u1ea3 c\u1ee7a vi\u1ec7c ph\u1ed1i h\u1ee3p 4 thu\u1ed1c v\u1ec1 c\u1ea3 hi\u1ec7u qu\u1ea3, kh\u1ea3 n\u0103ng dung n\u1ea1p v\u00e0 t\u00ednh an to\u00e0n c\u1ee7a bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb.<\/p>\n\n\n\n

Tuy \u0111\u00e3 c\u00f3 nhi\u1ec1u h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb v\u00e0 \u0111\u1ed3ng thu\u1eadn qu\u1ed1c t\u1ebf v\u1ec1 c\u00e1c bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p v\u00e0 m\u1ee5c ti\u00eau huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n, tuy nhi\u00ean v\u1eabn c\u00f3 nhi\u1ec1u kho\u1ea3ng tr\u1ed1ng trong vi\u1ec7c th\u1ef1c h\u00e0nh kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb, \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u v\u00e0 quan tr\u1ecdng l\u00e0 thuy\u1ebft ph\u1ee5c b\u1ec7nh nh\u00e2n quay tr\u1edf l\u1ea1i t\u00e1i kh\u00e1m. C\u00e1c n\u1ed7 l\u1ef1c \u0111i\u1ec1u tr\u1ecb lu\u00f4n h\u01b0\u1edbng \u0111\u1ebfn vi\u1ec7c khi\u1ebfn b\u1ec7nh nh\u00e2n \u0111\u1ea1t \u0111\u01b0\u1ee3c hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb m\u1ed9t c\u00e1ch an to\u00e0n h\u01a1n. Tuy nhi\u00ean vi\u1ec7c d\u1ef1 \u0111o\u00e1n b\u1ec7nh nh\u00e2n \u0111\u00e1p \u1ee9ng t\u1ed1t h\u01a1n v\u1edbi m\u1ed9t thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 l\u00e0 \u0111i\u1ec1u kh\u00f4ng th\u1ec3, do v\u1eady ph\u1ed1i h\u1ee3p 4 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb kh\u00e1c nhau v\u1edbi li\u1ec1u th\u1ea5p h\u01a1n c\u00f3 th\u1ec3 l\u00e0 m\u1ed9t c\u00e1ch ti\u1ebfp c\u1eadn an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3.<\/p>\n\n\n\n

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T\u00e0i li\u1ec7u tham kh\u1ea3o<\/strong><\/p>\n\n\n\n

    \n
  1. Sue Hughes. Four-Drug Combo Gets BP Down in One Step: QUARTET-USA. Medscape. updated 08 nov 2022. Accessed date 09 Nov 2022. URL: https:\/\/www.medscape.com\/viewarticle\/983724#vp_2<\/li>\n\n\n\n
  2. Chow CK, Atkins ER, Hillis et al. QUARTET Investigators. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet. 2021 Sep 18;398(10305):1043-1052. doi: 10.1016\/S0140-6736(21)01922-X.<\/li>\n\n\n\n
  3. SPRINT Research Group, Wright JT Jr, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26;373(22):2103-16. doi: 10.1056\/NEJMoa1511939. Epub 2015 Nov 9. Erratum in: N Engl J Med. 2017 Dec 21;377(25):2506.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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