PHAN BO SO DO HUYET AP VA CAC HINH THAI TANG HUYET AP TRONG C O N G DONG TAI HUYEN BA VI N A M 2005
Nguyen Ngpc Quang^'^, Pham Thai Sdn^, Nguyin Thj Kim Chuc^ Nguyen Lan Vlet^"'
^Trddng Dai hoc Y Ha Ndi, -Benh vien Bach Mai Tang huyet ap (THA) la yeu td nguy ca tim mach ca ban giy ginh nang Idn trong cdng dong vdi nhieu hinh thai khac nhau. Muc tieu: (1) xac dinh ty le hien mic THA trong cdng dong, (2) xac dinh ty le cac loai hinh THA. Doi tugng va phuang phap nghien ciiu: dieu tra cit ngang tai huyen Ba VI nam 2005 tren 2374 ngdd, do tud'i 25 - 74, duac chon ngiu nhien phin tang theo tdng nhdm tuoi va gidi, sd dung may do huyet ap td ddng theo quy trlnh chuan. Ket qua: ty le hien mic THA la 15,6%o (95%oCI 13,3 - 17,9%o) d nam va 6,9% (95%oCI 5,4 - 8,4%o) d nd. Trong sd ngUdi THA, ty le duac phat hien td trudc chiem 25,6% va <y le duac dieu tri chi chiem 5,6%. Trong sd cac loai THA, THA tim thu dan doc chiem ty le 40,3%o (95%oCI 34,6 - 45,9%o) d nam va 49,7%o (95%oCI 42,5 - 57,0%o) d nd trong khi THA ca tim thu va tim truang chiem ty le 49,1 % (95%oCI 43,4 - 54,9%a) d nam va 35,7%o (95%oCI 28,7 - 42,6%o) d nd. Ket luan: tang huyet ap la van de it difac chii y d cdng dong. Tai Ba VI, ganh nang chi) yeu ve huyet ap va mde huyet ap can giam thudc ve nhdm THA ca tim thu va tim truang, dac biet la d nam.
TO khoa: ty le hien mac, tang huyet ap, tang huyet ap tam thu ddn dpc, FilaBavi
I. DAT VAN DE
Viet Nam dang la nUdc phai ddi mat vdi g I n h nang cua nhflng benh ly lay nhiem cung nhU khong lay n h i l m (bao gdm ca benh tim mach) trong giai doan ehuyen tiep p h l t trien v l kinh t l va xa hdi. Tang huyet ap (THA) vdi cac loai hinh dae thu theo tudi va gidi khdng nhflng la yeu td tim maeh nguy cd chu y l u ma cdn la mpt g I n h nang Idn trong epng ddng, trong sd dd dang Iflu y nhat la THA tam thu dPn dpc d ngfldi cao tudi [6,3]. Nghien cdu djeh t l hoc nay dUpe tien hanh nham muc tieu:
7. Xac dinh ty le hien mac cua tang huyet ap d ngUdi trudng thanh trong cong dong.
2. Danh gia den triin cua tang huyet ap va xac dinh ty le cac loai hinh THA theo tdng nhom tudi va gidi.
II. DOI TUONG VA PHUONG PHAP NGHIEN CL/U
1. Ddi tffging va thie't ke nghien cffu: nghien cdu thupe loai d i l u tra eat ngang dupe t i l n hanh
tai huyen Ba V i , tinh Ha Tay cu (nay thudc thanh phd Ha Npi), trong khudn khd CP sd ThUc dia Dich t l hpe Ba Vi (FilaBavi), nam trong khudn khd dfl an d i l u tra v l eac yeu t d nguy eo cua cac benh khdng lay n h i l m d nhflng ngfldi thudc dp tudi trfldng thanh trong epng ddng (tfl 25 - 74 tudi). Dfl an nay sfl dung d c h lay m l u n g l u nhien cd phan tang theo dp tudi (10 nam mpO va gidi (5 nhdm tudi * 2 gidi), lay dfl lieu eua FilaBavi lam cdng cu chpn m l u n g l u nhien ddn: dfla vao danh sach ten, ma e l nhan eua tat c l nhflng ngfldi thupe dp tudi tfl 25 - 74 trong khu vfle theo ddi cua FilaBavi: chpn n g l u nhien ra danh sach 250 ngifdi d mdi nhdm tudi va gidi, vdi tdng sd 1 0 do vay cd m l u do tinh cho dfl an nghien cflu va chfnh nghien cflu nay la 2500.
2. Phffdng phap nghien cffu: tren cd sd danh sach ngifdi dflpc chpn n g l u nhien, se phan theo tflng xa de t i l n hanh dieu tra cat ngang tap trung tai tflng xa hoae cum xa gan nhau. H u y l t ap dpng maeh dflpc do theo khuyen cao cua Td chdc Y t l T h i gidi (WHO), bang quan d canh tay, tO the ngdi, bang h u y l t ap k l tfl dpng hieu OMRON
M 4 ® (difdc W H O chap nhan trong dieu tra cpng ddng), theo quy ti.nh ehuan, it nhat la hai lan, each nhau it nhat 5 phdt sau khi ngUdi dan da nghi ngdi trifdc do tdi thieu 15 phut. Tri sd huyet ap dflpe ghi nhan la trung binh cua hai lan do cudi cung theo dung quy trinh. Cae d i l u tra vien se hdi d c thdng sd khae theo bp eau hdi chuan ddng thdi giam sat de ngUdi tham gia nghien cdu dung la ngUdi cd trong danh sach mdi.
3. Phan do va phan loai hinh thai tang huyet i p Tang huyet I p (THA) dUpc dinh nghTa la khi HA t i m thu > 140 m m H g va/hoae HA tam trifdng
> 90 miTiHg va/hoac dang dUde d i l u trj thud'c ha huyet I p . THA t i m thu ddn dpc khi HA t i m thu >
140 m m H g v l HA t i m trUdng < 90 m m H g , THA tam trifdng ddn dpc khi HA tam trUdng > 90 m m H g va HA t i m thu < 140 m m H g . THA c l tam thu va tam trifdng khi ddng thdi HA tain thu > 140 m m H g va HA t i m trOdng > 90 m m H g .
4. Xu' ly sd lieu: so lieu dope nhap va phan tfch bang phan m l m EpiData va Stata 10. Cac ket qua deu dflpc chuan hda bang trpng sd' thee tflng
nhdm tudi va gidi. Cac ty le difdc bieu d i l n dfldi dang % (khoang tin cay 9 5 % Ci), d c trung binh dope bieu d i l n dfldi dang trung binh ± sai chuan 9 5 % sau khi da chuan hda.
III. KET QUA
Nghien cdu dupe t i l n hanh trong khoing thdi gian to thang 7 - 9 nam 2005 tai 10 xa cua huyen Ba V i , tren tdng sd 2374 ngUdi dp tudi tO 25 - 74 vdj ty le nam/nfl la 4 7 , 6 % / 52,4% (1/1.1).
1. Bien thien cua sd do huyet ap theo tudi va gidi Huyet ap tam thu va tam trUPng trung binh d nam gidi lan lifdt la 128,7 ± 0,6 mmHg va 77,7 ± 0,4 mmHg, eao hdn d i n g ke so vdi d nO gidi, tifdng flng l l n lUpt la 119,8 ± 0,6 mmHg va 72,4 ± 0,3 mmHg (p < 0,001). Tri sd huyet ap trung binh theo tflng dp tudi d nam cao hon han d nfl d ddi vdi HA tam thu l l n HA tam trifdng, mac do ed xu hifdng nhich lai g i n nhau d Ida tudi 55 - 60. H u y l t ap tang dan theo tudi va mde ddi tien trien theo tudi eua HA tam thu rd ret hdn han HA tam trUPng (hinh 1).
•ff -
E 5 i -
igbin
S o -
1
Q.
ta.
x
S-
^
^ ^ - ^
HA Tam ihu (Mam)
HA Tam truortg (Mam) HA Tam tajorxj (Mu)
25 30 36 *0 46 50 55 60 65 70 Tuoi (nam)
Hinh 1. Bien thien cua sddo huyet ap theo tudi va gidi trong cong dong A
2. Ty le hien mac va cac hinh thai tang huyet ap trong cong ddng | Ty le hien mac THA tai Ba Vi d nam ludn cao hon d nfl noi ehung trong dp tuoi 25 - 74 (15,6% (95% !
Cl 1 3,3 - 1 7,9%) so vdi 6,9% (95%CI 5,4 - 8,4%)) hay ndi rieng d bat ky Ida tudi nao. Ty le nay tang d i n j
theo tudi, tang rd ret sau 40 tudi d nam va 50 tudi d nfl (Bang 1). Tai Ba Vl, ty le THA dflpc phat hien tO trifdc ehi chiem 25,6% (95%CI 21,7 - 29,4%), khdng khae biet gifla hai gidi. Ty le THA dflpc d i l u tri cung ehi chiem 8,6% (95%CI 6,1 - 11,1%), khdng khae biet giOa hai gidi. -
Xem xet e l c hinh t h i i THA trong nhdm THA khdng dflpc d i l u tri hoac chifa difdc kiem soat tdt thi ty le THA tam thu dpn dpc d nam trong dp tudi 25 - 74 la 40,3% (95% Cl 34,6 - 45,9%) thap hpn han d nfl 49,7% (95% Cl 4 2 , 3 % - 57,0%) trong khi ty le THA c l tam thu va tam trifdng d nam lai cao hon han d nfl (49,1% (95% Cl 43,4 - 54,9%) so vdi 35,7% (95% Cl 28,7 - 42,6%), cd y nghTa thdng ke vdi p < 0,05 (bang 1). . .1,
Bang 1. Ty le hien mac THA & THA tam thu dan doc theo tudi va gidi '
Ty le THA d tam thu & tam Ty le THA tam thu ddn doc N h ' m ^ ^ '^ ' ^ ' ^ " '^^^ ^^^ trOdng d nhdm THA khong d nhdm THA khong dOdc
trong cpng ddng dope dleu trj hoac ehffa dleu trj hoac ehffa dffdc
% ( 9 5 % Cl) dffdc kiem soat tdt kiem soat tdt
% (95% Cl) % (95% Cl) tuo
25-
35-
45-
55-
65 • - 34
- 4 4
- 5 4
- 6 4
- 7 4
Chung
Nam gldl 2,1 (0,6 - 4 , 1 )
8,5 ( 4 , 7 - 12,2)
12,2 (7,6 - 16,8)
21,2 (15,6 - 2 6 , 7 )
36,4 (29,2 - 4 3 , 5 )
15,6 (13,3 - 17,9)
Nam gidi 0,7 ( 0 , 0 - 1,8)
2,1 (0,3 - 3 , 9 )
4,2 (1,6 - 6 , 8 )
12,3 ( 7 , 8 - 16,8)
18,2 ( 1 2 , 8 - 2 3 , 6 )
6,9 (5,4 - 8,4)
Nam gldl 20,0 ( 1 9 , 7 - 3 8 , 0 )
38,6 ( 2 4 , 0 - 5 3 , 2 )
51,1 ( 3 6 , 6 - 6 5 , 5 )
56,9 ( 4 5 , 4 - 6 8 , 5 )
52,7 . (43,3 -62,1)
49,1 ( 4 3 , 4 - 5 4 , 9 )
NO gidi
-
30,7 (4,6 -56,9)
34,6 (15,9 - 53,3)
39,7 (26,9 - 52,4)
36,6 (26,1 -47,1)
35,7 (28,7 -42,6)
Nam gldl 65,0 (43,5 -86,5)
38,6 (24,0 - 53,2)
34,0 (20,3 -47,8)
33,3 (22,3 - 4 4 , 3 )
43,6 (34,3 - 53,0)
40,3 (34,6 - 4 5 , 9 )
NO gidi
-
15,4 ( 0 , 0 - 35,9)
38,5 (19,3 -57,6)
53,4 (40,5 - 66,4)
59,8 (49,0 - 70,5)
49,7 (42,5 - 57,0)
3. Ganh nang cua huyet ap tam thu d ngffdi THA ca tam thu tam trffdng va THA tam thu ddn dgc Tri sd huyet ap tam thu trung binh d nhdm THA tam thu ddn dpc la 149,9 ± 1,1 d nam, khdng khac biet dang ke so vdi d nO 1 52,2 ± 1,3 mmHg, nhflng thap hdn han tri sd huyet I p trung binh tifdng xflng d nhdm THA c l tam thu va tam trfldng, l l n Iflpt tUPng xdng la 165,4 ± 1,6 va 168,0 ± 2,7 mmHg (bang 2).
Ndi khac di, ganh nang ve huyet ap can p h i i giam (de difa dUpe v l ngUdng dieu tri vdi HA tam thu
< 140 mmHg) d nhdm THA tam thu dPn dpc thap hdn n h i l u so vdi nhdm THA d tam thu va tam trUdng (9,9 ± 1,1 so vdi 25,5 ± 1,6 m m H g d nam va 12,2 ± 1,3 so vdi 28,0 ± 2,7 mmHg), ganh nang nay la tifdng dUdng d hai gidi.
IV B A N I U A N '"'"'^ ^^'^^ huyet ap. K i t q u i nghien cflu v l b i l n thien sd do huyet I p (el tam thu va tam trfldng) Bie'n thien cua sddo huylt ap theo tudi va gidi ^ , g ^^,^^^ ^g. ^^^ j^^^^^g ^ . ^ ^ ^^ ^^. ^^^..^^ ^g|^.g^
Tudi va gidi la hai yeu td nguy cd t r u y i n tho'ng eflu djch t l hpe khac ve THA trong epng ddng cho khdng the thay ddi eua benh tim mach cung nhfl thay huylt ap tam thu va tam trifpng deu tang
Bang 2. Huyet ap tam thu trung binh va mtic HA phai ha d ngudi THA tam thu dgc va THA ca tam thu va tam truang theo nhom tudi & gidi
Nhdm tuoi
Sd^ do huyet ap tam thu trung binh (mmHg)
Mffc HA phai ha de kiem soat chat (HA tam thu < 140 mmHg)
THA ca tam thu va tam trOdng
THA tam thu ddn doc
THA ca tam thu va tam trffdng
THA tam thu ddn doc Nam gidi
25 - 3 4 35 - 4 4 45 - 54 55 - 6 4 65 - 74 Chung
148,8 ± 2 , 8 153,8 ± 3,2 157,3 ± 3,3 167,7 ± 2,9 171,9 ± 2,7 1 6 5 , 4 ± 1,6
143,5 ± 1,1 144,9 ± 0 , 9 148,4 ± 1,6 1 5 1 , 8 ± 2 , 6 • 153,0 ± 2 , 2 149,9 ± 1,1
8,8 ± 2 , 8 1 3 , 8 ± 3,2 17,3 ± 3 , 3 27,7 ± 2,9 31,9 ± 2,7 25,5 ± 1,6
3,5 ± 1,1 4,9 ± 0 , 9 8,4 ± 1,6 11,8 ± 2,6 13,0 ± 2 , 2 9,9 ± 1,1 Nfl gidi
25 - 3 4 35 - 4 4 45 - 5 4 55 - 6 4 65 - 7 4 Chung
-
162,0 ± 16,1 162,3 ± 8 , 6 169,8 ± 4 , 5 169,1 ± 3,8 168,0 ± 2 , 7
-
144,5 ± 1,5 146,6 ± 1,7 148,7 ± 1,5 155,9 ± 2 , 1 152,2 ± 1,3
-
22,0 ± 16,1 22,3 ± 8 , 6 29,8 ± 4 , 5 29,1 ± 3,8 28,0 ± 2 , 7
-
4,5 ± 1,5 6,6 ± 1,7 8,7 ± 1,5 15,9 ± 2 , 1 12,2 ± 1,3 theo tudi va thfldng d nam gidi cao hdn d nfl gidi
[4, 5, 6, 9]. Cae t i e g i l Burt [1], Swales [10] ghi nhan ed sfl tang lien tue cua huyet I p tam thu theo tudi sau dp tudi 50 - 60 trong khi huyet ap tam trfldng cd xu hudng giam sau dp tudi nay, nhflng thay ddi dien hinh vdn dflpc cho cd nguyen nhan la do sfl tang len dp ci'fng eua thanh mach.
Nghien eflu cua chdng tdi chfla the hien rd rang sfl khac biet nay do dd'i tflpng nghien cdu ehi tap trung d dp tudi trifdng t h i n h difdi 75 (tfl 25 - 74), song dd thi d Hinh 1 cung cho thay xu hifdng tang cham dan va giam nhe cua h u y l t I p tam trUdng sau dp tudi 65 (nhl't la d nam gidi) trong khi huyet I p tam thu van tiep tuc cdn tang theo tudi. Du cdn nhieu tranh cai song d e t i c gia • nhfl Lewington [5], Franklin [4], Pastor - Barriuso [8]
d i u ghi nhan gia tri eua trj sd huyet I p tam thu
trong viee tien lUpng cac b i l n c d tim maeh chfnh nhu td vong do nguyen nhan tim maeh, benh mach vanh, suy t i m . . . hdn han so vdi tri sd huyet I p tam trUdng hoac chenh lech huyet ap. SU bien thien song hanh eua tri sd huylt I p tam thu theo tudi trong nghien cdu nay eung cho thay tam quan trpng cua viee theo ddi va giam sit HA tam thu trong viec quan ly va theo ddi huylt ap tai cpng ddng.
Ty le hien mac tang huyet ap tai Ba Vi
Tang huyet ap dang la mpt ganh nang trong cpng ddng ddi vdi ta't c l eae nUdc da va dang phat trien trong dd cd Viet Nam [ 1 , 3, 6, 7).
Nghien cflu cua Pham Gia Khai va cpng sfl v l THA va d e ye'u t d nguy co tim mach tai d c tinh m i l n Bac Viet Nam 2001 - 2002 eho thay ty le THA chung d ngUdi trUdng thanh > 25 tudi trong
cpng ddng la 16,3% (19,0% d nam so vdi 14,8%
d nfl) va ty le THA tam thu ddn dpc ehung la 7,3% chie'm k h o i n g 4 8 , 4 % d e trUdng hpp THA.
Nghien cdu cua chung tdi nam 2005 eho thay ty le THA trong dp tudi 25 - 74 tai Ba Vi d nam la 15,6% (95% Cl 13,3 - 17,9%) va d nfl I I 6,9%
(95% Cl 5,4 - 8,4%). Ty le THA trong epng ddng eua d e t i e g i l nflde ngoai khac cdn cao hdn nhieu sd vdi ehdng tdi hoac cua Pham Gia K h i i . Sfl k h I e biet nay cung nhfl khae biet gifla chdng toi va e l c k i t qua trong nUde k h I e cd the dUpc ly g i i i do sfl k h I e biet v l kinh t l xa hpi. Nghien cdu cda chung tdi dupe thflc hien tai Ba V i , mpt huyen ndng thdn dien hinh vdi mfle d i l u kien kinh te xa hpi d mfle thap - trung binh nen ty le m i c THA edn d mde tha'p hPn so vdi e l c dja phfldng phat trien k h I e trong d nUdc. Pham Gia K h I i [9] cung nhan tha'y tan suat THA d khu vfle thanh thi cao hdn n h i l u so vdi d khu vfle ndng thdn. Khdng khIe biet nhieu vdi d c khu vfle khac, ty le THA dflpc p h l t hien tO trOdc trong nghien cdu cua chung tdi chi chiem 2 5 , 6 % (95% Cl 21,7 - 29,4%) va ty le THA dope d i l u trj trong so' benh nhan THA dflde p h l t hien cung chi chiem 8,6%
(95% Cl 6,1 - 11,1%), tha'p mpt d c h dang bang dpng trong khi THA la nguyen n h i n kha thfldng gap va gay nhieu bie'n chdng tim mach k h I e trong cpng ddng.
Ganh nang cua tang huyet ap tam thu ddn dpc Trong nghien cdu nay, d e hinh t h i i THA nhu THA tam thu ddn dpc, THA tam trUPng ddn dpc, THA d tam thu va tam trUdng dfldc fldc tinh ty le theo tflng nhdm tudi va gidi. So vdi ghi nhan eua Pham Gia K h I i , ty le THA tam thu ddn dpc trong sd benh nhan THA eua chung tdi khdng k h I c biet: 40,3% (95% Cl 34,6 - 45,9%) d nam so vdi 49,7% (95% Cl 42,5 - 57,0%) d nfl. Tuy nhien neu xem xet THA tam thu dPn ddc thep tflng nhdm tudi va gidi, ty le THA tam thu ddn ddc d nam tang khdng d i n g ke, va n l u tinh ca nam va
nO thi THA tam thu ddn ddc khdng he chiem t'y' trpng Idn trong eac nhdm THA. Ket qua nay hoan toan khac so vdi k i t luan eua Franklin [3], Pastor - Barriuso [8] hay mpt s o ' t i e gia k h I c khi THA tam thu dpn ddc la loai hinh THA ehd y l u (65% theo Franklin) d benh nhan THA khdng dope d i l u tri va d ngfldi cac tudi. D i l u tra cP b i n NHANES III [3] so s i n h nhflng ngfldi THA t i m thu ddn dpc va d c loai THA khac theo d e Ida tudi tren va dUdi 50 tudi cho tha'y: g I n h nang chu yeu d ngUdi > 50 tudi la THA tam thu dPn dpc, nhdm benh nhan n l y cd mde HA tam thu trung binh cao hon n h i l u so vdi d e loai hinh THA khae va mfle HA p h i i ha de dat ngUdng k i l m solt chat (< 140 mmHg) d nhdm THA tam thu dPn dpc cap nhieu so vdi vdi THA d tam thu v l tam trUPng. K i t q u i cda chdng tdi lai cho tha'y ddi vdi THA d Ba Vi, THA c l tam thu va tam trUdng v i n la g I n h nang ft nhat la dd'i vdi nam gidi khdng nhflng e l ve ty' le phan tram (41.9%) ma cdn e l ve mde HA c i n p h i i ha de dat ngfldng (25,5 ± 1,6 mmHg d nhdm THA d tam thu tam trUdng so vdi 9,9 ± 1,1 d nhdm THA tam thu ddn dpc). Ddng tren khia canh y te cdng cpng va dfl phdng, k i t qua nay se d i n d i n nhflng k h u y i n cao k h I c v l ham Ifldng va loai thudc c i n dung de kiem soat THA trong epng ddng.
Han che cua nghien cffu
Mac du nghien cflu eua chdng tdi ed cd mau ldn va each chpn m l u dai dien, q u I n the nghien cflu eua chung tdi chi tap trung d huyen Ba V i , va chi ed kha nang dai dien cho mpt phan epng ddng ngfldi Viet Nam (ddng bang Bac bd). T h i l t ke nghien cdu dfldi dang dieu tra eat ngang nen chUa the tim hieu sau hpn v l e l c nguyen nhan gay nen sfl k h I e biet trong phan b d d c loai hinh THA so vdi d c t i e g i l khac tren t h i gidi. Ddi vdi THA ndi ehung va THA tam thu dprj doe ndi rieng, cdn can them n h i l u nghien cflu k h I c de t r i _ Idi e l c cau hdi v l xu hUdng t i l n trien, ty le phan
bd, yeu t d nguy eP... cda chung trong cpng ddng.
V. KET LUAN
Ty le hien m i c tang huyet I p d ngifdi trifdng thanh tfl 25 - 74 tudi tai huyen Ba Vi nam 2005 I I 15,6% (95% Cl 13,3 - 17,9%) d nam va 6,9%
(95% Cl 5,4 - 8,4%) d nfl. Ty le THA tang d i n theo tudi va d nam eao hdn so vdi nfl. Trong sd ngifdi THA, ty le THA dflpe phat hien tfl trflde ehi ehiem 25,6% (95% Cl 21,7 - 29,4%) va ty le THA dflpc dieu tri chi chiem 8,6% (95% Cl 6,1 -
11,1%). Tang h u y l t ap v i n la v i n d l it dflde ehd y d epng ddng nha't la nhdm ngfldi eao tudi.
Trong sd d e loai THA, THA tam thu don dpc chiem ty le 40,3% (95% Cl 34,6 - 45,9%) d nam va 49,7% (95% Cl 42,5 - 57,0%) d nfl. THA d tam thu va tam trifpng chiem ty le 4 9 , 1 % (95% Cl 43,4 - 54,9%) d nam va 35,7% (95% Cl 28,7 - 42,6%) d nfl. Tai Ba Vi, ganh nang chu yeu v l huylt ap va mfle h u y l t I p can g i l m van thupe v l nhdm THA e l tam thu va tam trifdng, dae biet la 0 nam.
TAI LIEU THAM KHAO
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(1995). Prevalence of hypertension in the U.S.
adult population. Results from the Third National Health and Nutrition Examination Survey, 1988 - 1 9 9 1 . Hypertension 1 995; 25: 305 - 31 3.
2. Chobanlan, AV. (2007). Clinical practice.
Isolated systolic hypertension in the elderly. N Engl j Med 2007; 357: 789.
3. Franklin SS, Jacobs MJ, Wong N D , et al.
(2001). Predominance of isolated systolic
hypertension among middle - aged and elderly U.S.
hypertensives. Hypertensidn 2 0 0 1 ; 37: 869 - 874.
4. Franklin, SS, Custin, W , Wong, N D , et al.
(1997). Hemodynamic patterns of age - related changes in blood pressure. The Framingham Hcirt Study. Circulation 1997; 96: 308.
5. Lewington S, Clarke R, Qlzllbash N, et al.
(2002). Age - specific relevance of usual blood pressure to vascular mortality: a meta - analysis of individual data for one million adults in 61 prospective studies. Lancet; 360: 1903 - 1913.
6. Kearney PM, Whelton M , Reynolds K, et al.
(2005). Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 21 7 - 223.
7. Ostchega, Y, Dillon, CF, Hughes, JP, et al.
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Summary
DISTRIBUTION OF BLOOD PRESSURE AND PATTERN OF HYPERTENSION IN COMMUNITY AT BAVI DISTRICT IN 2005
Hypertension is major cardiovascular disease risk factor, having big burden in community. Each pattern of hypertension, especially isolated systolic hypertension (ISH) has different prognostic impacts.
Objectives: (1) to indentify the prevalence of hypertension in community; (2) to indentify the prevalence of
each pattern of hypertension stratified by age group and sex. Method: a epidemiological cross - sectional survey was done in 2005 at Bavi District on 2374 randomly selected people, aged from 25 - 74, using standardized protocol with automatic digital blood pressure monitors. Results: Hypertension prevalence was 15.6% (95%CI 13.3 - 17.9%) in men and 6.9% (95%CI 5.4 - 8.4%) in women. In people with high blood pressure, only 25.6% was previously detected and 8.6% was treated. Prevalence ISH was 40.3%
(95%CI 34.6 - 45.9%) in men and 49.7% (95%CI 42.5 - 57.0%) in women while prevalence of systolic and diastolic hypertension (SDH) was 4 9 . 1 % (95%CI 43.4 - 54.9%) in men and 35.7% (95%CI 28.7 - 42.6%) in women. Conclusion: Hypertension was neglected issue in community. Prominent burden of hypertension and required reduction in systolic blood pressure still resulted from SDH, especially in men.
Keywords: prevalence, hypertension. Isolated systolic hypertension, FilaBavi
DAC DIEM LAM SANG VA CAN LAM SANG BENH NHAN HIV/AIDS DUOC DIEU TRj BANG ARV THEO PHAC DO BAC 1
Nguyen Thj Kim Chuc, Nguyen Phffdng Hoa Trddng Dai hoc Y Ha Ndi Mot yeu to quan trong trong dieu trj ARV cho benh nhin HIV/AIDS la benh nhan phai tuan thu viec dung thuoc mot each chat che. Muc tieu: md ta mot so die diem lim sang, cin lim sang cua benh nhan HIV/
AIDS khi bit dau thu nhin vao dieu tri ARV. Doi tugng va phuang phap nghien ciiu: ddi tuang la benh nhin HIV/AIDS du tieu chuan dieu tri ARV phac do bac 1 duac thu nhin vao nghien cdu thd nghidm lim sang de danh gia hieu qua md hinh quan ly dieu tri ARV. Ket qua: td 7/2007 - 11/2009 thu nhin dUac 640 benh nhin. De danh gia hiSu qua md hinh quan ly dieu tri, cac benh nhin difac chia lam 2 nhdm. Co 308 benh nhin d nhdm chifng (70,1%, la nam gidi), 332 benh nhan d nhdm can thiep (71,1%, la nam gidi). Han mot nda sd benh nhin cd giai doan lim sang ban dau la III hoac IV, va khdng cd sU khac biet gida hai nhdm (55,7 so vdi 54,6; p > 0,05). Luang CD4 trung binh d nhdm chifng va can thiep tuang dng la 115,3 vi 115,4 (p > 0,05). Ket luan: cac die diem lim sang, mien djch va vi rut hoc ban dau cua hai nhdm (can thiep va ddi chdng) khdng cd sU khac biet.
TO khoa: benh nhan HIV/AIDS, dieu tn ARV
I.
DAT VANDE
D i n nay, tren the gidi van chifa tim dflpc bien phap dieu tri triet de HIV/AIDS, viee tim ra vac xin phdng nhiem vi rut HIV ehae cdn phai mat nhilu nam nfla. Vi vay, viec dieu tri bang d c thudc khang vi rut (ARV) la phUPng thflc duy nhat giup d i thien chat lifdng cude sd'ng cho sd ddng nhdng ngfldi dang sd'ng ehung vdi HIV/AIDS va lam thay ddi quan niem ve HIV/AIDS [ 1 , 7]. Tfl chd can benh nay bj coi la can benh c h i t ngifdi vd phffpng cdu chfla chuyen sang la can benh
man tfnh cd the quan ly dope. Ddng thdi, viee d i thien c h i t Ifldng eupc sd'ng cho nhflng ngfldi cd HIV se gdp phan nang cao kha nang ddng gdp eua hp eho xa hpi thay vi thay hp nhfl la mat trai cua xa hpi. Viee t i l p can rpng rai vdi thudc ARV danh cho ta't e l nhflng dd'i tifdng du tieu chLian v l lam sang va can lam sang se gdp p h i n quan trpng eho cdng tac phdng benh trong cpng ddng. Cd the ndi, chi rieng viec neu bat hieu qua cua viec dieu tri thudc k h I n g vi rut se la bien p h l p quan trpng nang eao nhan thdc cung nhfl tac dpng cua eae
