{"id":21111,"date":"2023-04-15T15:59:12","date_gmt":"2023-04-15T08:59:12","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21111"},"modified":"2023-04-17T15:02:35","modified_gmt":"2023-04-17T08:02:35","slug":"uc-che-thu-the-va-nhung-van-de-quan-tam","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/15\/uc-che-thu-the-va-nhung-van-de-quan-tam\/","title":{"rendered":"\u1ee8c ch\u1ebf th\u1ee5 th\u1ec3 v\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 quan t\u00e2m"},"content":{"rendered":"<p><strong>Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT1 c\u1ee7a angiotensin II (Angiotensin II receptor blockers \u2013 ARBs), g\u1ecdi t\u1eaft l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, vi\u1ebft t\u1eaft l\u00e0 \u01afCTT, tr\u00e1nh \u0111\u01b0\u1ee3c ph\u1ea7n l\u1edbn c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng bradykinin c\u1ee7a thu\u1ed1c \u01afCMC nh\u01b0 ho hay ph\u00f9 m\u1ea1ch.<\/strong><\/p>\n<h2><strong>1.G<\/strong><strong>i\u1edbi thi\u1ec7u chung <\/strong><\/h2>\n<p>V\u00ec t\u00e1c d\u1ee5ng ch\u1ee7 y\u1ebfu c\u1ee7a c\u00e1c thu\u1ed1c \u01afCMC l\u00e0 nh\u1edd \u1ee9c ch\u1ebf s\u1ef1 t\u1ea1o th\u00e0nh angiotensin II n\u00ean c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp v\u1edbi receptor c\u1ee7a angiotensin II c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng t\u01b0\u01a1ng t\u1ef1 h\u1ea7u h\u1ebft c\u00e1c thu\u1ed1c \u01afCMC. Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT1 c\u1ee7a angiotensin II (Angiotensin II receptor blockers \u2013 ARBs), g\u1ecdi t\u1eaft l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, vi\u1ebft t\u1eaft l\u00e0 \u01afCTT, tr\u00e1nh \u0111\u01b0\u1ee3c ph\u1ea7n l\u1edbn c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng bradykinin c\u1ee7a thu\u1ed1c \u01afCMC nh\u01b0 ho hay ph\u00f9 m\u1ea1ch. Do c\u00e1c t\u00e1c d\u1ee5ng n\u00f3i tr\u00ean, nh\u00f3m thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 t\u1ed1t v\u00e0 s\u1eed d\u1ee5ng ng\u00e0y c\u00e0ng nhi\u1ec1u trong t\u0103ng huy\u1ebft \u00e1p, suy tim, d\u1ef1 ph\u00f2ng \u0111\u1ed9t qu\u1ef5 v\u00e0 b\u1ec7nh th\u1eadn c\u00f3 protein ni\u1ec7u, bao g\u1ed3m c\u1ea3 b\u1ec7nh th\u1eadn do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng.<\/p>\n<h2><strong>2.C<\/strong><strong>\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng <\/strong><\/h2>\n<p>C\u00f3 hai lo\u1ea1i th\u1ee5 th\u1ec3 ch\u00ednh c\u1ee7a angiotensin II: AT1 v\u00e0 AT2. Tuy nhi\u00ean, h\u1ea7u h\u1ebft t\u00e1c d\u1ee5ng c\u1ee7a angiotensin II ch\u1ee7 y\u1ebfu th\u00f4ng qua th\u1ee5 th\u1ec3 AT1, thu\u1ed1c \u01afCTT \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT1, do \u0111\u00f3 \u1ee9c ch\u1ebf ho\u1ea1t \u0111\u1ed9ng c\u1ee7a h\u1ec7 th\u1ed1ng renin \u2013 angiotensin \u2013 aldosterone (tuy kh\u00f4ng \u1ee9c ch\u1ebf \u0111\u01b0\u1ee3c ho\u00e0n to\u00e0n).<\/p>\n<p>B\u1edfi angiotensin c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1ea3n xu\u1ea5t t\u1eeb c\u00e1c c\u01a1 quan b\u00ean ngo\u00e0i h\u1ec7 renin, vi\u1ec7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin c\u00f3 th\u1ec3 gi\u00fap ki\u1ec3m so\u00e1t ho\u1ea1t \u0111\u1ed9ng c\u1ee7a angiotensin II t\u1ed1t h\u01a1n thu\u1ed1c \u01afCMC. Th\u00eam v\u00e0o \u0111\u00f3, c\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng ch\u00ednh c\u1ee7a angiotensin II tr\u00ean tim kh\u00f4ng ch\u1ec9 th\u00f4ng qua men chuy\u1ec3n m\u00e0 c\u00f2n qua c\u00e1c enzyme kh\u00e1c nh\u01b0 serine protease, chymase .<\/p>\n<p>Angiotensin I c\u00f2n c\u00f3 th\u1ec3 chuy\u1ec3n th\u00e0nh angiotensin II th\u00f4ng qua c\u00e1c enzyme nh\u01b0 cathepsin, trypsin, tuy nhi\u00ean c\u01a1 ch\u1ebf ch\u00ednh x\u00e1c c\u00f2n ch\u01b0a \u0111\u01b0\u1ee3c s\u00e1ng t\u1ecf. Thu\u1ed1c \u01afCTT kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean th\u1ee5 th\u1ec3 AT2, c\u1ea7n l\u01b0u \u00fd r\u1eb1ng th\u1ee5 th\u1ec3 n\u00e0y c\u00f3 vai tr\u00f2 trung gian trong ho\u1ea1t \u0111\u1ed9ng sinh l\u00fd c\u1ee7a h\u1ec7 tim m\u1ea1ch nh\u01b0: s\u1ea3n xu\u1ea5t NO, prostaglandin, bradykinin \u1edf th\u1eadn, \u1ee9c ch\u1ebf s\u1ef1 t\u0103ng tr\u01b0\u1edfng, th\u00fac \u0111\u1ea9y bi\u1ec7t h\u00f3a t\u1ebf b\u00e0o, ch\u1ebft theo ch\u01b0\u01a1ng tr\u00ecnh\u2026<\/p>\n<h2><strong>3.Ch\u1ec9 \u0111\u1ecbnh<\/strong><\/h2>\n<h3><strong>3.1. T\u0103ng huy\u1ebft \u00e1p <\/strong><\/h3>\n<p>Thu\u1ed1c \u01afCTT c\u00f3 kh\u1ea3 n\u0103ng gi\u1ea3m huy\u1ebft \u00e1p nh\u01b0ng c\u0169ng gi\u1ea3m thi\u1ec3u c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n r\u1ea5t r\u00f5 r\u00e0ng, c\u1ee5 th\u1ec3 l\u00e0 c\u00e1c c\u01a1n ho gi\u1ea3m r\u1ea5t nhi\u1ec1u, th\u1eadm ch\u00ed l\u00e0 kh\u00f4ng c\u00f2n. Trong nh\u1eefng th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y v\u1edbi c\u00e1c di\u1ec5n bi\u1ebfn n\u1eb7ng nh\u01b0 suy th\u1eadn giai \u0111o\u1ea1n cu\u1ed1i c\u1ee7a b\u1ec7nh th\u1eadn do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 \u0111\u1ed9t qu\u1ef5 \u0111\u1ed1i v\u1edbi ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, thu\u1ed1c \u01afCMC v\u00e0 \u01afCTT cho k\u1ebft qu\u1ea3 t\u1ed1t h\u01a1n c\u00e1c nh\u00f3m kh\u00e1c trong vi\u1ec7c gi\u1ea3m t\u1ef7 l\u1ec7 \u0111\u1ed9t qu\u1ef5 n\u00e3o v\u00e0 suy tim.<\/p>\n<p>Hi\u1ec7n nay theo khuy\u1ebfn c\u00e1o c\u1ee7a ESC 2018 v\u00e0 AHA\/ACC 2017, thu\u1ed1c \u01afCTT v\u00e0 \u01afCMC \u0111\u1ec1u \u0111\u01b0\u1ee3c coi l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb THA (b\u00ean c\u1ea1nh \u0111\u00f3 l\u00e0 l\u1ee3i ti\u1ec3u thiazide v\u00e0 thu\u1ed1c ch\u1eb9n k\u00eanh canxi). Khi xem x\u00e9t m\u1ed9t c\u00e1ch h\u1ec7 th\u1ed1ng c\u00e1c nghi\u00ean c\u1ee9u so s\u00e1nh hai lo\u1ea1i thu\u1ed1c n\u00e0y c\u0169ng cho th\u1ea5y kh\u1ea3 n\u0103ng ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 c\u1ee7a 2 nh\u00f3m thu\u1ed1c l\u00e0 t\u01b0\u01a1ng t\u1ef1 nhau, trong \u0111\u00f3 thu\u1ed1c \u01afCTT \u00edt g\u00e2y ho v\u00e0 ph\u00f9 m\u1ea1ch h\u01a1n. C\u1ea7n ch\u00fa \u00fd r\u1eb1ng c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a thu\u1ed1c \u01afCMC nh\u01b0 ph\u1ee5 n\u1eef c\u00f3 thai hay h\u1eb9p \u0111\u1ed9ng m\u1ea1ch th\u1eadn hai b\u00ean, c\u0169ng l\u00e0 nh\u1eefng ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh c\u1ee7a thu\u1ed1c \u01afCTT.<\/p>\n<h3><strong>3.2. B\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh<\/strong><strong>:<\/strong><\/h3>\n<p>Bao g\u1ed3m c\u1ea3 b\u1ec7nh th\u1eadn do \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng<\/p>\n<ul>\n<li>\u00a0\u0110\u1ed1i v\u1edbi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, c\u00f3 nhi\u1ec1u t\u00e0i li\u1ec7u \u1ee7ng h\u1ed9 cho thu\u1ed1c \u01afCTT h\u01a1n. Ng\u01b0\u1ee3c l\u1ea1i trong \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 1 thu\u1ed1c \u01afCMC l\u1ea1i c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng t\u00edch c\u1ef1c h\u01a1n. \u0110\u1ed1i v\u1edbi c\u00e1c b\u1ec7nh th\u1eadn c\u00f3 protein ni\u1ec7u, c\u00f3 th\u1ec3 k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ho\u1eb7c kh\u00f4ng, th\u00ec c\u1ea3 hai \u0111\u1ec1u c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m protein ni\u1ec7u nh\u01b0 nhau.<\/li>\n<li>Trong t\u0103ng huy\u1ebft \u00e1p, losartan li\u00ean quan \u00edt h\u01a1n \u0111\u1ebfn s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi h\u01a1n l\u00e0 atenolol, c\u00f2n candesartan th\u00ec \u00edt h\u01a1n hydrochlorothiazide v\u00e0 valsartan th\u00ec \u00edt h\u01a1n amlodipine. Trong suy tim, c\u00f3 xu\u1ea5t hi\u1ec7n gi\u1ea3m t\u1ef7 l\u1ec7 b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng m\u1edbi m\u1eafc khi so s\u00e1nh candesartan v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Tuy nhi\u00ean, c\u1ea7n ph\u1ea3i ch\u00fa \u00fd l\u00e0 nh\u1eefng quan s\u00e1t n\u00e0y \u0111\u1ec1u l\u00e0 c\u00e1c ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p<\/li>\n<\/ul>\n<h3><strong>3.3. Suy tim <\/strong><\/h3>\n<p>C\u1ea3 thu\u1ed1c \u01afCMC v\u00e0 \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 \u0111\u1ec1u \u1ee9c ch\u1ebf h\u1ec7 renin-angiotensin-aldosteron v\u00e0 hi\u1ec7n nay \u0111\u1ec1u c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng cho th\u1ea5y hi\u1ec7u qu\u1ea3 t\u1ed1t \u0111\u1ed1i v\u1edbi suy tim. To\u00e0n b\u1ed9 d\u1eef li\u1ec7u t\u1eeb hai th\u1eed nghi\u1ec7m l\u1edbn, Val-HeFT v\u00e0 VALIANT cho th\u1ea5y thu\u1ed1c \u01afCTT cho k\u1ebft qu\u1ea3 t\u1ed1t nh\u01b0 thu\u1ed1c \u01afCMC. Do \u0111\u00f3, thu\u1ed1c n\u00e0y tr\u1edf th\u00e0nh m\u1ed9t li\u1ec7u ph\u00e1p thay th\u1ebf th\u00edch h\u1ee3p cho suy tim, kh\u00f4ng ch\u1ec9 trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p r\u1ea5t c\u1ea7n thi\u1ebft nh\u01b0 kh\u00f4ng dung n\u1ea1p thu\u1ed1c \u01afCMC.<\/p>\n<p>\u1ee6ng h\u1ed9 vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c \u01afCTT ch\u1ee7 y\u1ebfu l\u00e0:<\/p>\n<ul>\n<li>Thu\u1ed1c kh\u00f4ng c\u00f3 c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n \u0111\u00e1ng k\u1ec3, c\u1ee5 th\u1ec3 l\u00e0 vi\u1ec7c gi\u1ea3m r\u00f5 c\u00e1c c\u01a1n ho v\u00e0 ph\u00f9 m\u1ea1ch. Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT-1, m\u1ed9t ch\u1ea5t t\u1ea1o ra angiotensin II c\u00f3 vai tr\u00f2 k\u00edch th\u00edch c\u00e1c t\u00e1c d\u1ee5ng c\u00f3 h\u1ea1i trong ho\u1ea1t \u0111\u1ed9ng c\u1ee7a h\u1ec7 renin-angiotensin \u0111\u1ed1i v\u1edbi t\u00ecnh tr\u1ea1ng suy tim. C\u00e1c con \u0111\u01b0\u1eddng kh\u00f4ng c\u1ea7n men chuy\u1ec3n angiotensin c\u00f3 th\u1ec3 c\u00f3 vai tr\u00f2 quan tr\u1ecdng trong c\u01a1 ch\u1ebf b\u1ec7nh sinh n\u00f3i chung c\u1ee7a angiotensin II. Th\u1ee5 th\u1ec3 AT-2 kh\u00f4ng b\u1ecb \u1ee9c ch\u1ebf v\u00e0 v\u1eabn c\u00f3 kh\u1ea3 n\u0103ng \u0111\u00e1p \u1ee9ng v\u1edbi t\u0103ng n\u1ed3ng \u0111\u1ed9 angiotensin II do h\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT-1.<\/li>\n<li>Ho\u1ea1t \u0111\u1ed9ng kh\u00f4ng c\u00f3 s\u1ef1 \u0111\u1ed1i l\u1eadp c\u1ee7a th\u1ee5 th\u1ec3 AT-2 c\u00f3 th\u1ec3 c\u00f3 c\u1ea3 l\u1ee3i v\u00e0 h\u1ea1i. M\u1eb7c d\u00f9 \u0111\u00e3 c\u00f3 r\u1ea5t nhi\u1ec1u b\u1eb1ng ch\u1ee9ng trong suy tim, bao g\u1ed3m c\u1ea3 suy th\u1ea5t tr\u00e1i sau nh\u1ed3i m\u00e1u c\u01a1 tim, thu\u1ed1c \u01afCMC v\u1eabn l\u00e0 m\u1ed9t li\u1ec7u ph\u00e1p \u0111\u1ea7u tay trong suy tim, tuy nhi\u00ean trong th\u1ef1c t\u1ebf l\u00e2m s\u00e0ng thu\u1ed1c \u01afCTT \u0111\u00f4i khi \u0111\u01b0\u1ee3c \u01b0u ti\u00ean s\u1eed d\u1ee5ng do kh\u1ea3 n\u0103ng dung n\u1ea1p t\u1ed1t h\u01a1n (\u00edt g\u00e2y ho).<\/li>\n<\/ul>\n<h3><strong>3.4. \u0110\u1ed9t qu\u1ef5 n\u00e3o <\/strong><\/h3>\n<p>H\u01a1n 20 n\u0103m tr\u01b0\u1edbc, nh\u1eefng th\u1eed nghi\u1ec7m quan s\u00e1t l\u00e2m s\u00e0ng cho th\u1ea5y thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 t\u00e1c d\u1ee5ng ph\u00f2ng \u0111\u1ed9t qu\u1ef5 t\u1ed1t h\u01a1n thu\u1ed1c ch\u1eb9n beta, Brown \u0111\u00e3 cho r\u1eb1ng thu\u1ed1c \u1ee9c ch\u1ebf angiotensin II c\u00f3 th\u1ec3 c\u00f3 t\u00e1c d\u1ee5ng ch\u1ed1ng \u0111\u1ed9t qu\u1ef5. Ba th\u1eed nghi\u1ec7m g\u1ea7n \u0111\u00e2y \u0111\u00e3 \u1ee7ng h\u1ed9 cho gi\u1ea3 thuy\u1ebft n\u00e0y.<\/p>\n<p>\u0110\u1ea7u ti\u00ean, trong nghi\u00ean c\u1ee9u PROGRESS, thu\u1ed1c \u01afCMC gi\u00fap gi\u1ea3m huy\u1ebft \u00e1p nh\u01b0ng kh\u00f4ng gi\u1ea3m t\u00ecnh tr\u1ea1ng \u0111\u1ed9t qu\u1ef5 t\u00e1i ph\u00e1t tr\u1eeb khi s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c l\u1ee3i ti\u1ec3u.<\/p>\n<p>Th\u1ee9 hai, thu\u1ed1c \u01afCTT (eprosartan) l\u00e0m gi\u1ea3m t\u00e1i ph\u00e1t \u0111\u1ed9t qu\u1ef5 t\u1ed1t h\u01a1n thu\u1ed1c ch\u1eb9n k\u00eanh canxi, m\u1eb7c d\u00f9 \u0111\u00e2y l\u00e0 m\u1ed9t trong nh\u1eefng thu\u1ed1c ph\u00f2ng \u0111\u1ed9t qu\u1ef5 t\u1ed1t nh\u1ea5t.<\/p>\n<p>Th\u1ee9 ba, trong nghi\u00ean c\u1ee9u LIFE, \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, losartan ph\u00f2ng \u0111\u1ed9t qu\u1ef5 t\u1ed1t h\u01a1n atenolol. Tuy nhi\u00ean, xem x\u00e9t 12 th\u1eed nghi\u1ec7m tr\u00ean 94.338 b\u1ec7nh nh\u00e2n, amlodipine c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m \u0111\u1ed9t qu\u1ef5 n\u00e3o v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim t\u1ed1t h\u01a1n thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 l\u1ea7n l\u01b0\u1ee3t l\u00e0 16% v\u00e0 17%, c\u00f3 l\u1ebd m\u1ed9t ph\u1ea7n l\u00e0 do kh\u00e1c bi\u1ec7t nh\u1ecf s\u1ef1 gi\u1ea3m huy\u1ebft \u00e1p t\u00e2m thu.<\/p>\n<h2><strong>4.<\/strong><strong> T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/h2>\n<p>Thu\u1ed1c \u01afCTT \u00edt g\u00e2y ho h\u01a1n, do \u0111\u00f3 d\u1ec5 dung n\u1ea1p v\u00e0 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng thay th\u1ebf thu\u1ed1c \u01afCMC trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p.<\/p>\n<p><a href=\"https:\/\/www.vinmec.com\/\" target=\"_blank\" rel=\"nofollow noopener\"><b>B\u1ec7nh vi\u1ec7n \u0110a khoa Qu\u1ed1c t\u1ebf Vinmec<\/b><\/a> c\u00f3 \u0111\u1ed9i ng\u0169 D\u01b0\u1ee3c s\u0129 d\u01b0\u1ee3c l\u00e2m s\u00e0ng gi\u00e0u kinh nghi\u1ec7m v\u00e0 \u0111\u01b0a h\u1ec7 th\u1ed1ng m\u00e1y m\u00f3c, thi\u1ebft b\u1ecb hi\u1ec7n \u0111\u1ea1i \u0111\u1ea1t chu\u1ea9n v\u00e0o c\u00f4ng t\u00e1c th\u0103m kh\u00e1m, ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 c\u00e1c b\u1ec7nh l\u00fd tim m\u1ea1ch.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 AT1 c\u1ee7a angiotensin II (Angiotensin II receptor blockers \u2013 ARBs), g\u1ecdi t\u1eaft l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3, vi\u1ebft t\u1eaft l\u00e0 \u01afCTT, tr\u00e1nh \u0111\u01b0\u1ee3c ph\u1ea7n l\u1edbn c\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u00f3 li\u00ean quan \u0111\u1ebfn t\u0103ng bradykinin c\u1ee7a thu\u1ed1c \u01afCMC nh\u01b0 ho hay ph\u00f9 m\u1ea1ch. 1.Gi\u1edbi thi\u1ec7u chung V\u00ec [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":21117,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[3],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>\u1ee8c ch\u1ebf th\u1ee5 th\u1ec3 v\u00e0 nh\u1eefng v\u1ea5n \u0111\u1ec1 quan t\u00e2m - Vinmec<\/title>\n<meta name=\"description\" content=\"\u1ee8c ch\u1ebf th\u1ee5 th\u1ec3 l\u00e0 thu\u1ed1c quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch. 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