1.

Nhm thuc li tiu: Gm c Hydroclorothiazid, Indapamid, Furosemid,

Spironolacton, Amilorid, Triamteren... C ch ca thuc l lm gim s nc trong
c th, tc lm gim sc cn ca mch ngoi vi, dn n lm h huyt p. Dng n
c khi b huyt p nh, c th phi hp vi thuc khc khi cao huyt p nng thm.
Cn la chn loi ph hp do c loi lm thi nhiu kali, loi gi kali, tng acid uric
trong mu, tng cholesterol mu.
2. Nhm thuc tc ng ln h thn kinh trung ng: Gm c Reserpin, Methyldopa,
Clonidin... C ch ca thuc l hot ha mt s t bo thn kinh gy h huyt p.
Hin nay t dng do tc dng ph gy trm cm, khi ngng thuc t ngt s lm tng
vt huyt p.
3. Nhm thuc chn alpha: Gm c Prazosin, Alfuzosin, Terazosin, Phentolamin... C
ch ca thuc l c ch gii phng noradrenalin ti u dy thn kinh (l cht sinh hc
lm tng huyt p), do lm h huyt p. C tc dng ph gy h huyt p khi ng
ln (h huyt p t th ng), c bit khi dng liu u tin.
4. Nhm thuc chn beta: Gm c Propanolol, Pindolol, Nadolol, Timolol,
Metoprolol, Atenolol, Labetolol, Acebutolol... C ch ca thuc l c ch th th beta
- giao cm tim, mch ngoi vi, do lm chm nhp tim v h huyt p. Thuc dng
tt cho bnh nhn c km au tht lng, ngc hoc nhc na u. Chng ch nh i
vi ngi c km hen suyn, suy tim, nhp tim chm.
5. Nhm thuc i khng calci: Gm c Nifedipin, Nicardipin, Amlodipin, Felodipin,
Isradipin, Verapamil, Diltiazem... C ch ca thuc l chn dng ion calci khng cho
i vo t bo c trn ca cc mch mu, v vy gy gin mch v t lm h huyt
p. Dng tt cho bnh nhn c km au tht ngc, hiu qu i vi bnh nhn cao
tui, khng nh hng n chuyn ha ng, m trong c th.
6. Nhm thuc c ch men chuyn: Gm c Captopril, Enalapril, Benazepril,
Lisinopril, Perindopril (coversyl 4mg), Quinepril, Tradola-pril... C ch ca thuc l
c ch mt enzym c tn l men chuyn angiotensin (angiotensin converting enzym,
vit tt ACE). Nh men chuyn angiotensin xc tc m cht sinh hc angiotensin I
bin thnh angiotensin II v chnh cht sau ny gy co tht mch lm tng huyt p.
Nu men chuyn ACE b thuc c ch (lm cho khng hot ng) s khng sinh ra
angiotensin II, gy ra hin tng gin mch v lm h huyt p. Thuc hu hiu trong
60% trng hp khi dng n c (tc khng kt hp vi thuc khc). L thuc c
chn khi bnh nhn b km hen suyn (chng ch nh vi chn beta), i tho ng
(li tiu, chn beta). Tc dng ph: lm tng kali huyt v gy ho khan.
7. Nhm thuc mi c ch th th angiotensin: Nhng thuc dng tr huyt p thuc
cc nhm k trn vn cn nhiu nhc im v mt hiu qu cng nh cc tc dng
ph, v vy vic nghin cu tm nhng thuc mi vn tip tc c t ra. c bit,
nhm thuc c ch men chuyn xut hin t u nhng nm 1980 (c cng nhn l
thuc khng th thiu trong iu tr cao huyt p) thc y cc nh khoa hc tm ra

nhng thuc mi tc ng n men chuyn ACE. Cc nghin cu gn y nhn thy

nu tc dng chnh vo men chuyn ACE, lm cho men ny bt hot th thuc s gy
nhiu tc ng ph nh ho khan (l tc dng ph khin nhiu ngi bnh b thuc
khng tip tc dng). Nguyn do l v men chuyn ACE khng ch xc tc bin
angiotensin I thnh angiotensin II gy tng huyt p m cn c vai tr trong s phn
hy mt cht sinh hc khc c tn l bradykinin. Nu c ch men ACE, bradykinin
khng c phn hy mc cn thit, s tha v gy nhiu tc dng, trong c ho
khan. Thay v c ch men ACE, hng nghin cu mi l tm ra cc thuc c tc dng
ngn khng cho angiotensin II gn vo th th ca n (angiotensin II receptors, type
1) nm mch mu, tim, thn, do s lm h huyt p. V th, hin nay c nhm
thuc mi tr cao huyt p l nhm thuc c ch th th angiotensin II (Angiotensin II
receptors antagonists). Thuc u tin c dng l Losartan, sau l Irbesartan,
Candesardan, Valsartan... Nhm thuc mi ny c tc dng h huyt p, a huyt p
v tr s bnh thng, tng ng vi cc thuc nhm i khng calci, chn beta, c
ch men chuyn. c bit, tc dng h p ca chng tt hn nu phi hp vi thuc
li tiu Thiazid. Li im ca nhm thuc ny l do khng trc tip c ch men
chuyn nn gn nh khng gy ho khan nh nhm c ch men chuyn, hoc khng
gy ph nh thuc i khng calci. Tc dng ph c th gp l chng mt, hoc rt
him l gy tiu chy. Chng ch nh ca thuc l khng dng cho ph n c thai
hoc ngi b d ng vi thuc.
MT S NGUYN TC CN TUN TH KHI DNG THUC IU TR TNG
HUYT P
Cc thuc thuc nhng nhm k trn u c nc ta. iu tr bng thuc, ngi
bnh cn i khm v c bc s iu tr ch nh, hng dn s dng thuc. Bi v
ch c bc s mi nm vng tnh nng ca thuc, khm bnh trc tip v s la chn
loi thuc thch hp, ch dn cc nguyn tc dng thuc. S la chn thuc tr cao
huyt p s ty thuc vo yu t nguy c ca bnh tim mch, c s tn thng cc c
quan (nh suy thn, suy tim, dy tht tri...), c km bnh i tho ng... c bit,
cc bc s s gip bnh nhn tun th cc nguyn tc sau:
- Trc ht, dng thuc vi liu thp ban u v tng liu dn dn vi ch mt loi
thuc. Khi mi b tng huyt p, khuyn co mi khuyn nn dng thuc u tin l
nhm li tiu, c bit l nhm Thiazid.
- Nu khng hiu qu mi kt hp hai nhm thuc. Theo khuyn co mi (JNC 7), tuy
mi b bnh nhng khi huyt p ca ngi bnh cao hn mc cn phi t kh nhiu
(huyt p trn cao hn 20mmHg, huyt p di cao hn 10mmHg), th ngi bnh
cn c iu tr ngay vi 2 thuc phi hp, thng thng c thuc li tiu.
- Nu thuc c chn u tin c hiu qu km v gy nhiu tc dng ph th nn
i nhm thuc khc, ch khng cn tng liu hoc kt hp thm thuc th hai.
- Nn dng loi thuc cho tc dng ko di, loi ung 1 ln trong ngy.