{"id":34838,"date":"2023-06-10T12:10:44","date_gmt":"2023-06-10T05:10:44","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=34838"},"modified":"2023-06-10T12:10:44","modified_gmt":"2023-06-10T05:10:44","slug":"cac-nhom-thuoc-dieu-tri-tang-huyet-ap","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/06\/10\/cac-nhom-thuoc-dieu-tri-tang-huyet-ap\/","title":{"rendered":"C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p"},"content":{"rendered":"<p><strong>C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u00f3 nhi\u1ec1u c\u01a1 ch\u1ebf kh\u00e1c nhau v\u1edbi m\u1ee5c ti\u00eau chung l\u00e0 gi\u1ea3m t\u1eadt b\u1ec7nh tim m\u1ea1ch, th\u1eadn v\u00e0 gi\u1ea3m t\u1eed vong. C\u00f3 5 trong thu\u1ed1c ch\u00ednh trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p; Theo JNC-8 th\u00ec thu\u1ed1c kh\u1edfi tr\u1ecb kh\u00f4ng ch\u1ecdn Beta blocker. Ch\u1ecdn thu\u1ed1c n\u00e0o, \u0111\u01a1n tr\u1ecb li\u1ec7u hay ph\u1ed1i h\u1ee3p kh\u1edfi \u0111\u1ea7u t\u00f9y v\u00e0o b\u1ec7nh n\u1ec1n, m\u1ee9c THA, \u0111\u00e3 ki\u1ec3m so\u00e1t b\u1eb1ng thu\u1ed1c n\u00e0o tr\u01b0\u1edbc \u0111\u00f3 ch\u01b0a v\u00e0 hi\u1ec7u qu\u1ea3 ra sao. Nh\u1eb1m \u0111\u1ea1t m\u1ee5c ti\u00eau n\u00e0y, theo t\u1ea5t c\u1ea3 c\u00e1c khuy\u1ebfn c\u00e1o hi\u1ec7n nay c\u1ea7n thay \u0111\u1ed5i l\u1ed1i s\u1ed1ng v\u00e0 \u0111\u1ea1t tr\u1ecb s\u1ed1 HA &lt; 140\/90mmHg. Ri\u00eang v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 k\u00e8m \u0110T\u0110 ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n, m\u1ee9c HA c\u1ea7n \u0111\u1ea1t l\u00e0 d\u01b0\u1edbi 130\/80mmHg.<\/strong><\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone wp-image-34839 size-medium\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d280e091-bfbd-48e2-8bf5-8c61d7d85a66-300x300.jpg\" alt=\"thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p\" width=\"300\" height=\"300\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d280e091-bfbd-48e2-8bf5-8c61d7d85a66-300x300.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d280e091-bfbd-48e2-8bf5-8c61d7d85a66-150x150.jpg 150w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d280e091-bfbd-48e2-8bf5-8c61d7d85a66-768x768.jpg 768w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/06\/d280e091-bfbd-48e2-8bf5-8c61d7d85a66.jpg 1024w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2>1. Nguy\u00ean t\u1eafc chung<\/h2>\n<p><strong><br \/>\n<\/strong>M\u1ed9t s\u1ed1 \u0111i\u1ec1u c\u1ea7n ch\u00fa \u00fd khi s\u1eed d\u1ee5ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb THA :<br \/>\n&#8211; H\u1ea1 HA \u0111\u1ebfn m\u1ee9c mong mu\u1ed1n &lt; 140\/90mmHg ho\u1eb7c &lt; 130\/80 tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 k\u00e8m \u0110T\u0110 ho\u1eb7c suy th\u1eadn m\u1ea1n m\u00e0 kh\u00f4ng b\u1ecb t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c ho\u1eb7c xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng nh\u01b0 ch\u00f3ng m\u1eb7t, bu\u1ed3n ng\u1ee7, gi\u1ea3m kh\u1ea3 n\u0103ng t\u1ef1 v\u1ec7. Khuy\u1ebfn c\u00e1o ESC 2013 \u0111\u1ec1 ngh\u1ecb b\u1ec7nh nh\u00e2n THA k\u00e8m \u0110T\u0110 c\u00f3 th\u1ec3 gi\u1eef m\u1ee9c huy\u1ebft \u00e1p &lt; 140\/90 mmHg.<\/p>\n<p>&#8211; Kh\u00f4ng h\u1ea1 HA nhanh qu\u00e1 nh\u1eb1m gi\u1ea3m t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<br \/>\n&#8211; C\u1ea7n ch\u00fa \u00fd \u0111\u1ebfn t\u1ef7 l\u1ec7 \u0111\u00e1y \u0111\u1ec9nh c\u1ee7a thu\u1ed1c (trough and peak ratio) nh\u1eb1m b\u1ea3o v\u1ec7 HA su\u1ed1t 24 gi\u1edd<br \/>\n&#8211; L\u1ef1a ch\u1ecdn thu\u1ed1c \u0111\u1ea7u ti\u00ean \u0111i\u1ec1u tr\u1ecb THA c\u00f2n c\u1ea7n quan t\u00e2m \u0111\u1ebfn b\u1ec7nh n\u1ed9i khoa ph\u1ed1i h\u1ee3p.<\/p>\n<p>R\u1ea5t nhi\u1ec1u b\u1ec7nh nh\u00e2n THA kh\u00f4ng tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng do \u0111\u00f3 kh\u00f4ng quan t\u00e2m ho\u1eb7c sau m\u1ed9t th\u1eddi gian \u0111i\u1ec1u tr\u1ecb c\u00f3 HA \u1ed5n \u0111\u1ecbnh l\u00e2u d\u00e0i th\u01b0\u1eddng t\u1ef1 \u00fd ng\u01b0ng thu\u1ed1c. Do \u0111\u00f3 c\u00f3 m\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 m\u00e0 th\u1ea7y thu\u1ed1c c\u1ea7n quan t\u00e2m nh\u1eb1m gia t\u0103ng s\u1ef1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb c\u1ee7a b\u1ec7nh nh\u00e2n:<br \/>\n&#8211; Th\u1ea7y thu\u1ed1c c\u1ea7n c\u1ea3nh gi\u00e1c v\u1edbi v\u1ea5n \u0111\u1ec1 kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb v\u00e0 c\u1ea7n ph\u00e1t hi\u1ec7n s\u1edbm c\u00e1c d\u1ea5u hi\u1ec7u c\u1ee7a v\u1ea5n \u0111\u1ec1 n\u00e0y<br \/>\n&#8211; X\u00e1c \u0111\u1ecbnh m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb l\u00e0 h\u1ea1 HA \u0111\u1ebfn m\u1ee9c b\u00ecnh th\u01b0\u1eddng v\u1edbi r\u1ea5t \u00edt ho\u1eb7c kh\u00f4ng t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ee7a thu\u1ed1c.<br \/>\n&#8211; C\u1eaft ngh\u0129a cho b\u1ec7nh nh\u00e2n v\u1ec1 b\u1ec7nh THA v\u00e0 khuy\u1ebfn kh\u00edch t\u1ef1 \u0111o HA t\u1ea1i nh\u00e0. Khuy\u1ebfn kh\u00edch s\u1ef1 tr\u1ee3 gi\u00fap c\u1ee7a gia \u0111\u00ecnh.<br \/>\n&#8211; C\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u00edt t\u1ed1n k\u00e9m v\u00e0 gi\u1ea3n d\u1ecb. C\u00f3 th\u1ec3 d\u00f9ng vi\u00ean thu\u1ed1c ph\u1ed1i h\u1ee3p s\u1eb5n nh\u1eb1m gi\u1ea3m s\u1ed1 vi\u00ean thu\u1ed1c ph\u1ea3i u\u1ed1ng h\u00e0ng ng\u00e0y.<br \/>\n&#8211; C\u1ea7n tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb theo qui tr\u00ecnh ch\u1eb7t ch\u1ebd : kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p, gi\u1ea3m 5-10mmHg HA m\u1ed7i b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb, m\u1ed7i l\u1ea7n t\u0103ng li\u1ec1u th\u00eam 1 thu\u1ed1c, m\u1ed7i b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb c\u00e1ch kho\u1ea3ng 2-4 tu\u1ea7n l\u1ec5, ph\u00f2ng ng\u1eeba qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch b\u1eb1ng h\u1ea1n ch\u1ebf mu\u1ed1i v\u00e0 l\u1ee3i ti\u1ec3u, u\u1ed1ng thu\u1ed1c ngay v\u00e0o l\u00fac s\u00e1ng s\u1edbm m\u1edbi th\u1ee9c d\u1eady (c\u00f3 th\u1ec3 c\u1ea3 v\u00e0o l\u00fac 4 gi\u1edd s\u00e1ng n\u1ebfu t\u1ec9nh gi\u1ea5c).<\/p>\n<p>&nbsp;<\/p>\n<h2>2. C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb huy\u1ebft \u00e1p.<\/h2>\n<p><strong>2.1 L\u1ee3i ti\u1ec3u<\/strong><\/p>\n<p>C\u00f3 4 nh\u00f3m thu\u1ed1c l\u1ee3i ti\u1ec3u s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb tim m\u1ea1ch :<br \/>\n&#8211; Thu\u1ed1c \u1ee9c ch\u1ebf men carbonic anhydrase, t\u00e1c d\u1ee5ng tr\u00ean \u1ed1ng l\u01b0\u1ee3n g\u1ea7n c\u1ee7a vi c\u1ea7u th\u1eadn; th\u01b0\u1eddng d\u00f9ng trong t\u00e2m ph\u1ebf m\u1ea1n, \u00edt d\u00f9ng h\u1ea1 HA.<\/p>\n<ul>\n<li>L\u1ee3i ti\u1ec3u quai : t\u00e1c \u0111\u1ed9ng l\u00ean quai Henl\u00e9 ; th\u01b0\u1eddng d\u00e0nh ri\u00eang cho b\/n c\u00f3 \u0111\u1ed9 l\u1ecdc c\u1ea7u th\u1eadn &lt; 30ml\/ph\/ 1,73 m2 dtet ho\u1eb7c THA kh\u00e1ng tr\u1ecb.<\/li>\n<li>C\u00e1c thiazides ho\u1eb7c gi\u1ed1ng thiazides nh\u01b0 indapamide (Natrilix \u00d2): ph\u1ed5 bi\u1ebfn nh\u1ea5t trong \u0111i\u1ec1u tr\u1ecb<\/li>\n<li>C\u00e1c l\u1ee3i ti\u1ec3u gi\u1eef kali.<\/li>\n<\/ul>\n<p>M\u1ed9t s\u1ed1 nguy\u00ean t\u1eafc c\u1ea7n ch\u00fa \u00fd khi s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u \u0111i\u1ec1u tr\u1ecb THA:<br \/>\n&#8211; D\u00f9ng li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c.<br \/>\n&#8211; N\u00ean d\u00f9ng thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng d\u00e0i v\u1eeba ph\u1ea3i. Thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng d\u00e0i qu\u00e1 nh\u01b0 chlothalidone l\u00e0m m\u1ea5t nhi\u1ec1u h\u01a1n kali. Tuy nhi\u00ean m\u1ed9t s\u1ed1 t\u00e1c gi\u1ea3 l\u1ea1i th\u00edch s\u1eed d\u1ee5ng chlothalidone nhi\u1ec1u h\u01a1n<br \/>\n&#8211; H\u1ea1n ch\u1ebf mu\u1ed1i natri &lt; 100mmol\/ng\u00e0y<br \/>\n&#8211; T\u0103ng kali trong th\u1ee9c \u0103n h\u00e0ng ng\u00e0y.<br \/>\n&#8211; H\u1ea1n ch\u1ebf s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi thu\u1ed1c nhu\u1eadn tr\u01b0\u1eddng.<br \/>\n&#8211; N\u00ean ph\u1ed1i h\u1ee3p l\u1ee3i ti\u1ec3u m\u1ea5t kali v\u1edbi l\u1ee3i ti\u1ec3u gi\u1eef kali<br \/>\n<strong>2.2 Thu\u1ed1c ch\u1eb9n b\u00eata<br \/>\n<\/strong>Ch\u1eb9n b\u00eata ho\u1eb7c l\u1ee3i ti\u1ec3u th\u01b0\u1eddng \u0111\u01b0\u1ee3c khuy\u00ean l\u00e0 thu\u1ed1c l\u1ef1a ch\u1ecdn \u0111\u1ea7u ti\u00ean \u0111i\u1ec1u tr\u1ecb THA kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh b\u1eaft bu\u1ed9c. L\u1ef1a ch\u1ecdn thu\u1ed1c ch\u1eb9n b\u00eata cho ph\u00f9 h\u1ee3p v\u1edbi t\u00ecnh tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh d\u1ef1a v\u00e0o \u0111\u1eb7c t\u00ednh c\u1ee7a thu\u1ed1c n\u00e0y: t\u00ednh ch\u1ecdn l\u1ecdc b\u00eata 1, ho\u1ea1t t\u00ednh gi\u1ed1ng giao c\u1ea3m n\u1ed9i t\u1ea1i (ISA), t\u00ednh tan trong m\u1ee1 hay tan trong n\u01b0\u1edbc v\u00e0 c\u00f3 k\u00e8m \u1ee9c ch\u1ebf alpha kh\u00f4ng. \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n tim \u0111\u00e3 ch\u1eadm, n\u00ean ch\u1ecdn thu\u1ed1c c\u00f3 ISA d\u01b0\u01a1ng, \u1edf b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh l\u00fd ph\u1ed5i ch\u1ec9 n\u00ean s\u1eed d\u1ee5ng ch\u1eb9n b\u00eata 1 ch\u1ecdn l\u1ecdc, \u1edf b\u1ec7nh nh\u00e2n c\u00f3 nhi\u1ec1u \u00e1c m\u1ed9ng t\u1eeb khi s\u1eed d\u1ee5ng ch\u1eb9n b\u00eata, n\u00ean s\u1eed d\u1ee5ng ch\u1eb9n b\u00eata \u00edt tan trong m\u1ee1 nh\u01b0 atenolol ho\u1eb7c nadolol. Ch\u1eb9n b\u00eata c\u00f3 k\u00e8m t\u00e1c d\u1ee5ng alpha \u00edt l\u00e0m co m\u1ea1ch.<\/p>\n<p>Ngo\u00e0i s\u1ef1 l\u1ef1a ch\u1ecdn l\u00e0 thu\u1ed1c h\u1ea1 HA \u0111\u1ea7u ti\u00ean tr\u00ean h\u1ea7u h\u1ebft tr\u01b0\u1eddng h\u1ee3p THA kh\u00f4ng b\u1ec7nh n\u1ed9i khoa k\u00e8m theo, ch\u1eb9n b\u00eata c\u00f2n \u0111\u01b0\u1ee3c \u0111\u1eb7c bi\u1ec7t ch\u1ec9 \u0111\u1ecbnh trong THA c\u00f3 k\u00e8m b\u1ec7nh \u0110MV, THA c\u00f3 k\u00e8m t\u0103ng \u0111\u1ed9ng, THA c\u00f3 k\u00e8m lo l\u1eafng th\u00e1i qu\u00e1, THA tr\u00ean b\u1ec7nh nh\u00e2n sau nh\u1ed3i m\u00e1u c\u01a1 tim, THA c\u00f3 k\u00e8m lo\u1ea1n nh\u1ecbp nhanh v\u00e0 THA c\u00f3 k\u00e8m suy tim. Tr\u01b0\u1eddng h\u1ee3p THA c\u00f3 k\u00e8m suy tim, n\u00ean kh\u1edfi \u0111\u1ea7u b\u1eb1ng UCMC hay l\u1ee3i ti\u1ec3u, th\u00eam thu\u1ed1c ch\u1eb9n b\u00eata c\u00f3 nghi\u00ean c\u1ee9u trong \u0111i\u1ec1u tr\u1ecb suy tim, kh\u1edfi \u0111\u1ea7u li\u1ec1u th\u1ea5p (metoprolol succinate, carvedilol, bisoprolol, nebivolol)<br \/>\n<strong>2.3. \u1ee8c ch\u1ebf men chuy\u1ec3n<br \/>\n<\/strong>C\u00f3 4 c\u00e1ch \u0111\u1ec3 gi\u1ea3m ho\u1ea1t t\u00ednh c\u1ee7a h\u1ec7 renin-angiotensin \u1edf ng\u01b0\u1eddi. C\u00e1ch th\u1ee9 nh\u1ea5t l\u00e0 s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n b\u00eata \u0111\u1ec3 gi\u1ea3m ph\u00f3ng th\u00edch renin t\u1eeb t\u1ebf b\u00e0o c\u1ea1nh vi c\u1ea7u th\u1eadn. C\u00e1ch th\u1ee9 hai l\u00e0 \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp ho\u1ea1t t\u00ednh c\u1ee7a renin. Th\u1ee9 ba l\u00e0 ng\u0103n ch\u1eb7n ho\u1ea1t t\u00ednh c\u1ee7a men chuy\u1ec3n, do \u0111\u00f3 ng\u0103n Angiotensin I b\u1ea5t ho\u1ea1t tr\u1edf th\u00e0nh Angiotensin II (thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n). C\u00e1ch th\u1ee9 t\u01b0 l\u00e0 \u1ee9c ch\u1ebf c\u00e1c th\u1ee5 th\u1ec3 c\u1ee7a Angiotensin II (thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin II).<\/p>\n<p>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a UCMC<strong><br \/>\n<\/strong>UCMC ng\u0103n c\u1ea3n chuy\u1ec3n Angiotensin I th\u00e0nh Angiotensin II, \u0111\u1ed3ng th\u1eddi ng\u0103n s\u1ef1 ph\u00e2n h\u1ee7y Bradykinin; do \u0111\u00f3 t\u00e1c d\u1ee5ng ch\u00ednh l\u00e0 l\u00e0m gi\u00e3n m\u1ea1ch (h\u00ecnh 7). Ngo\u00e0i hi\u1ec7u qu\u1ea3 d\u00e3n m\u1ea1ch, t\u00e1c d\u1ee5ng h\u1ea1 HA c\u1ee7a UCMC c\u00f2n th\u00f4ng qua c\u00e1c ho\u1ea1t t\u00ednh sau (19) :<br \/>\n&#8211; Gi\u1ea3m ti\u1ebft aldosterone, do \u0111\u00f3 t\u0103ng b\u00e0i ti\u1ebft natri.<br \/>\n&#8211; T\u0103ng ho\u1ea1t 11b-hydroxysteroid dehydrogenase ; do \u0111\u00f3 b\u00e0i ti\u1ebft natri.<br \/>\n&#8211; Gi\u1ea3m t\u0103ng ho\u1ea1t giao c\u1ea3m khi d\u00e3n m\u1ea1ch, do \u0111\u00f3 UCMC d\u00f9 l\u00e0m d\u00e3n m\u1ea1ch nh\u01b0ng t\u1ea7n s\u1ed1 tim kh\u00f4ng t\u0103ng.<br \/>\n&#8211; Gi\u1ea3m ti\u1ebft endothelin (ch\u1ea5t co m\u1ea1ch t\u1eeb n\u1ed9i m\u1ea1c).<br \/>\n&#8211; C\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng n\u1ed9i m\u1ea1c.<\/p>\n<p><strong>2.4 Ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin II (ch\u1eb9n AGII)<br \/>\n<\/strong>C\u00f3 \u00edt nh\u1ea5t 2 th\u1ee5 th\u1ec3 c\u1ee7a angiotensin II (AG II). Th\u1ee5 th\u1ec3 AT 1 trung gian h\u1ea7u h\u1ebft c\u00e1c ho\u1ea1t t\u00ednh c\u1ee7a AG II. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc th\u1ee5 th\u1ec3 AT 1 c\u1ee7a AG II \u0111\u00e3 \u0111\u01b0\u1ee3c t\u1ed5ng h\u1ee3p v\u00e0 s\u1eed d\u1ee5ng trong \u0111i\u1ec1u tr\u1ecb THA. Cho t\u1edbi nay \u0111\u00e3 c\u00f3 6 thu\u1ed1c ch\u1eb9n AG II \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng.<\/p>\n<p>Ch\u1eb9n th\u1ee5 th\u1ec3 AGII \u0111\u1ea9y angiotensin II ra kh\u1ecfi th\u1ee5 th\u1ec3 AT 1 do \u0111\u00f3 l\u00e0m m\u1ea5t t\u00e1c d\u1ee5ng c\u1ee7a AGII, trong khi n\u1ed3ng \u0111\u1ed9 AGII t\u0103ng cao trong tu\u1ea7n ho\u00e0n. Ngo\u00e0i \u0111\u01b0\u1eddng men chuy\u1ec3n, angiotensin I c\u00f3 th\u1ec3 chuy\u1ec3n th\u00e0nh angiotensin II qua \u0111\u01b0\u1eddng men chymase v\u00e0 v\u00e0i \u0111\u01b0\u1eddng kh\u00e1c ; Do \u0111\u00f3 thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 AG II s\u1ebd ng\u0103n ch\u1eb7n angiotensin II ho\u00e0n to\u00e0n h\u01a1n UCMC.<\/p>\n<p><strong>2.5 C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf calci<br \/>\n<\/strong>Ion calci \u0111\u00f3ng vai tr\u00f2 ch\u00ednh trong s\u1ef1 co c\u01a1, do \u0111\u00f3 co m\u1ea1ch m\u00e1u. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf calci ng\u0103n c\u1ea3n s\u1ef1 di chuy\u1ec3n ion calci v\u00e0o trong t\u1ebf b\u00e0o qua c\u00e1c k\u00eanh calci t\u00f9y thu\u1ed9c \u0111i\u1ec7n th\u1ebf v\u00e0 k\u00eanh calci t\u00e1c \u0111\u1ed9ng qua th\u1ee5 th\u1ec3 (k\u00eanh ki\u1ec3u L); do \u0111\u00f3 c\u00f3 t\u00e1c d\u1ee5ng d\u00e3n m\u1ea1ch.<br \/>\nC\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf calci \u0111\u01b0\u1ee3c chia ra 2 nh\u00f3m ch\u00ednh :<br \/>\n* Nh\u00f3m dihydropyridine: bao g\u1ed3m c\u00e1c thu\u1ed1c d\u00f9ng th\u01b0\u1eddng d\u00f9ng nh\u01b0 nif\u00e9dipine, nicardipine,<br \/>\nisradipine, amlodipine, f\u00e9lodipine, lacidipine, nitrendipine, bercanidipine.<br \/>\n* Nh\u00f3m kh\u00f4ng dihydropyridine bao g\u1ed3m :<br \/>\n&#8211; Verapamil (d\u1eabn ch\u1ea5t c\u1ee7a diphenyl \u2013 alkylamine)<br \/>\n&#8211; Diltiazem (d\u1eabn ch\u1ea5t c\u1ee7a benzothiazepine).<\/p>\n<p>Xem th\u00eam: <a href=\"https:\/\/docs.google.com\/document\/d\/1ClnBP4Ka9hok1pp60Lfw6GnxCK4mHSeTBEuXHrEYHbg\/edit?usp=sharing\">Ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n t\u0103ng huy\u1ebft \u00e1p v\u00e0 nh\u1eefng d\u1ea5u hi\u1ec7u c\u1ea7n ch\u00fa \u00fd<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u00f3 nhi\u1ec1u c\u01a1 ch\u1ebf kh\u00e1c nhau v\u1edbi m\u1ee5c ti\u00eau chung l\u00e0 gi\u1ea3m t\u1eadt b\u1ec7nh tim m\u1ea1ch, th\u1eadn v\u00e0 gi\u1ea3m t\u1eed vong. C\u00f3 5 trong thu\u1ed1c ch\u00ednh trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p; Theo JNC-8 th\u00ec thu\u1ed1c kh\u1edfi tr\u1ecb kh\u00f4ng ch\u1ecdn Beta blocker. Ch\u1ecdn thu\u1ed1c n\u00e0o, \u0111\u01a1n tr\u1ecb [&hellip;]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p - Vinmec<\/title>\n<meta name=\"description\" content=\"C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p c\u00f3 nhi\u1ec1u c\u01a1 ch\u1ebf kh\u00e1c nhau v\u1edbi m\u1ee5c ti\u00eau chung l\u00e0 gi\u1ea3m t\u1eadt b\u1ec7nh tim m\u1ea1ch, th\u1eadn v\u00e0 gi\u1ea3m t\u1eed vong.\" \/>\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=\"C\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p - 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