{"id":20898,"date":"2023-04-14T20:54:33","date_gmt":"2023-04-14T13:54:33","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=20898"},"modified":"2023-04-17T15:44:22","modified_gmt":"2023-04-17T08:44:22","slug":"amlodipine-va-cac-chi-dinh-tren-thuc-hanh-lam-sang","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/14\/amlodipine-va-cac-chi-dinh-tren-thuc-hanh-lam-sang\/","title":{"rendered":"Amlodipine v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng"},"content":{"rendered":"

Amlodipine l\u00e0 thu\u1ed1c \u0111\u1ea7u ti\u00ean trong c\u00e1c DHP th\u1ebf h\u1ec7 th\u1ee9 hai. Nh\u1eefng \u01b0u \u0111i\u1ec3m ch\u00ednh c\u1ee7a amlodipine l\u00e0: kh\u1edfi ph\u00e1t ch\u1eadm v\u00e0 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i, thu\u1ed1c c\u00f3 nhi\u1ec1u th\u1eed nghi\u1ec7m l\u1edbn trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p. Amlodipine g\u1eafn v\u1edbi c\u00f9ng m\u1ed9t v\u1ecb tr\u00ed tr\u00ean k\u00eanh canxi (v\u1ecb tr\u00ed N) gi\u1ed1ng v\u1edbi c\u00e1c DHP kh\u00e1c, v\u1edbi s\u1ef1 li\u00ean k\u1ebft v\u00e0 ph\u00e2n ly r\u1ea5t ch\u1eadm, do \u0111\u00f3 kh\u1edfi ph\u00e1t t\u00e1c d\u1ee5ng v\u00e0 k\u1ebft th\u00fac ch\u1eadm. Ngo\u00e0i ra, thu\u1ed1c c\u0169ng g\u1eafn v\u1edbi c\u00f9ng v\u1ecb tr\u00ed t\u01b0\u01a1ng t\u1ef1 nh\u01b0 verapamil v\u00e0 diltiazem, m\u1eb7c d\u00f9 \u1edf m\u1ee9c \u0111\u1ed9 th\u1ea5p h\u01a1n.<\/strong><\/p>\n

1<\/strong>. C\u00e1c ch\u1ec9 \u0111\u1ecbnh c\u1ee7a amlodipine <\/strong><\/h2>\n

1.1 <\/strong>T\u0103ng huy\u1ebft \u00e1p <\/strong><\/h3>\n

Nhi\u1ec1u th\u1eed nghi\u1ec7m l\u1edbn cho th\u1ea5y t\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a amlodipine trong \u0111i\u1ec1u tr\u1ecb THA. Li\u1ec1u kh\u1edfi \u0111\u1ea7u ph\u1ed5 bi\u1ebfn l\u00e0 5 mg\/24h, c\u00f3 th\u1ec3 t\u0103ng l\u00ean \u0111\u1ebfn 10 mg\/24h. Trong m\u1ed9t th\u1eed nghi\u1ec7m l\u1edbn v\u1ec1 t\u0103ng huy\u1ebft \u00e1p nh\u1eb9 \u1edf nh\u00f3m tu\u1ed5i trung ni\u00ean theo d\u00f5i tr\u00ean 4 n\u0103m, amlodipine 5mg\/24h \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t nh\u1ea5t so v\u1edbi c\u00e1c thu\u1ed1c ch\u1eb9n alpha, thu\u1ed1c ch\u1eb9n beta, thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n.<\/p>\n

Trong nghi\u00ean c\u1ee9u ALLHAT, amlodipine c\u00f3 k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 c\u00e1c nh\u00f3m thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 \u1ee9c ch\u1ebf men chuy\u1ec3n tr\u00ean k\u1ebft c\u1ee5c ch\u00ednh (b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh g\u00e2y t\u1eed vong v\u00e0 kh\u00f4ng t\u1eed vong) nh\u01b0ng t\u1ef7 l\u1ec7 suy tim t\u0103ng nh\u1eb9 trong khi gi\u1ea3m t\u1ef7 l\u1ec7 \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi m\u1eafc. \u1ede b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 c\u00f3 THA, nghi\u00ean c\u1ee9u ALLHAT cho th\u1ea5y amlodipine c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u trong gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch. Trong nghi\u00ean c\u1ee9u ASCOT, amlodipine k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n perindopril cho k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n nhi\u1ec1u so v\u1edbi thu\u1ed1c ch\u1eb9n beta k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u. \u0110\u1eb7c bi\u1ec7t, t\u1ea5t c\u1ea3 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch \u0111\u1ec1u gi\u1ea3m k\u1ec3 c\u1ea3 suy tim, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi m\u1eafc v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong d\u1eabn \u0111\u1ebfn k\u1ebft th\u00fac s\u1edbm th\u1eed nghi\u1ec7m.<\/p>\n

Nghi\u00ean c\u1ee9u ACCOMPLISH so s\u00e1nh \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p ban \u0111\u1ea7u b\u1eb1ng benazepril k\u1ebft h\u1ee3p amlodipine v\u00e0 benazepril k\u1ebft h\u1ee3p hydrochlorothiazide, \u0111\u00e3 b\u1ecb ch\u1ea5m d\u1ee9t s\u1edbm v\u00ec k\u1ebft h\u1ee3p \u01afCMC \u2013 thu\u1ed1c ch\u1eb9n k\u00eanh canxi cho hi\u1ec7u qu\u1ea3 v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi \u01afCMC \u2013 l\u1ee3i ti\u1ec3u. C\u1ea3 ti\u00eau ch\u00ed ch\u00ednh v\u00e0 ti\u00eau ch\u00ed ph\u1ee5 \u0111\u1ec1u gi\u1ea3m kho\u1ea3ng 20%. S\u1ef1 k\u1ebft h\u1ee3p n\u00e0y c\u0169ng l\u00e0m gi\u1ea3m ti\u1ebfn tri\u1ec3n c\u1ee7a b\u1ec7nh th\u1eadn.<\/p>\n

1.2 <\/strong>H\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh <\/strong><\/h3>\n

Nhi\u1ec1u th\u1eed nghi\u1ec7m cho th\u1ea5y hi\u1ec7u qu\u1ea3 c\u1ee7a amlodipine trong \u0111i\u1ec1u tr\u1ecb \u0111au th\u1eaft ng\u1ef1c khi g\u1eafng s\u1ee9c, v\u1edbi t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i trong 24h v\u00e0 th\u01b0\u1eddng dung n\u1ea1p t\u1ed1t h\u01a1n thu\u1ed1c ch\u1eb9n beta. Nghi\u00ean c\u1ee9u CAMELOT s\u1eed d\u1ee5ng amlodipine trong 2 n\u0103m cho 663 b\u1ec7nh nh\u00e2n c\u00f3 t\u1ed5n th\u01b0\u01a1ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh tr\u00ean phim ch\u1ee5p m\u1ea1ch; amlodipine l\u00e0m gi\u1ea3m 31% c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch so v\u1edbi enalapril m\u1eb7c d\u00f9 m\u1ee9c gi\u1ea3m HA l\u00e0 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng nhau trong khi th\u1ec3 t\u00edch m\u1ea3ng x\u01a1 v\u1eefa v\u00e0 k\u00edch th\u01b0\u1edbc l\u00f2ng m\u1ea1ch kh\u00f4ng thay \u0111\u1ed5i. Trong nghi\u00ean c\u1ee9u PREVENT, s\u1eed d\u1ee5ng amlodipine cho b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n t\u00ednh l\u00e0m gi\u1ea3m bi\u1ebfn c\u1ed1 sau 3 n\u0103m.<\/p>\n

1.3 <\/strong>Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 khi g\u1eafng s\u1ee9c (\u0110<\/strong>au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh<\/strong>)<\/strong><\/h3>\n

gi\u1ea3m hi\u1ec7u qu\u1ea3 h\u01a1n khi d\u00f9ng amlodipine so v\u1edbi atenolol, trong khi \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh \u0111\u01b0\u1ee3c gi\u1ea3m t\u1ed1t h\u01a1n b\u1edfi atenolol v\u00e0 \u0111\u1ed1i v\u1edbi c\u1ea3 hai t\u00e1c d\u1ee5ng, s\u1ef1 k\u1ebft h\u1ee3p thu\u1ed1c cho hi\u1ec7u qu\u1ea3 t\u1ed1t nh\u1ea5t. Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 khi g\u1eafng s\u1ee9c l\u00e0 c\u01a1 s\u1edf c\u1ee7a h\u1ed9i ch\u1ee9ng \u0111\u1ed9ng m\u1ea1ch v\u00e0nh m\u1ea1n. Sau khi c\u01a1n \u0111au th\u1eaft ng\u1ef1c \u0111\u01b0\u1ee3c gi\u1ea3m b\u1edbt b\u1edfi nitrat, ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u c\u1ea7n 30 ph\u00fat \u0111\u1ec3 h\u1ed3i ph\u1ee5c, \u0111\u00f3 l\u00e0 bi\u1ec3u hi\u1ec7n c\u1ee7a t\u00ecnh tr\u1ea1ng \u0111\u1edd c\u01a1 tim do thi\u1ebfu m\u00e1u. C\u00f3 gi\u1ea3 thuy\u1ebft cho r\u1eb1ng qu\u00e1 t\u1ea3i canxi trong t\u1ebf b\u00e0o l\u00e0 c\u01a1 ch\u1ebf g\u00e2y ra \u0111\u1edd c\u01a1 tim, do \u0111\u00f3 amlodipine l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 t\u00ecnh tr\u1ea1ng \u0111\u1edd c\u01a1 tim nh\u01b0 v\u1eady.<\/p>\n

\u0110au th\u1eaft ng\u1ef1c do co th\u1eaft m\u1ea1ch v\u00e0nh trong c\u01a1n Prinzmetal, amlodipine 5 mg m\u1ed7i 24h l\u00e0m gi\u1ea3m c\u00e1c tri\u1ec7u ch\u1ee9ng v\u00e0 s\u1ef1 thay \u0111\u1ed5i ST.<\/p>\n

2<\/strong>. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng v\u00e0 t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n. <\/strong><\/h2>\n

Amlodipine c\u00f3 c\u00f9ng ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi c\u00e1c DHP kh\u00e1c. Thu\u1ed1c ch\u01b0a \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m trong \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p. Trong tr\u01b0\u1eddng h\u1ee3p suy tim, thu\u1ed1c ch\u1eb9n k\u00eanh canxi l\u00e0 m\u1ed9t nh\u00f3m n\u00ean tr\u00e1nh nh\u01b0ng c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng amlodipine khi c\u1ea7n ki\u1ec3m so\u00e1t \u0111au th\u1eaft ng\u1ef1c t\u1ed1t h\u01a1n. N\u00ean gi\u1ea3m li\u1ec1u n\u1ebfu c\u00f3 b\u1ec7nh gan.<\/p>\n

Trong s\u1ed1 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n, ph\u00f9 ngo\u1ea1i bi\u00ean l\u00e0 hay g\u1eb7p nh\u1ea5t, x\u1ea3y ra \u1edf kho\u1ea3ng 10% b\u1ec7nh nh\u00e2n \u1edf li\u1ec1u 10 mg\/24h. \u1ede ph\u1ee5 n\u1eef hay g\u1eb7p ph\u00f9 (15%) h\u01a1n so v\u1edbi nam gi\u1edbi (6%). D\u1ea5u hi\u1ec7u ch\u00f3ng m\u1eb7t 3- 4% v\u00e0 n\u00f3ng b\u1eebng m\u1eb7t 2- 3%. So v\u1edbi verapamil, ph\u00f9 hay g\u1eb7p h\u01a1n nh\u01b0ng \u0111au \u0111\u1ea7u v\u00e0 t\u00e1o b\u00f3n \u00edt h\u01a1n. So v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, \u0111au \u0111\u1ea7u kh\u00f4ng t\u0103ng h\u01a1n. Amlodipine cho ch\u1ea5t l\u01b0\u1ee3ng cu\u1ed9c s\u1ed1ng t\u1ed1t h\u01a1n so v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c trong nghi\u00ean c\u1ee9u TOMH.<\/p>\n

3.T\u00f3m <\/strong>t\u1eaft v\u1ec1 Amlodipine<\/strong>: <\/strong><\/h2>\n

Amlodipine l\u00e0 m\u1ed9t trong nh\u1eefng thu\u1ed1c kh\u1edfi tr\u1ecb\u00a0 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p b\u00ean c\u1ea1nh c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c nh\u01b0 \u1ee9c ch\u1ebf men chuy\u1ec3n, ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin, l\u1ee3i ti\u1ec3u thiazide.<\/p>\n

Th\u1eddi gian b\u00e1n h\u1ee7y r\u1ea5t d\u00e0i, dung n\u1ea1p t\u1ed1t v\u00e0 kh\u00f4ng c\u00f3 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c (ngo\u1ea1i tr\u1eeb: simvastatin li\u1ec1u cao) l\u00e0m cho amlodipine tr\u1edf th\u00e0nh m\u1ed9t thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p hi\u1ec7u qu\u1ea3 d\u00f9ng m\u1ed9t l\u1ea7n\/24h, \u01b0u \u0111i\u1ec3m h\u01a1n v\u1edbi c\u00e1c thu\u1ed1c hai l\u1ea7n ho\u1eb7c ba l\u1ea7n m\u1ed7i 24h.<\/p>\n

T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n r\u1ea5t \u00edt; n\u1ebfu c\u00f3 th\u01b0\u1eddng l\u00e0 ph\u00f9 m\u1eaft c\u00e1 ch\u00e2n. Thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9 khi g\u1eafng s\u1ee9c \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t h\u01a1n khi d\u00f9ng amlodipine so v\u1edbi atenolol, v\u00e0 s\u1ef1 k\u1ebft h\u1ee3p hai thu\u1ed1c th\u1eadm ch\u00ed c\u00f2n cho hi\u1ec7u qu\u1ea3 t\u1ed1t h\u01a1n.<\/p>\n

Nghi\u00ean c\u1ee9u ASCOT trong t\u0103ng huy\u1ebft \u00e1p \u0111\u00e3 cho th\u1ea5y t\u00e1c d\u1ee5ng b\u1ea3o v\u1ec7 tim m\u1ea1ch c\u1ee7a amlodipine, do \u0111\u00f3 xua tan ni\u1ec1m tin r\u1eb1ng thu\u1ed1c ch\u1eb9n k\u00eanh canxi c\u00f3 m\u1ed9t s\u1ed1 t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Amlodipine l\u00e0 thu\u1ed1c \u0111\u1ea7u ti\u00ean trong c\u00e1c DHP th\u1ebf h\u1ec7 th\u1ee9 hai. Nh\u1eefng \u01b0u \u0111i\u1ec3m ch\u00ednh c\u1ee7a amlodipine l\u00e0: kh\u1edfi ph\u00e1t ch\u1eadm v\u00e0 t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i, thu\u1ed1c c\u00f3 nhi\u1ec1u th\u1eed nghi\u1ec7m l\u1edbn trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p. Amlodipine g\u1eafn v\u1edbi c\u00f9ng m\u1ed9t v\u1ecb tr\u00ed tr\u00ean k\u00eanh canxi (v\u1ecb tr\u00ed N) gi\u1ed1ng v\u1edbi c\u00e1c […]<\/p>\n","protected":false},"author":7,"featured_media":20900,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"\nAmlodipine v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec<\/title>\n<meta name=\"description\" content=\"Amlodipine l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch quen thu\u1ed9c. Tham kh\u1ea3o b\u00e0i vi\u1ebft d\u01b0\u1edbi \u0111\u00e2y v\u1ec1 c\u00e1c ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Amlodipine v\u00e0 c\u00e1c ch\u1ec9 \u0111\u1ecbnh tr\u00ean th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng - Vinmec\" \/>\n<meta property=\"og:description\" content=\"Amlodipine l\u00e0 thu\u1ed1c \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch quen thu\u1ed9c. 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