4. T N SU T, NH N TH C, I U TRẦ Ấ Ậ Ứ Đ Ề Ị
VÀ T L KI M SOÁT HA VI T NAMỶ Ệ Ể Ở Ệ
Năm
2002
Tần suất lưu hành Biết bệnh Điều trị Kiểm soát
16,3% 21,3% 16,8% 9,4%
Năm
2015
Tần suất lưu hành Biết bệnh Điều trị Kiểm soát
47,3% 60,9% 56,5% 17,7%
Năm
2012
Tần suất lưu hành Biết bệnh Điều trị Kiểm soát
25,1% 48,4% 29,6% 10,7%
5. Nghiên cứu tim Framingham – Nguy cơ bị các biến cố tim mạch tăng theo
tình trạng tăng HA ở những người tuổi 35-64; theo dõi 36 năm
5
BỆNH NHÂN THA FRAMINGHAM
14. 035 140 530
14
0 : No tobacco
3 : walk 3km daily or 30 min
5 : proportion of fruit and vegetables a day
140 : blood pressure less than 140mmHg systolic
5 : total cholesterol < 5mmol/L
3 : LDLc < 3mmol/L
0 : Avoidance of overweight and diabetes
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Education
33. Average no. of antihypertensive medications
Trial (SBP achieved)
ASCOT-BPLA (136.9 mmHg)
ALLHAT (138 mmHg)
IDNT (138 mmHg)
RENAAL (141 mmHg)
UKPDS (144 mmHg)
ABCD (132 mmHg)
MDRD (132 mmHg)
HOT (138 mmHg)
AASK (128 mmHg)
ACCOMPLISH (132 mmHg)
Initial 2-drug combination therapy
1 2 3 4
Multiple antihypertensive agents are needed to reach BP goal
* 32.3% in ACCOMPLISH
SBP: systolic blood pressure Düsing. Vasc Health Risk Manag 2010;6:321–5
33
∼33% normalized with 1 agent
∼33% normalized with 2 agents
∼33% normalized with ≥3 agents*
34. Hypertensive patients
►ESC/ESH guidelines: recommendation for using
combination therapy
Hypertension with SBP >160 mmHg or DBP >100 mmHg
or HTN with multiple risk factors
or HTN with subclinical organ damage
or HTN with diabetes, renal or CV disease
35. 35
Phối hợp thuốc
Cơ chế bệnh sinh phức tạp
Tương tác cơ chế gâyTHA
Giảm tác dụng phụ của thuốc
Tăng tuân thủ của người bệnh
Hypertension is a growing public health problem worldwide.
The estimated total number of adults with hypertension in 2000 was 333 millionin economically developed countries and 639 million in economically developing countries.
The number of adults with hypertension in 2025 is projected to increase by about 24% to 413 million in economically developed countries and by about 80% to1.15 billion in economically developing countries.
Overall, 26.4% of the worldwide adult population in 2000 had hypertension, and 29.2% are projected to have this condition by 2025.
These escalating numbers underscore the need for better methods to prevent, detect, and treat hypertension.
Kearney PM et al. Lancet. 2005;365:217-223.
Achieving blood pressure (BP) control is one of the most important issues in the management of hypertension.1 Unfortunately, it is difficult or impossible to control BP with a single agent in the majority of patients with hypertension.
As an estimate from the number of antihypertensive drugs used in interventional studies, one-third of patients with hypertension require 2 drugs to achieve BP control (BP &lt;140/90 mmHg) and one-third of patients will require 3 or more antihypertensive agents to achieve BP control.2
In a study by Materson et al., use of an agent providing BP lowering via a single mechanism was inadequate to achieve a diastolic BP of &lt;95 mmHg after 1 year of treatment in 4060% of patients with hypertension.3 As such, because hypertension is multifactorial in nature, the majority of patients will require at least two antihypertensive agents, targeting multiple regulatory mechanisms, to achieve BP goal.4
References
Neutel. Fixed combination antihypertensive therapy. In: Oparil S, Weber MA, editors. Hypertension. Companion to Brenner & Rector’s The Kidney. 2nd ed. Philadelphia: Elsevier Saunders, 2005. p. 5229.
Düsing et al. Optimizing blood pressure control through the use of fixed combinations. Vasc Health Risk Manag 2010;6:3215.
Materson et al. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. N Engl J Med 1993;328:91421.
Milani. Reaching for aggressive blood pressure goals: role of angiotensin receptor blockade in combination therapy. Am J Manag Care 2005;11:S2207.