KIEM SOAT HUYET AP 6 BENH NHAN TANG HUYET AP CO BENH THAN MAN - ©AlVH GIA QUA THlTC HANH DIEU TRI NGOAI TRU TAI KHOA NOI TIM MACH - BENH VIEN TW HUE
Nguyin Td Dong' TOM T A T
Muc tidu: Danh gia viec kiem soat HA d bdnh nhan THA cd bdnh than man tai phong kham ngoai tru Khoa Ngi Tim mach-BVTW Hue, va xdc dinh lgi ich ciia viec kidm soat HA d^t muc tidu qua ty le nhap vidn vi cac bidn co tim mach(TBMMN, benh maeh vanh va suy tim).
Ddi tugng va phuvng phap: Ddi tugng la tSt ca benh nhan den kham tai phong kham ngoai tru Ndi tim mach - BVTW Hud dugc chan doan tang huydt ap. Ddi tugng dugc chia thanh 2 nhdm la benh nhan THA cd bdnh than man va THA khdng cd bdnh than man.
Phuang phap nghien cuu md ta cat ngang, so sanh cd theo doi.
Kit qua: Ty Id benh nhan THA cd bdnh than man la 24,89 %. Ty Id cac bdnh ly tim mach kem theo nhu BMV, TBMMN, suy tim, DTD va benh DM ngoai bien d nhom THA cd benh than man cao ban ban nhom THA khdng cd bdnh than man cd y nghTa. Ty Id bdnh nhan THA co bdnh than man dat HA muc tidu la 55,95 % thap hem nhdm THA khdng cd BTM dat 77,91 %.
Va kiem soat HA dat muc tieu lam giam dugc ty Id nhap vidn va cac bien co tim mach.
Ket lu?n: Kidm soat HA d bdnh nhan THA cd BTM tai phong kham ngoai tru chi dat muc tidu 55,95 %, va kidm soat HA dat muc tidu lam giam ty le nhap vien va ty Id cac bidn cd tim mach.
Tir khda: Kiem sodt huyet dp, THA co benh than mgn.
ABSTRACT
H I G H B L O O D P R E S S U R E C O N T R O L I N O U T P A T I E N T S W I T H C H R O N I C K I D N E Y D I S E A S E A T H U E C E N T R A L H O S P I T A L
Nguyen Ta Dong Objects: To valuate management of hypertension in patients with chronic kidney disease in non-resident clinic of cardiovascular intemal departement - Hue central hospital, and to determine benefit of standard management ofhypertension based on rate of rehospitalization and rate of cardiovascular events.
Subjects and method: All of patients with high blood pressure were monitored and treated in non-resident clinic of cardiovascular intemal departement - Hue central hospital. This patients were separated into two groups: the patients with hypertension and typ 2 diabette mellitus and the patients with hypertension without typ 2 diabette mellitus.
Cohort study with following rate of rehospitalization and cardiovascular events.
Trung tam lim mach Hue ' Hue cardiovascular center
TAP CHi TIM MACH HOC VIET NAM SO 66 - 2014 280
Results: Rate ofthe patients with chronic kidney disease was 24,89 % in the patients with hypertension. Associated diseases (coronan.. stroke, periferal arterial disease and heart failure) of the patients with hypertension and chronic kidney disease were significantly higher than the patients with hypertension without chronic kidney disease. Rate of standard management of hypertension in patients with chronic kidney disease only was 55,95 %. Standard management of hypertension (target hypertension control) could reduce rate of rehospitalization and cardiovascular events.
Conclusion: Rate of standard management ofhypertension in patients with chronic kidney disease in non-resident clinic only was 55,95 %. Standard management ofhypertension (target hypertension control) could reduces rate of rehospitalization and cardiovascular events.
Keyword: Hypertension, Hypertension with chronic kidney disease.
1. DAT VAN DE
THA la mdt bdnh phd bidn va ngay cang tang nhanh tren khap thd gidi. THA cd benh than man ma trong dd bdnh than cd the la mgt trong nhirng bien ehung ca quan dich cua THA va THA ciing co thd la trieu ehung cua bdnh than man. Mdi nam, tang huyet ap gay ra hon 25.000 trudng hgp bi suy than d Hoa Ky (Bdo cdo ndm 2007 ciia He thdng dir lieu Than Hoa Ky){6].
Mdi quan he song doi nay khidn cho nhidu khi ngudi ta khdng xac dinh dugc cai nao cd tnrdc, cai nao cd sau. Tang huydt ap (THA) luon la mot trong nhung ydu td nguy ca hang dau ddi vdi cac bdnh ly tim mach. Bdnh than man dang cd xu hudng ngay cang tang va THA. rdi loan lipid mau, beo phi va DTD la cac bdnh ly khong thd tach rdi khoi benh than man. Wiu hit ngudi bdnh THA chi dieu tri khi thay nhuc dau, dau tue nguc. kho chiu d ngyc va didu tri ddn khi thay cac chi so huyet ap trd vd binh thudng hoae khdng cdn trieu ehung nao nua la ty y bd thudc dot ngpt khdng theo doi...
Vi vay, nhung bien ehung do THA d bdnh nhan co bdnh than man nhu tai bidn mach mau nao, nhdi mau ca tim, suy tim, bdnh DM ngoai bidn... ngay cang tang. Ty Id benh nhan phai tai nhap vidn, tan phd hoac tu vong do bdnh THA va bdnh than man gay ra vin con rat cao. Didu tri THA cd thd lam giam 40 % nguy ca TBMMN va 15 % nguy caNMCT [7.9.12]. Tuy vay, vide kidm soat HA dac biet d benh nhan cd bdnh than man vin cdn chua thoa dang.
Vdi mong mudn giup ngudi bdnh ban che dugc cac bidn ehung nguy hidm. kidm soat dugc huydt ap, dong thdi sdm phat hien va didu tri kip thai cac dau hidu bdnh nguy hidm, nhung bdnh nhan THA cd bdnh than man can phai dugc kham dinh ky ban. didu tri tdi uu va giao due thudng xuydn ban vd Igi ich eua viec kidm soat THA.
Muic tieu nghien cuu:
Chung toi tidn hanh nghien cuu nay vdi hai muc tidu:
1. Ddnh gid viec dieu tri vd kiem sodt HA a binh nhdn co benh than man tgi phong khdm ngogi trd Npi tim mgch - BVTW Hui
2. Xdc dinh lgi ich cua viec kiem sodt H.4 dat muc tiiu tren ty li nhdp vien vd cdc biin co tim mgchfTBMMN, suy tim. benh mgch vanh vd DM ngogi bien).
2. DOI TU^gtNG VA PHT/ONG PHAP NGHIEN ClTU 2.1. Ddi tirgng
675 benh nhan ddn kham tai phdng kham ngoai tru Ngi tim mach - BVTW Hud dugc chSn doan tang huydt ap. Ddi tugng nay dugc chia thanh 2 nhdm benh nhan: 168 bdnh nhan THA cd bdnh than man (microalbumin nieu ducmg tinh) va 507 benh nhan THA khdng cd bdnh than man (microalbumin nieu am tinh).
- Chan doan THA: Theo WHO/ISH/ JNC VIII va Hgi THA Viet nam [17]. HA tam thu
> 140 mmHg va / hoac HA tam truang > 90 mmHg.
- Chan doan cd benh than man khi microalbumin nieu (+) tinh nghia la albumin nieu > 30 mg^4 gid, 2.2. Phuvng phap nghien cuu
Md ta cat ngang, so sanh cd theo doi 1 nam. Phuang phap dugc thyc bidn nhu sau:
- Kham lam sang: Hdi bdnh su, tidn su, do cac chi sd nhan trac.
- Lam cac xet nghiem: Microalbumin nieu, dudng mau (neu nghi ngd cd thd lam HbAIC), bilan lipide, chuc nang than, ghi didn tam do thdng thudng, sidu am tim...
- Chan doan benh mach vanh. Cd the dya vao:
+ Tidn su cd bdnh mach vanh (nhu NMCT da dugc xac dinh chan doan, chup mach vanh CO ton thuang he thdng dpng mach thugng tam mac ca bang chup mach can thiep hay chup CT - scan 64 nhat cat hay cd bidn ddi S T - T trdn didn tam dd thdng thudng)...
+ Chan doan benh mach mau ngoai bien: bang sieu am doppler he thdng dpng mach hai chi dudi cd ton thuang xa viia gay hep long mach cd y nghTa (cd anh hudng dong chay).
+ Chan doan bdnh than: cd thd dya vao ca dp thanh thai Creatinin mau va xet nghiem djnh lugng microalbumin nieu (> 30 mg /24 gid).
+ Chan doan suy tim: Cd trieu ehung ca nang suy tim (khd thd khi gang sue hay khi nghi, met mdi); va trieu ehung dac thu cua suy tim (tim nhanh. thd nhanh, nghe ran am d phoi, tran dieh (dich tham) mang phoi, tang ap tinh mach cd, phii ngoai vi, gan Idn,...) va ehung cu khach quan ciia bat thudng chuc nang hay cau true tim luc nghi (tim Idn, T3, am thoi tim, bit thudng ECG. tang peptide bai nieu NT - proBNP), phoi hgp them: Sidu am tim chan doan roi loan chuc nang tam thu, tam trucmg.
- Danh gia HA dat muc tidu: Ddi vdi hSu hdt bdnh nhan THA didu tri dat HA muc tidu khi HATT < 140 mmHg va HATTr < 90 mmHg (ridng bdnh nhan > 65 tudi HATT < 150 mmHg va HATTr < 90 mmHg). Neu cd benh than man thi dat HA muc tidu khi HATT < 130 mmHg va HATTr < 80 mmHg. [17,18]:
+ Chan doan cac bien co tim mach bao gdm: Hdi ehung vanh cip (can dau that ngyc khdng dn djnh, nhdi mau ca tim cap), tai bien mach mau nSo (nhun nao hoac xuat huydt nao bang CT - scan sg nao), tac mach chi va suy tim...
+ Thdi gian theo doi 1 nam tu thang 10/2011 ddn thang 10/2012.
TAP CHI TIM MACH HOC VIET NAM SO 66 - 2014 282
3. KET QUA
3.1. Mgt so dale diem cua doi tuong nghidn cuu
Sd benh nhan Ty 18 % Tuoi (nam) BMI (Kg/m") Cholesterol (mmol/1) Triglyceride(mmo!/l) HDL (mmol/1) LDL- C (mmol/1) lire (mmol/l) Creatinin (^mol/1)
Nhom THA co BTM 168 24,89 % 65,03 ± 11,41
20,17 + 2.53 5,89 ±1,43 2.19 ±1,04 0,79 ±0,91 4.05 ±1,51 10,27 ± 5 J 3 198,22 ± 19,06
Nhom THA khong BTM 507 75,11 % 59J4 ± 13,04
21,01±4.65 6,01 ±1,19 2,28 ±1,01 0,82 ±1,03 3,67 ±1.53 5,97 ± 3,37 79,29 ± 10,13
P
<0,05
>0.05
>0.05
>0,05
>0,05
>0.05
<0,05
<0,05 Ty Id bdnh nhan THA cd bdnh than man la 24,89 %, tudi trung binh d nhdm THA cd BTM cao han cd y nghTa so vdi nhdm THA khdng cd BTM.
3.2. Ty Id cac benh kem theo cua doi tugng nghien cihi N=675
Nhom THA co BTM (168) THA khong co BTM (507)
P Tong cpng
BDM ngbien 13 07,74 %
11 02,17%
<0,05 24
BMV 92 54. -6 %
171 33,73%
<0,05 263
TBMMN 56 33.33 %
120 23,69 %
<0,05 176
OTB 37 22.02 %
52 10.27%
<0,01 S9
Suy tim 81 48,21 %
91 r.95%
<0,05 172 Ty Id cac bdnh ly kem theo nhu BMV, benh DM ngoai bidn, TBMMN, DTD \ a suy tim d nhdm THA cd BTM cao ban nhdm THA khdng cd BTM cd y nghTa.
3 J . Phan do THA va muc nguy cff t n r d c khi kiem soat HA
Nhom THA co BTM (168) THA khong c6 BTM (507) Tong cOng
Phan do B 9 I
0 123 123
Bo 2 28 336 364
B93 140 48 188
MIJC nguy cof thap
0 80 80
TB 0 451 451
cao 168 24 144 Nhom THA co BTM chu yeu 6 phan dp III va deu a mirc nguy ca cao.
3.4. Sir dung thudc dieu tri
THA CO BTM (168) THA kh6ng
BTM(507)
UCMC 123 73,21 %
224 44,18%
347
UCTTA 45 26,79%
179 35,31 %
224
UCCa 143 85,12 %
199 39,25 %
342
UC padre 106 6i,10 %
156 30.77%
262
Loi tieu 109 64,8S %
63 12,43 %
172 Thudc su dung nhidu nhat la U'CMC hay l/CTT va UCCa, lgi tieu cung dang kd d nhom THA cd BTM, cdn nhdm khdng cd BTM thi ddng lgi tidu it ban.
3.5. Ty le phoi hgp thuoc
n = 675 THA c6 BTM (168)
THA khong BTM (507)
P Tong cong
1 loai n 2 122
124
%
1,19 24,06
<0,01 18,37
2 loai n 46 234
280
%
27,38 46.15
<0,05 41,48
3 loai n 97 144
241
%
57,74 28,40
<0,05 35,70
4 loai n 23 07
30
%
13,69 1,38
<0,01 4,44 Ty Id phdi hgp 02 - 03 loai thudc la phd bidn, hidm hon la dung 04 loai. Nhdm THA c6 BTM cd xu hudng dung phdi hgp nhidu loai thudc han.
3.6. Ty 1| dat HA muc tieu
Nhom THA c6 BTM Nhom THA khong BTM
P Tong cong (n = 675)
B^t HA muc tieu n
094 395
489
%
55,95 77,Pi
<0,05 72,44
Khong d^t HA mvc tieu n
074 112
186
%
44,05 22,09 P < 0,05
27,56 Ty le dat HA muc tieu cr nhom THA co BTM thap hon co y nghia so vai nhom THA khong CO BTM.
TAP CHi TIM MACH HOC VIET NAM SO 66 - 2014 284
3.7. Ty le dat HA muc tieu theo thuoc va ket hgp thudc
01 loai (124)
2 loai (280) 3 loai (241) 4 Ioai (30)
THA CO BTM THA khong
BTM THA CO BTM
THA khong BTM THA c6 BTM
THA khong BTM THA CO BTM
THA khong BTM Tong e6ng (n = 675)
Dat HA miic tieu n
2 111 36 177 47 101 9 6 489
%
100 90,98 78,26 '5.64 48,45 70,14 39,13 85,71 72,44
Khong d^t HA muc tieu n
0 11 10 57 50 43 14 1 186
%
9,02 21,74 24,36 51,55 29,86 60,87 14,29 27,56
Tdng c6ng 2 122
46 234 97 144
23 07 675 Ty Id dat HA muc tidu cao nhat d nhdm THA cd BTM chi dung 01 loai thudc, ty Id nay cang giam d nhdm phai dung phdi hgp 02 hay 03 loai ha HA va giam thap nhat d nhdm THA cd BTM da dung ddn 04 loai ha HA.
3.8. Dat HA muc tieu theo dieu tri thudng xuyen hay khdng
THA CO BTM DT thudng xuyen (96) DT khong th/xuyen (72) Tong cpng: 168
t
p THA khong cd BTM
DT thuemg xuyen (362) DT khong th/xuyen (145) ''ong cpng: 507
t
P
Bat HA muc tieu n 67 27 94
%
71,28 28,72 100
Khong dat HA muc ti£u n 29 45 74
%
3919 60,81 100 8,97
<0,05 347
48
87,85 12,15 395
15 97
13.40 86,60 112 12,65
<0.01
Dieu tri thuang xuyen de dat HA muc tieu hon dieu trj khong thuong xuyen o ca hai nhom THA CO BTM va THA khong BTM.
3.9. Tac dung phu thudng gap
Dau dau Chong mat Ho khan RL tieu hoa PhCi chan Hoi hop
UCMC (247) n
/ /
18
/
2
/
% / /
7,29
/
0.81 1
UCTTA (324) n
/ /
03
/ / /
% / /
0.93 1 1 1
UC canxi (412) n 04 2
/ /
14 3
%
0.97 0.48
/ /
3,40 0,73
P - block (365) n 5 7
/
11
/
1
%
1.43 1,92 1 3,01
1 1
Loi tieu (123) n
/
3
/ / /
5
% /
2.44
/
1 1 4,06 Co mdt s6 tac dung phu nhat dinh d muc dp nhe d mdt vai nhdm thudc khac nhau, tat ca ddu khong can phai ngung didu tri.
3.10. Ty le nhap vien
D?t HA miic tieu (489) Kh6ng dst HA muc tieu (186) Tong CQng (n = 675)
t
P
Khdng nhap vien (n= 632) n 478 124 632
%
97,75 66,67 8919
Tid nhSp vien (n = 43) n 11 62 73
%
02,25 33,33 10,81 /3,7;
<0.01
Ty Id nhap vidn 10,81 % chu ydu tap trung d nhom khdng dat HA muc tieu {33,33 %) so vdi nhom dat HA muc tieu chi la (2,25 % ) .
3.11. Ty le cac bien co tim mach Cac bien co
tim mach TBMMN Benh m^ch vanh Suy tim BDM ngoai bien TSng cong
Bat HA muc tieu
4 7 9 0 20
Khdng dat HA muc tiia
19 25 IS 05 67
Tong cgng 23 32 27 05 87
%
3,41 4,74 4,00 0,74 12,89
TAP CHi TIM MACH HOC VIET NAM SO 66 - 2014 286
Cac bien co tim mach ddu cao ban d nhom HA khdng dat muc tieu. Bien cd nhieu nhat la bdnh mach vanh, suy tim va TBMMN, it gap ban la benh DM ngoai bidn. Ty Id cac bien co chiem khdang 12.89 % / nam.
3.12. Ty le nhap vien va BCTM if ddi tuffng nghien euu Cac bien co
tim mach
TBMMN Benh mach vanh Suy tim BDM ngo^i bien Nhap vifn
THA CO BTM (168) n
12 18 11 4 34
%
7,14 10.71 6,55 2.38 20,24
THA khong co BTM (507) n 11 14 16 01 39
%
217 2,76 3,16 0,19 7,69
P
<0,05
<0.01
<0.05
<0.05
<0,05 TSng cgng 23 32 27 05 73 Ty Id nhap vien va cac bidn cd tim mach d nhdm THA cd BTM deu cao hon cd y nghia so vdi nhdm THA khong cd BTM.
4. BAN LUAN
THA cd bdnh than man la kha thudng gap tren thuc hanh lam sang. Ty Id bdnh nhan THA cd bdnh than man (24,89 %) ty Id bat gap mdt each nglu nhien trong nghien cuu nay tuy rang nd khdng dai didn dugc cho quan the tang huyet ap ndi ehung nhung nd cung ndi len dugc muc do bat gap dugc trong khi kham chua benh hang ngay cua ehung ta. Khi phan nhom nghien cuu ehung tdi nhan thay ty le cd BTM d benh nhan THA thap ban ty Id tang huydt ap d bdnh nhan cd bdnh ly than man nhu mgt sd nghien cuu trudc day da cdng bd [3]. Mdt nghien cuu cua Nguydn Oanh Oanh. Bui Trgng Dai phat bidn 33.33 % benh nhan THA nguydn phat cd microalbumin nieu duang tinh, ty Id nay cho thay THA gay tdn thuang than rat Idn va phat hien thudng mudn ndu khdng cd xet nghidm smh hda nay [4]. Khi nhan xet tdn thuang tim mach d bdnh nhan benh than man, mdt nghidn cuu cua Nguydn Van Tan va Ld Due Thang cho thay ty Id tang huydt ap d bdnh nhan BTM dang didu tri la 78,1% tang huyet ap tam thu, 60,9 % tang huyet ap tam truang, da sd bdnh nhan bi tang huyet ap d giai doan 2 (59 %) [2], Ngidn cuu cua Tnin Dang Dang khoa, Vo Tam cd ty Id THA trdn bdnh nhan suy than cac giai doan la 62,7 %[5].
Nguyen Thi Tuyet, TrSn Xuan Thuy, Le Minh Hieu cd ty Id tang huyet ap 80,73 % a benh nhan suy than man[2]. Pham Thi Kim Hoa, Ngd Van Truydn va cdng su khi nghidn cuu vi dam nieu va mdi lien quan ton thuang co quan dich d bdnh nhan THA ghi nhan ty Id bdnh nhan cd bdnh than man (microalbumin nieu (+) tinh) la 39,4 %[3b]. Tinh trang tang huydt ap vira la ydu to nguy ca vira la h^u qua cua bdnh nhan eo bdnh than man. Su ddng thdi hien dien cua ca THA va benh than man se lam tang nguy ca bj cae bdnh ly mach mau Idn, bao gom dot quy, bdnh mach vanh, suy tim. benh mach mau ngoai bien va tang ty Id tu vong. Dieu nay co thd thay trong bang cac bdnh ly kem theo trong mau nghidn cuu, mot sd bdnh nhu bdnh mach vanh, DTD, bdnh mach mau ngoai bien d nhdm THA cd BTM ddu cao ban cd y nghia so vdi nhdm THA khong cd BTM [8].
- Su dung thudc didu tri va phdi hgp thudc: Trong nghien cuu nay, ehung tdi chu yeu chi su dung 05 loai thudc ca ban thudng dugc phd bien trdn lam sang. Viec phdi hgp thudc dd dam bao dat HA muc tidu sdm khi chi ckn co tn sd HA cao ban HA muc tidu la HA tam thu > 20 mmHg hoac HA tam truang > 10 mmHg [17]. Tiiy theo chi dinh dung nhu khuyen cao didu tn benh kem theo, ehung tdi dua vao phan do THA, danh gid mdc nguy ca va bdnh kem theo dd chi dinh cac nhdm thudc phu hgp vdi tung benh nhan. Ty Id phdi hgp hai loai thudc la phd bien nhat trong nghien cuu nay. Nhung ddi vdi benh nhan THA cd BTM, ^ Id su dung 3 Ioai thude la cao ban ca chidm ddn 57,74 %.
- Ty Id dat HA muc tidu: Ty le benh nhan THA khi chua co tdn thuang ca quan dich ddu c4n > hai loai thudc phdi hgp de dat dugc huyet ap muc tidu chidm 19 - 47%. Nhung khi eo tdn thuang ca quan dich can > 3 loai thudc dd dat huyet ap muc tidu chiem 78 - 93%. Trong nghien cuu ciia ehung tdi, khi chi can 1 thudc ha HA thi chl mdt so rat it bdnh nhan THA khong co BTM va de dat muc tidu. H3u hdt bdnh nhan THA cd BTM can ban 2 loai thuoc de dat HA muc tieu. Theo Kaplan - 2007, ty Id benh nhan THA cSn > 03 loai thuoc dd dat huyet ap muc tieu chiem 27.3 %, nhung trong so do ty Id dat huyet dp muc tidu cung chi dat 66 %. Chung toi co 57,74 % bdnh nhan THA cd BTM c5n 3 loai thuoc ha HA nhung chi cd 48,45 % la dat HA muc tieu [15]. Trong nghien cuu Idn, da trung tam ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) trdn 42.448 bdnh nhan, trong thdi gian 05 nam, cac tac gid thSy rang ty Id bdnh nhan phai su dung > 03 loai thuoc dd dat huydt ap muc tidu chidm 30 % [11], Trong nghien cuu LIFE mac dd da didu tri ti'ch eye nhung van cdn 40 - 50% bdnh nhan chua d?t huydt ap muc tidu. Trong nghien cuu RIAT (Reasons for not intensifying antihypertensive treatment) tren 2.621 benh nhan THA, ty Id benh nhan can phdi hgp > 02 loai thudc dd dat huyet dp muc tidu chidm 3 1 % ; > 03 loai thuoc chidm 12%; nhidu loai thudc chiem 3%. Cung trong nghien cuu nay cac tac gia thay rang ty Id bdnh nhSn khong dat huydt ap muc tidu chidm kha cao 26 - 31 % so vdi huydt ap muc tidu dat ra trudc nghien cuu [11]. Trong nghidn cuu ciia ehung toi, ty Id bdnh nhan THA dat HA muc tieu chi la 72,44 % va khong dat HA muc tidu la 27,56 %. Ty Id HA khdng dat muc tidu d nhom THA cd BTM la 44,05 %, cao hem rat nhidu so vdi nh6m THA khdng cd BTM chi la 22,09 %. Ngudi ta nhan thay rang ty Id bdnh nhan THA khang tri la khoang 5 % (Kaplan - 2007), Theo Sandra J - 2000 thi ty Id khang tri d cac phdng kham Y khoa la < 1 %, cdn d cac phdng kham chuyen khoa tang huydt ap la 11 % ddn 13 %. Cac bac sy chuydn khoa than nhan thay rang ly Id benh nhan THA khang thuoc rat cao > 50 % [10,15]. Cac ly do lam cho viec didu tri HA khd dat muc tieu d nhdm THA cd BTM la vide tuan thu didu tri ciia benh nhan, muc tidu ha HA thdp ban THA thdng thudng 10 mmHg cho mdi gid tri, ty Id benh 1^
kem theo cao ban nhdm THA khdng cd BTM va do tudi nhdm nay cung cao ban cd y nghia so vdi nhdm THA khdng cd BTM. Didu tri thudng xuydn de dat HA muc tidu han didu tri khong thudng xuydn d cd hai nhdm benh nhan THA cd BTM va THA khdng cd BTM.
- Tac dung phu thudng gap: Cd mgt so tac dung phu nhat dinh, muc do nhe cua mgt vai nhdm thuoc khac nhau, tat ca deu khdng dang lo ngai va trdn thuc td chiing tdi khdng cdn phai
TAP CHI TIM MACH HOC VIET NAM S 6 66 - 2014 288
ngung dieu tri. Cung cd nhidu nghidn cuu bao cao tac dung phu ciia nhidu nhdm thudc khde nhau Cling nhu ciia timg loai thudc ridng bidt nhung hdu nhu cung khdng nghidm trgng lam.
- Ty Id nhap vidn va cac bidn cd tim mach: Nhieu nghien cuu trudc ddy da ehung minh rang t\ Id nhdp vidn vi cac bidn co tim mach lidn quan vdi tri sd huyet ap, HATT tang 2 mmHg thi da lam tang 2 - 4 lan tu vong va cdc bidn cd mach vanh [12]. Trong nghidn cdu ciia chiing tdi, bidn cd thudng gap la bdnh mach vanh, TBMMN va suy tim, it gap han la benh DM ngoai bien.
Trong nghien cuu ndy ty Id nhap vidn va cdc bidn cd tim mach ddu cao hon d nhdm HA khdng dat muc tieu. Ty le nay cung tang cao han d nhdm THA co BTM so vdi nhdm khdng cd BTM.
Trong nghidn cuu chiing tdi, t>' Id nhap vidn 10,81 % chu \eu tap trung d nhdm khdng dat HA muc tidu (33,33 %) so vdi nhdm dat HA muc tidu chi la (2,25 % ) . Didu nay ciing phu hgp vdi cac nghidn ciiru trudc dd [8,9].
5. KET LUAN
Kiem soat HA d benh nhan THA cd BTM tai phdng khdm ngoai tni chi dat muc tieu 55,95 %, thdp ban so vdi nhdm bdnh nhan THA khdng cd BTM 77,91 %. Didu tri thudng xuyen dd dat HA mue tieu ban didu tri khdng thudng xuydn d cd hai nhdm bdnh nhan THA cd BTM va THA khdng CO BTM.
Kiem soat HA dat muc tidu cd ty id nhap \ idn va cdc bidn co tim mach thap ban cd y nghTa so vdi nhdm HA khdng dat muc tidu. Ty Id nhap vidn vd cdc bien cd tim mach d nhdm THA cd BTM cao ban cd y nghia so vdi nhom THA khdng cd BTM.
TAI LIEU THAM KHAO
1. Nguyen Van Tan, Le Due Thang - Cac bieu hien tim mach d bdnh nhdn suy than man Idn tudi chua loc mau chu ky - Tap chi Tim mach sd 17; ISSN 1859-1779.
2. Nguydn Thi Tuyet, Tran Xuan Thuy. Ld Minh Hidu- Nhan xet dac diem lam sang va can lam sang bdnh hdn su\ than man do tang huydt dp. Tap chi Tun mach hgc Viet Nam sd 65, thdng 8. 2013; tr 107-109.
3. Nguydn Duy Cudng va Tran Xudn Thuy - Nhan xet tinh trang tang huyet dp benh nhan loc mau chu ky. Tap chi Tim mach hgc Viet Nam sd 65, thang 8, 2013;tr 146-148.
3b. Pham Thi Kim Hoa, Ngd Van Truydn, Nguyen Thi Cdm Tu, Le Van Cudng. Nghien cuu vi dam nieu va mdi lidn quan tdn thuemg ca quan dich d bdnh nhan THA. Tap chi tim mach hgc Viet Nam sd 65, thang 8,2013; tr 78-83
4. Nguyen Oanh Oanh, Bui Trgng Dai - Mdi Hdn quan giua microalbumin nieu vdi cac bien ehung d bdnh nhdn tang huydt dp. Tap chi ngi khoa 3/ 2009; ISSN 1859 -1884; tr 413- 418.
5. Trdn Dang Dang Khoa, Vo Tam - Tang huydt dp trdn bdnh nhan suy than man. Tap chi Tim mach hgc Viet Nam sd 65, thang 8, 2013; tr 48-53
6. KDIGO- 2012 Clinical Practice Guidelme for the Evaluation and Management of Chronic Kidney Disease, volume 3, issue 1, January 2013.
