Professional Documents
Culture Documents
COM
GII THIU
GII THIU CAC TAI NGHIN CU KHOA HOC TAI HI NGHI NI KHOA TOAN QUC TAI THANH PH H CHI MINH THANG 7/ 2011
DEMA-CVN.COM
DEMA-CVN.COM
Tui th
Tui th ngy cng tng c tnh n 2030, ngi > 65 tui chim 20% dn s Hoa K.
DEMA-CVN.COM
Tui i v bnh tt
DEMA-CVN.COM
CVD 50%
Cancer 21%
DEMA-CVN.COM
BP, blood pressure; CHF, congestive heart failure; MI, myocardial infarction.
Rosamond W et al. Circulation. 2007;115:1-103.
DEMA-CVN.COM
DEMA-CVN.COM
DEMA-CVN.COM
DEMA-CVN.COM
HUYT P
HA tm trng tng nh n 60 tui, sau n nh v gim nh. (Generally increases 1 mm Hg per decade)
DEMA-CVN.COM
100 80 60 40 20 0 0 2 4 6 8 10 12 14 16 18 20 Years
Men Women
Residual lifetime risk of developing hypertension among people with blood pressure <140/90 mmHg
Vasan RS, et al. JAMA. 2002; 287:1003-1010. Copyright 2002, American Medical Association. DEMA-CVN.COM
90% ngi > 55 tui s xut hin tng HA thi im no trong cuc i.
13
Nhp tim
Khng thay i khi nm ngh, gim t th ngi (gim p ng vi h giao cm) D b h HA t th Khi gng sc, nhp tim gim theo tui.
DEMA-CVN.COM
DEMA-CVN.COM
Gim tn s tim ti a.
DEMA-CVN.COM
Khng c s thay i quan trng theo tui trng thi ngh ngi, c th gim khi hot ng th lc.
C th do gim th tch cui tm trng tht tri do thnh tht tri dy v km n hi.
DEMA-CVN.COM
DEMA-CVN.COM
ISH
11%
48.3
37.4
34.7
43.8 38.1
23.8
20.6
25.5
16. 9
24.6
25.3
25.2
13. 9
10.3
24.9
11. 8
12.8
12.6
11.8
9.2
(mm Hg)
<70
<120
Adapted from Neaton JD et al. Arch Intern Med. 1992;152:56-64. MRFIT = Multiple risk factor intervention trial. Risk factor changes and mortality results. DEMA-CVN.COM Multiple Risk Factor Intervention Trial Research Group.
Tng huyt p tm thu n c gy tng nguy c bnh l tim mch v bnh thn.
Disease Risk
Kidney failure (ESRD) Stroke Heart failure Peripheral vascular disease Myocardial infarction* Coronary artery disease
ESRD = end-stage renal disease; SBP 165 mm Hg. *Men only. Adapted from Kannel WB. Am J Hypertens. 2000;13:3S-10S; Perry HM Jr et al. Hypertension. 1995;25(part 1):587-594; Klag MJ et al. N Engl J Med. 1996;334:13-18; Nielsen WB et al. Ugeskr Laeger. 1996;158:3779-3783; Neaton JD et al. DEMA-CVN.COM Arch Intern Med. 1992;152:56-64.
Relative
2.8 2.7 1.5 1.8 = 1.6 1.5
Gim nguy c t qu 42% Gim nguy c xut hin bin c bnh MV 14%
Gim t vong ton b Gim t vong do bnh l TM Gim t qu Gim bnh l ng mch vnh
Lancet 1990;335:827-38 DEMA-CVN.COM
BN > 60 tui
(SBP 160 mm Hg and DBP < 90 mm Hg)
Gim nguy c t qu 42% Gim nguy c xut hin bin c bnh l ng mch vnh 26%
Lancet 1997;350:757-64
DEMA-CVN.COM
H p l vn then cht
Meta-analysis of 61 prospective, observational studies* 1 million adults 12.7 million person-years
Gim 7% nguy c t vong bnh tim thiu mu cc b Gim 10% nguy c t vong do t qu
*Epidemiologic studies, not clinical trials of HTN agents. BP, blood pressure; IHD, ischemic heart disease.
DEMA-CVN.COM
*LV Hypertrophy, Angina, MI, PTCA, Bypass; Sroke or TIA, Peripheral Arterial Disease, retinopathy, carotid plaque, microalbuminurea
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European DEMA-CVN.COM Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-87
DEMA-CVN.COM
DEMA-CVN.COM
No. of
Tiu ch chnh.
nh gi mi lin quan gia nhng bin c
v tim mch vi 3 tr s HA tm trng ch (< 90, < 85 v < 80 mm Hg) trong thi gian iu tr tng HA.
DEMA-CVN.COM
HOT STUDY
DEMA-CVN.COM
c im dn s nghin cu (%)
90 DBP target group (mm Hg) 85 80 n=6 264 n=6 264 n=6 262 52.3 52.7 15.8 1.5 6.0 1.2 8.0
Previous treatment 52.6 Smokers 15.9 15.9 Previous MI 1.6 1.5 Other previous CHD 5.9 5.9 Previous stroke 1.2 Thi gian theo di = 36 thng 1.2 Diabetes mellitus 8.0 DEMA-CVN.COM 8.0
85 mm Hg
80 mm Hg
HOT STUDY
DEMA-CVN.COM
DEMA-CVN.COM
DEMA-CVN.COM
HOT : Kt lun
Hiu qu h HA i km vi gim t l bin c
v tim mch.
DEMA-CVN.COM
Cu hi?
Ngi Chu c t c tiu ch chnh trong NC HOT hay khng? Mc HA ti u ca ngi Chu trong iu tr tng HA?
DEMA-CVN.COM
Asian 205 38% (78) 62% (127) 58.8+6.3 years (50-80 years)
N: Nam: Tui:
DEMA-CVN.COM
90
85
90
85
80 mm Hg
p<0.0001
p<0.01 p<0.0001
DBP mm Hg
SBP mm Hg
DEMA-CVN.COM
80%
83%
85%
86% 86%
89%
97%
97%
98%
95%
97%
17.1
***
8.5
10.8
ns ns
6.5
6.2
7.0
6.2 3.7
ns
p<0.01
*
2.6
4.9
4.3 1.6
p<0.05
ns
3.9
p<0.01
1.1
**
3.2 1.1
ns
0.6
2.5
ns
3.0
54M
0 Final
**
Time of follow-up
DEMA-CVN.COM
Hiu qu iu tr tng HA vi thuc c ch knh Ca (Plendil) tt hn nhm BN chu . BN Chu t xut hin tc dng ph.
?
DEMA-CVN.COM
DEMA-CVN.COM
nh gi hiu qu iu tr tng HA trong 10 tun l bnh nhn tng HA nguyn pht ngi Trung Quc theo Protocol ca NC HOT. nh gi tnh an ton v kh nng dung np vi Plendil trong iu tr tng HA nguyn pht ngi Trung Quc.
DEMA-CVN.COM
Dn s nghin cu
Tui: 18 - 90 Tng HA v cn, SBP > 140mmHg v/hay DBP > 90mmHg N khng mang thai hay cho con b. Khng s dng Plendil t nht 4 tun l.
DEMA-CVN.COM
Cc bc nghin cu
1st step 2nd step 3rd step 4th step Plendil 5mg * Plendil 5mg + Betaloc 25mg BID /Low dose of ACEI * Plendil 10mg + Betaloc 25mg BID/Low dose of ACEI * Plendil 10mg + Betaloc 50mg BID/High dose of ACEI * 5th step Plendil 10mg + Betaloc 50mg BID/High dose of ACEI + Low dose of other anti-hypertensive drugs (-blocker/ACEI)/Diuretic
Dn s nghin cu
Repeated data
56,438
Unqualified data
53,040
1,530
DEMA-CVN.COM
KT QU
DEMA-CVN.COM
KT QU
DEMA-CVN.COM
TC DNG PH
AE = Ankle Edema
DEMA-CVN.COM
Cc bc iu tr tng HA trong NC HOT ph hp vi bnh tng HA nguyn pht ngi Trung Quc. Cc bc iu tr c tnh an ton, hiu qu v dung np tt. Kt hp thuc liu thp gia cc nhm thuc nh Plendil + Betaloc / ACEI khng lm tng thm hiu qu h HA nhng lm gim c tc dng ph khi tng liu thuc trong ch iu tr 1 thuc Bnh nhn tng HA nguyn pht ngi Trung Quc c kim sot HA an ton v hiu qu hn.
DEMA-CVN.COM
Lisheng Liu, Yuqing Zhang, Guozhang Liu, Wei Li, Xuezhong Zhang and Alberto Zanchetti for the FEVER Study Group (Beijing, China and Milan, Italy)
1338 Z
DEMA-CVN.COM
FEVER: MC TIU
1. So snh hiu qu trn bin c v bnh l tim mch ca Plendil liu thp 5mg/ngy vi placebo BN tng HA c iu tr bng thuc li tiu liu thp (HCTZ 12,5mg/ngy).
1340 Z
DEMA-CVN.COM
DEMA-CVN.COM
DEMA-CVN.COM
-26.8%
15 co (%)
32.5%
0 0 6 12 18 24 30 36 42 48 54 60
(the FEVER Study Group)
-33.2%
0 0 6 12 18 24 30 36 42 48 54 60
(the FEVER Study Group)
0.72 0.70 0.72 0.72 0.66 0.70 0.68 0.68 0.76 1.03 0.60
Felodipine better
1355 Z
Placebo better
DEMA-CVN.COM
FEVER: KT LUN
BN tng HA ngi Trung Quc iu tr bng HCTZ (12.5 mg/d) v Felodipine liu thp 5mg/ngy gim c HA nhiu hn (SBP/DBP # 4/2 mmHg) v gim quan trng cc bin c t qu (28%), bin c v bnh tim mnh (28%), bin c v bnh ng mch vnh (32%), gim t vong do tt c cc nguyn nhn (30%), gim t vong do bnh l tim mch (17%). iu tr kt hp liu thp UC knh Ca v HCTZ cho kt qu tt hn n tr liu HCTZ liu thp. iu tr vi liu thp ch c 1% xut hin bnh l T mi mc.
1362 Z
DEMA-CVN.COM
DEMA-CVN.COM
BHS IV, 2004 and Update of the NICE Hypertension Guideline, 2006
DEMA-CVN.COM
DEMA-CVN.COM
ESH
Compelling and possible indications, contraindications, and cautions for the major classes of antihypertensive drugs
Class of drug Beta-blockers Compelling indications MI, Angina Possible indications Heart failure Caution Heart failure, PVD, Diabetes (except with CHD) Combination with betablockade Compelling contraindications Asthma/COPD, Heart block
Angina Elderly
DEMA-CVN.COM
-blockers
AT1-receptor antagonists
Calcium antagonists
ypertens. 2007;25:1105-1187.
JNC 7.
Nn bt u iu tr bng thay i li sng. Nn khi u dng thuc vi liu thp. HA mc tiu < 140/90 mm Hg. Nhm thuc c ch knh Ca l mt trong nhng thuc chn la u tin.
DEMA-CVN.COM
DEMA-CVN.COM
DEMA-CVN.COM
V. KT LUN
Tng huyt p ngi ln tui rt thng gp. Thng l tng huyt p tm thu n c. Tng huyt p tm thu cng gy ra nhng bin c v tim mch trm trng v t vong. iu tr tt tng HA tm thu lm gim quan trng t xut v cc bin chng tng HA. Nhm thuc c ch knh calci dihydropyridines tc dng ko di (nh Felodipine - Plendil) c vai tr quan trng trong kim sot tt HA ngi ln tui.
DEMA-CVN.COM
Chn thnh cm n s ch ca Qu v
DEMA-CVN.COM
Thay i tim
nng ln khi c
Ph i tm tht tri c th gy chm th gin trong thi k tm trng. Gin nh tri th pht sau ph i tm tht tri.
DEMA-CVN.COM
DEMA-CVN.COM
JNC 7.
Stage 1 Hypertension
(SBP 140159 or DBP 9099 mmHg) Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination.
Stage 2 Hypertension
(SBP >160 or DBP >100 mmHg) 2-drug combination for most (usually thiazide-type diuretic and ACEI, or ARB, or BB, or CCB)
Not at Goal Blood Pressure Optimize dosages or add additional drugs until goal blood pressure is achieved. Consider consultation with hypertension specialist. DEMA-CVN.COM
1345 Z
1345 Z
FEVER: THIT K V S NC
+ Felodipine 5 mg/d HCTZ 12.5 mg/d + Placebo
visits weeks 1 -6 2 -4 3 -2 4 0 5 1 6 2 7 3 8 4 9 5 10 11 12 6 9 12 16 24 20 36 24 48 28 60 months
Add-on diuretic or other agents (not CA) if BP > 160/90 mmHg, at investigators discretion Screening Randomization
1344 Z
DEMA-CVN.COM
1345 Z