{"id":5748,"date":"2019-03-26T10:25:21","date_gmt":"2019-03-26T03:25:21","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=5748"},"modified":"2019-03-29T10:28:45","modified_gmt":"2019-03-29T03:28:45","slug":"thuoc-dieu-tri-tang-huyet-ap-cho-benh-nhan-chay-than-nhan-tao","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/thuoc-dieu-tri-tang-huyet-ap-cho-benh-nhan-chay-than-nhan-tao\/","title":{"rendered":"Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p cho b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o"},"content":{"rendered":"<h2>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p cho b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o: Quan \u0111i\u1ec3m hi\u1ec7n t\u1ea1i<\/h2>\n<p>Ng\u01b0\u1eddi d\u1ecbch: Ho\u00e0ng Th\u1ecb B\u00edch Ng\u1ecdc, \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Th\u00e1i Nguy\u00ean. Email: ngochbn94@gmail.com<\/p>\n<p>Hi\u1ec7u \u0111\u00ednh: \u0110\u1eb7ng Th\u1ecb Ng\u1ecdc Mai \u2013 Trung t\u00e2m D\u01b0\u1ee3c l\u00fd l\u00e2m s\u00e0ng \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i. Email: dangngocmai.hmu@gmail.com Nh\u1ecbp C\u1ea7u D\u01b0\u1ee3c L\u00e2m S\u00e0ng.<\/p>\n<p>Ngu\u1ed3n: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/?fbclid=IwAR1OgMrq9n6MdIxxok9Ys9o5ZUAX853UtNm7U6ttW-qqVu7CP4MubPF4_t8\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/?fbclid=IwAR1OgMrq9n6MdIxxok9Ys9o5ZUAX853UtNm7U6ttW-qqVu7CP4MubPF4_t8<\/a><\/p>\n<h2>T\u00f3m t\u1eaft<\/h2>\n<p><strong>T\u0103ng huy\u1ebft \u00e1p<\/strong> \u1ea3nh h\u01b0\u1edfng t\u1edbi h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 th\u01b0\u1eddng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t k\u00e9m. Ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u0111\u1ea7y \u0111\u1ee7 trong ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o chu k\u1ef3 l\u00e0 kh\u00f3 kh\u0103n nh\u01b0ng r\u1ea5t quan tr\u1ecdng trong vi\u1ec7c c\u1ea3i thi\u1ec7n c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch. Can thi\u1ec7p kh\u00f4ng d\u00f9ng thu\u1ed1c \u0111\u1ec3 c\u1ea3i thi\u1ec7n huy\u1ebft \u00e1p bao g\u1ed3m vi\u1ec7c gi\u00e1o d\u1ee5c b\u1ec7nh nh\u00e2n h\u1ea1n ch\u1ebf l\u01b0\u1ee3ng mu\u1ed1i \u0103n v\u00e0o nh\u01b0ng v\u1eabn ph\u1ea3i b\u1ea3o \u0111\u1ea3m c\u00e2n b\u1eb1ng v\u1edbi l\u01b0\u1ee3ng mu\u1ed1i l\u1ea5y ra trong qu\u00e1 tr\u00ecnh l\u1ecdc, v\u00e0 \u0111\u1ea3m b\u1ea3o \u0111\u1ea1t m\u1ee5c ti\u00eau v\u1ec1 c\u00e2n n\u1eb7ng. Tuy nhi\u00ean, h\u1ea7u h\u1ebft c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u1ec1u c\u1ea7n s\u1eed d\u1ee5ng thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p \u0111\u1ec3 \u0111\u1ea1t ng\u01b0\u1ee1ng huy\u1ebft \u00e1p m\u1ee5c ti\u00eau. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p \u0111\u1ea7u tay bao g\u1ed3m thu\u1ed1c \u1ee9c ch\u1ebf enzym chuy\u1ec3n angiotensin v\u00e0 thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin \u0111\u00e3 \u0111\u01b0\u1ee3c minh ch\u1ee9ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. Thu\u1ed1c ch\u1eb9n beta v\u00e0 thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 alpha-beta k\u1ebft h\u1ee3p c\u0169ng n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng cho b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh tim m\u1ea1ch ho\u1eb7c suy tim sung huy\u1ebft. Thu\u1ed1c ch\u1eb9n k\u00eanh calci v\u00e0 thu\u1ed1c gi\u00e3n m\u1ea1ch tr\u1ef1c ti\u1ebfp c\u0169ng hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p. Nhi\u1ec1u thu\u1ed1c huy\u1ebft \u00e1p c\u00f3 th\u1ec3 cho u\u1ed1ng 1 l\u1ea7n m\u1ed7i ng\u00e0y, \u01b0u ti\u00ean l\u00e0 thu\u1ed1c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p v\u00e0o ban \u0111\u00eam v\u00e0 gi\u1ea3m thi\u1ec3u t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc. \u1ede b\u1ec7nh nh\u00e2n kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, c\u00e1c thu\u1ed1c th\u1ea3i tr\u1eeb qua th\u1eadn (nh\u01b0 l\u00e0 lisinopril v\u00e0 atenolol) c\u00f3 th\u1ec3 d\u00f9ng 3 l\u1ea7n\/tu\u1ea7n sau khi ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p lo\u1ea1i c\u0169 \u0111\u01b0\u1ee3c d\u00f9ng v\u1edbi li\u1ec1u 3 l\u1ea7n\/ ng\u00e0y n\u00ean tr\u00e1nh d\u00f9ng do g\u00e1nh n\u1eb7ng s\u1eed d\u1ee5ng thu\u1ed1c l\u00e0m b\u1ec7nh nh\u00e2n kh\u00f3 tu\u00e2n th\u1ee7, d\u1eabn t\u1edbi hi\u1ec7n t\u01b0\u1ee3ng t\u0103ng huy\u1ebft \u00e1p d\u1ed9i ng\u01b0\u1ee3c. Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1edbi h\u01a1n, nh\u01b0 thu\u1ed1c \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp renin, c\u00f3 th\u1ec3 l\u00e0 l\u1ef1a ch\u1ecdn thay th\u1ebf cho b\u1ec7nh t\u0103ng huy\u1ebft \u00e1p nh\u01b0ng c\u1ea7n th\u1eed nghi\u1ec7m \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n tr\u00ean b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n<p>T\u0103ng huy\u1ebft \u00e1p \u1ea3nh h\u01b0\u1edfng t\u1edbi 90% nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o duy tr\u00ec v\u00e0 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 c\u1ee7a b\u1ec7nh tim m\u1ea1ch, bao g\u1ed3m ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i ti\u1ebfn tri\u1ec3n, gi\u00e3n th\u1ea5t tr\u00e1i, suy tim, v\u00e0 t\u1eed vong (1-5). H\u01a1n n\u1eefa, nh\u1eefng nghi\u00ean c\u1ee9u g\u1ea7n \u0111\u00e2y ch\u1ee9ng minh ki\u1ec3m so\u00e1t t\u1ed1t huy\u1ebft \u00e1p tr\u00ean b\u1ec7nh nh\u00e2n g\u00f3p ph\u1ea7n c\u1ea3i thi\u1ec7n ch\u1ee9ng ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, t\u1ec9 l\u1ec7 m\u1eafc v\u00e0 t\u1eed vong do b\u1ec7nh tim m\u1ea1ch (6-8). \u1ede m\u1ed9t ph\u00e2n t\u00edch g\u1ed9p \u0111\u00e1nh gi\u00e1 tr\u00ean c\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1ec1 \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o cho th\u1ea5y, \u0111i\u1ec1u tr\u1ecb l\u00e0m gi\u1ea3m huy\u1ebft \u00e1p c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c gi\u1ea3m 29% nguy c\u01a1 bi\u1ebfn c\u1ed1 tim m\u1ea1ch, gi\u1ea3m 29% nguy c\u01a1 t\u1eed vong do b\u1ec7nh tim m\u1ea1ch v\u00e0 gi\u1ea3m 20% nguy c\u01a1 t\u1eed vong n\u00f3i chung (8).<\/p>\n<p>M\u1eb7c d\u00f9 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n b\u1ec7nh tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, nh\u01b0ng vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p tr\u00ean \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n n\u00e0y v\u1eabn l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c. Vi\u1ec7c c\u00e2n \u0111\u1ed1i l\u01b0\u1ee3ng d\u1ecbch ngo\u1ea1i b\u00e0o l\u00e0 ch\u00eca kh\u00f3a then ch\u1ed1t trong \u0111i\u1ec1u ch\u1ec9nh huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o (9). Bi\u1ec7n ph\u00e1p kh\u00f4ng d\u00f9ng thu\u1ed1c nh\u01b0 gi\u1ea3m thi\u1ec3u l\u01b0\u1ee3ng mu\u1ed1i \u0103n v\u00e0o sao cho \u0111\u1ea3m b\u1ea3o c\u00e2n b\u1eb1ng v\u1edbi l\u01b0\u1ee3ng mu\u1ed1i l\u1ea5y ra trong qu\u00e1 tr\u00ecnh l\u1ecdc, v\u00e0 \u0111\u1ea1t m\u1ee5c ti\u00eau v\u1ec1 c\u00e2n n\u1eb7ng n\u00ean \u0111\u01b0\u1ee3c coi l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p (10). Ngo\u00e0i c\u00e1c li\u1ec7u ph\u00e1p tr\u00ean th\u00ec v\u1eabn c\u1ea7n d\u00f9ng thu\u1ed1c \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. \u0110a s\u1ed1 c\u00e1c nh\u00f3m thu\u1ed1c c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u01b0\u1ee3c cho b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 th\u01b0\u1eddng c\u1ea7n ph\u1ed1i h\u1ee3p nhi\u1ec1u nh\u00f3m thu\u1ed1c \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p. V\u00ec th\u1ebf, b\u00e0i vi\u1ebft n\u00e0y s\u1ebd review l\u1ea1i vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p tr\u00ean b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n c\u1ee7a c\u00e1c thu\u1ed1c, k\u1ebft qu\u1ea3 thu \u0111\u01b0\u1ee3c t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, v\u00e0 c\u00e1c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1edbi tri\u1ec3n v\u1ecdng tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y.<\/p>\n<h2>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p<\/h2>\n<h3>Thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 th\u1ed1ng Renin Angiotensin Aldosteron<\/h3>\n<p>Thu\u1ed1c \u1ee9c ch\u1ebf h\u1ec7 Renin Angiotensin Aldosteron (RAAS) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem nh\u01b0 l\u00e0 thu\u1ed1c \u0111\u1ea7u tay \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p c\u1ee7a b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o b\u1edfi \u0111\u1ed9 an to\u00e0n v\u00e0 dung n\u1ea1p c\u1ee7a ch\u00fang, t\u00e1c d\u1ee5ng t\u1ed1t tr\u00ean ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, x\u01a1 c\u1ee9ng \u0111\u1ed9ng m\u1ea1ch, ch\u1ee9c n\u0103ng t\u1ebf b\u00e0o n\u1ed9i m\u00f4 v\u00e0 m\u1ea5t c\u00e2n b\u1eb1ng oxy h\u00f3a (11-14). H\u01b0\u1edbng d\u1eabn c\u1ee7a T\u1ed5 ch\u1ee9c nghi\u00ean c\u1ee9u c\u00e1c s\u00e1ng ki\u1ebfn hi\u1ec7u qu\u1ea3 ch\u1ea5t l\u01b0\u1ee3ng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh th\u1eadn (Kidney Foundatin Kidney Disease Outcomes Quality Initiative \u2013 KDOQI) c\u0169ng g\u1ee3i \u00fd thu\u1ed1c \u1ee9c ch\u1ebf RAAS l\u00e0 thu\u1ed1c \u01b0u ti\u00ean d\u00f9ng \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o, \u0111\u1eb7c bi\u1ec7t v\u1edbi nh\u1eefng ng\u01b0\u1eddi \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 c\u00f3 ti\u1ec1n s\u1eed suy tim (15).<\/p>\n<h4>Thu\u1ed1c \u1ee9c ch\u1ebf enzym chuy\u1ec3n angiotensin:<\/h4>\n<p>M\u1ed9t s\u1ed1 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u0111\u00e3 ch\u1ee9ng minh thu\u1ed1c \u1ee9c ch\u1ebf enzym chuy\u1ec3n angiotensin (ACE-I) l\u00e0 an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 v\u1edbi b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o. Trong m\u1ed9t nghi\u00ean c\u1ee9u nh\u1ecf v\u1edbi 11 b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o, theo d\u00f5i d\u00f9ng lisinopril 3 l\u1ea7n\/tu\u1ea7n sau khi l\u1ecdc m\u00e1u cho hi\u1ec7u qu\u1ea3 h\u1ea1 huy\u1ebft \u00e1p t\u00e2m thu xu\u1ed1ng 22mmHg (t\u1eeb 149\/84 xu\u1ed1ng 127\/73 mmHg) v\u00e0 kh\u00f4ng l\u00e0m t\u0103ng nguy c\u01a1 t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc (16). Nh\u1eefng th\u1eed nghi\u1ec7m kh\u00e1c c\u0169ng \u0111o \u0111\u01b0\u1ee3c m\u1ee9c huy\u1ebft \u00e1p t\u00e2m thu \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o gi\u1ea3m 5-12 mmHg khi d\u00f9ng ACE-I (11,17). Th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng c\u0169ng ch\u1ec9 ra r\u1eb1ng ACE-I l\u00e0 thu\u1ed1c thay th\u1ebf an to\u00e0n \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o b\u1edfi kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn kali m\u00e1u v\u00e0 t\u1ec9 l\u1ec7 t\u1ee5t huy\u1ebft \u00e1p c\u00f3 tri\u1ec7u ch\u1ee9ng &lt; 3% (17,18). Nh\u1eefng nghi\u00ean c\u1ee9u kh\u00e1c c\u00f3 \u0111\u1ec1 c\u1eadp thu\u1ed1c \u1ee9c ch\u1ebf RAAS c\u00f3 nguy c\u01a1 l\u00e0m t\u0103ng kali m\u00e1u \u1edf b\u00eanh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 kh\u1ea3 n\u0103ng do \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh th\u1ea3i kali ngo\u00e0i th\u1eadn (19,20). Do \u0111\u00f3, khi \u1ea3nh h\u01b0\u1edfng c\u1ee7a thu\u1ed1c \u1ee9c ch\u1ebf RAAS \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 kali m\u00e1u ch\u01b0a th\u1ed1ng nh\u1ea5t, vi\u1ec7c theo d\u00f5i n\u1ed3ng \u0111\u1ed9 kali m\u00e1u sau khi b\u1eaft \u0111\u1ea7u d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf RAAS l\u00e0 c\u1ea7n thi\u1ebft. ACE-I nh\u00ecn chung dung n\u1ea1p t\u1ed1t v\u00e0 l\u00fd do ph\u1ed5 bi\u1ebfn khi\u1ebfn b\u1ec7nh nh\u00e2n d\u1eebng thu\u1ed1c n\u00e0y l\u00e0 ho (21). Ho c\u00f3 th\u1ec3 x\u1ea3y ra \u1edf 5-20% b\u1ec7nh nh\u00e2n v\u00e0 th\u01b0\u1eddng h\u1ebft trong v\u00f2ng 2-6 tu\u1ea7n sau khi d\u1eebng thu\u1ed1c. ACE-I c\u0169ng l\u00e0m t\u0103ng li\u1ec1u y\u1ebfu t\u1ed1 k\u00edch th\u00edch s\u1ea3n sinh h\u1ed3ng c\u1ea7u (ESA) v\u00e0 c\u00f3 th\u1ec3 c\u00f3 li\u00ean quan \u0111\u1ebfn ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7 v\u1edbi m\u00e0ng l\u1ecdc AN69 (22, 23)<\/p>\n<p>Nh\u1eefng ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u v\u00e0 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng nh\u1ecf g\u1ee3i \u00fd r\u1eb1ng ACE-I gi\u00fap b\u1ea3o t\u1ed3n ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 c\u1ea3i thi\u1ec7n hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. Moist v\u00e0 c\u1ed9ng s\u1ef1, trong m\u1ed9t ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p tr\u00ean 1842 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c theo d\u00f5i trong nghi\u00ean c\u1ee9u USRDS Wave 2, ch\u1ec9 ra r\u1eb1ng vi\u1ec7c s\u1eed d\u1ee5ng ACE-I ngay t\u1eeb \u0111\u1ea7u l\u00e0m gi\u1ea3m 30% nguy c\u01a1 m\u1ea5t ch\u1ee9c n\u0103ng th\u1eadn sau 1 n\u0103m. Theo Efrati v\u00e0 c\u1ed9ng s\u1ef1, trong m\u1ed9t ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u tr\u00ean 126 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o (60 ng\u01b0\u1eddi d\u00f9ng ACE-I v\u00e0 66 ng\u01b0\u1eddi kh\u00f4ng d\u00f9ng ACE-I), \u0111\u00e3 x\u00e1c \u0111\u1ecbnh vi\u1ec7c d\u00f9ng ACE-I l\u00e0m t\u0103ng c\u01a1 h\u1ed9i s\u1ed1ng cho b\u1ec7nh nh\u00e2n (25). Hai ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u tr\u00ean b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p cho th\u1ea5y s\u1eed d\u1ee5ng ACE-I sau nh\u1ed3i m\u00e1u c\u01a1 tim l\u00e0m gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong (26,27).<\/p>\n<p>M\u1ed9t ph\u00e2n t\u00edch kh\u00e1c cho th\u1ea5y vi\u1ec7c d\u00f9ng ACE-I c\u00f3 th\u1ec3 l\u00e0m t\u0103ng c\u01a1 h\u1ed9i s\u1ed1ng sau khi ng\u1eebng tim (28). Ichihara v\u00e0 c\u1ed9ng s\u1ef1, trong 1 th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng trong 12 th\u00e1ng so s\u00e1nh vi\u1ec7c s\u1eed d\u1ee5ng ACE-I v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin (ARB) v\u1edbi gi\u1ea3 d\u01b0\u1ee3c tr\u00ean 64 b\u1ec7nh nh\u00e2n l\u1ecdc m\u00e1u, \u0111\u00e3 ch\u1ee9ng minh r\u1eb1ng li\u1ec1u th\u1ea5p ACE-I v\u00e0 ARB \u0111\u00e3 c\u1ea3i thi\u1ec7n v\u1eadn t\u1ed1c s\u00f3ng m\u1ea1ch (11). M\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean nh\u1ecf kh\u00e1c \u0111\u00e3 ch\u1ee9ng t\u1ecf \u0111\u01b0\u1ee3c s\u1ef1 gi\u1ea3m ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i khi d\u00f9ng ACE-I h\u00e0ng ng\u00e0y so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u1edf 30 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o (12).<\/p>\n<p>Nghi\u00ean c\u1ee9u ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng l\u1edbn nh\u1ea5t th\u1eed nghi\u1ec7m t\u00e1c d\u1ee5ng c\u1ee7a ACE-I tr\u00ean c\u00e1c ti\u00eau ch\u00ed tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o l\u00e0 th\u1eed nghi\u1ec7m FOSIDIAL (B\u1ea3ng 1). Trong nghi\u00ean c\u1ee9u n\u00e0y, 397 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o li\u00ean t\u1ee5c duy tr\u00ec &gt;= 6 th\u00e1ng v\u00e0 c\u00f3 ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i \u0111\u01b0\u1ee3c ch\u1ecdn d\u00f9ng thu\u1ed1c ng\u1eabu nhi\u00ean theo t\u1ec9 l\u1ec7 1:1 (1 ng\u01b0\u1eddi d\u00f9ng fosinopril 20mg\/ng\u00e0y \u0111\u1ed1i chi\u1ebfu v\u1edbi 1 ng\u01b0\u1eddi d\u00f9ng gi\u1ea3 d\u01b0\u1ee3c) v\u00e0 theo d\u00f5i trong kho\u1ea3ng 2 n\u0103m. Ti\u00eau ch\u00ed ch\u00ednh l\u00e0 k\u1ebft \u0111i\u1ec3m ph\u1ed1i h\u1ee3p c\u1ee7a t\u1eed vong do b\u1ec7nh tim m\u1ea1ch, nh\u1ed3i m\u00e1u c\u01a1 tim kh\u00f4ng g\u00e2y t\u1eed vong, \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, \u0111\u1ed9t qu\u1ef5, t\u00e1i t\u01b0\u1edbi m\u00e1u tim m\u1ea1ch, nh\u1eadp vi\u1ec7n v\u00ec suy tim v\u00e0 ng\u1eebng tim. M\u1eb7c d\u00f9 t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng ph\u1ea3i l\u00e0 ti\u00eau chu\u1ea9n \u0111\u1ea7u v\u00e0o c\u1ee7a nghi\u00ean c\u1ee9u, nh\u01b0ng vi\u1ec7c s\u1eed d\u1ee5ng fosinopril \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 t\u0103ng huy\u1ebft \u00e1p l\u00e0m gi\u1ea3m huy\u1ebft \u00e1p t\u00e2m thu x\u1ea5p x\u1ec9 6 mmHg so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c (v\u1edbi s\u1ef1 thay \u0111\u1ed5i tuy\u1ec7t \u0111\u1ed1i v\u1ec1 huy\u1ebft \u00e1p t\u00e2m thu l\u00e0 11,7 mmHg). M\u1eb7c d\u00f9 kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a th\u1ed1ng k\u00ea gi\u1eefa fosinopril v\u00e0 gi\u1ea3 d\u01b0\u1ee3c, nh\u01b0ng \u0111\u00e3 gi\u1ea3m 10-20% khi \u0111\u00e1nh gi\u00e1 ti\u00eau ch\u00ed ch\u00ednh \u1edf nh\u00f3m s\u1eed d\u1ee5ng fosinopril (17).<\/p>\n<p>B\u1ea3ng 1: C\u00e1c th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"128\">Ngu\u1ed3n tham kh\u1ea3o<\/td>\n<td width=\"128\">B\u1ec7nh nh\u00e2n<\/td>\n<td width=\"128\">Thu\u1ed1c can thi\u1ec7p<\/td>\n<td width=\"128\">Th\u1eddi gian theo d\u00f5i<\/td>\n<td width=\"128\">K\u1ebft qu\u1ea3<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Th\u1eed nghi\u1ec7m ACE-I<\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Zannad v\u00e0 c\u1ed9ng s\u1ef1 (17)<\/td>\n<td width=\"128\">397 b\u1ec7nh nh\u00e2n HD c\u00f3 LVH<\/td>\n<td width=\"128\">Fosinopril v\u00e0 gi\u1ea3 d\u01b0\u1ee3c<\/td>\n<td width=\"128\">24<\/td>\n<td width=\"128\">Fosinopril kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ec9 l\u1ec7 CV<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Th\u1eed nghi\u1ec7m k\u1ebft h\u1ee3p (ACE-I, ARB v\u00e0 CCB)<\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Ichihara\u00a0 c\u1ed9ng s\u1ef1 (11)<\/td>\n<td width=\"128\">64 b\u1ec7nh nh\u00e2n HD<\/td>\n<td width=\"128\">Losartan, randolapril ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c<\/td>\n<td width=\"128\">12<\/td>\n<td width=\"128\">Gi\u1ea3m PWV v\u1edbi losartan v\u00e0trandolapril<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Shibasaki v\u00e0 c\u1ed9ng s\u1ef1 (66)<\/td>\n<td width=\"128\">30 b\u1ec7nh nh\u00e2n HD c\u00f3 t\u0103ng huy\u1ebft \u00e1p<\/td>\n<td width=\"128\">Losartan, enalapril ho\u1eb7c amlodipin<\/td>\n<td width=\"128\">6<\/td>\n<td width=\"128\">Tho\u00e1i lui LVH v\u1edbi losartan<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">London v\u00e0 c\u1ed9ng s\u1ef1 (54)<\/td>\n<td width=\"128\">24 b\u1ec7nh nh\u00e2n HD c\u00f3 t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng ki\u1ec3m so\u00e1t<\/td>\n<td width=\"128\">Perindopril vs nitredipin<\/td>\n<td width=\"128\">12<\/td>\n<td width=\"128\">Tho\u00e1i lui LVH v\u1edbi perindopril<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Th\u1eed nghi\u1ec7m ARB<\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Kanno v\u00e0 c\u1ed9ng s\u1ef1 (67)<\/td>\n<td width=\"128\">24 b\u1ec7nh nh\u00e2n HD b\u1ecb ti\u1ec3u \u0111\u01b0\u1eddng v\u00e0 LVH<\/td>\n<td width=\"128\">Losartan ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c<\/td>\n<td width=\"128\">12<\/td>\n<td width=\"128\">Tho\u00e1i lui LVH v\u1edbi losartan<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Takahashi v\u00e0 c\u1ed9ng s\u1ef1 (13)<\/td>\n<td width=\"128\">80 b\u1ec7nh nh\u00e2n HD<\/td>\n<td width=\"128\">Candesartan so v\u1edbi kh\u00f4ng d\u00f9ng candersartan<\/td>\n<td width=\"128\">19<\/td>\n<td width=\"128\">Gi\u1ea3m t\u1ec9 l\u1ec7 CV v\u1edbi candesartan<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Suzuki v\u00e0 c\u1ed9ng s\u1ef1 (14)<\/td>\n<td width=\"128\">366 b\u1ec7nh nh\u00e2n HD c\u00f3 t\u0103ng huy\u1ebft \u00e1p<\/td>\n<td width=\"128\">Losartan, candesartan, ho\u1eb7c valsartan v\u00e0 gi\u1ea3 d\u01b0\u1ee3c<\/td>\n<td width=\"128\">36<\/td>\n<td width=\"128\">Gi\u1ea3m t\u1ec9 l\u1ec7 CV v\u1edbi ARB<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Th\u1eed nghi\u1ec7m thu\u1ed1c ch\u1eb9n alpha-beta<\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Cice v\u00e0 c\u1ed9ng s\u1ef1 (46,49)<\/td>\n<td width=\"128\">132 b\u1ec7nh nh\u00e2n HD c\u00f3 gi\u00e3n c\u01a1 tim<\/td>\n<td width=\"128\">Carvedilol v\u00e0 gi\u1ea3 d\u01b0\u1ee3c<\/td>\n<td width=\"128\">12-24<\/td>\n<td width=\"128\">Gi\u1ea3m t\u00ecnh tr\u1ea1ng gi\u00e3n c\u01a1 tim v\u00e0 c\u1ea3i thi\u1ec7n s\u1ee9c s\u1ed1ng v\u1edbi carvediolol<\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Th\u1eed nghi\u1ec7m thu\u1ed1c ch\u1eb9n k\u00eanh canxi<\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<td width=\"128\"><\/td>\n<\/tr>\n<tr>\n<td width=\"128\">Tepel v\u00e0 c\u1ed9ng s\u1ef1 (51)<\/td>\n<td width=\"128\">251 b\u1ec7nh nh\u00e2n HD c\u00f3 t\u0103ng huy\u1ebft \u00e1p<\/td>\n<td width=\"128\">Amlodipin v\u00e0 gi\u1ea3 d\u01b0\u1ee3c<\/td>\n<td width=\"128\">30<\/td>\n<td width=\"128\">Kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn t\u1ef7 l\u1ec7 t\u1eed vong chung nh\u01b0ng gi\u1ea3m bi\u1ebfn c\u1ed1 CV v\u1edbi amlodipin<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>ACE-I: thu\u1ed1c \u1ee9c ch\u1ebf enzym chuy\u1ec3n angiotensin; ARB: thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin; CV: bi\u1ebfn c\u1ed1 tim m\u1ea1ch; HD: l\u1ecdc m\u00e1u; LVH: ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i; PWV: v\u1eadn t\u1ed1c s\u00f3ng m\u1ea1ch.<\/p>\n<p>M\u1eb7c d\u00f9 ACE-I l\u00e0 thu\u1ed1c \u0111\u1ea7u tay trong \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p, \u0111a s\u1ed1 c\u00e1c thu\u1ed1c ACE-I (tr\u1eeb fosinopril) b\u1ecb l\u1ecdc trong qu\u00e1 tr\u00ecnh ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o (B\u1ea3ng 2). Vi\u1ec7c ACE-I b\u1ecb lo\u1ea1i b\u1ecf trong qu\u00e1 tr\u00ecnh ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u1edf \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n v\u00e0 c\u00f3 th\u1ec3 gi\u00fap tr\u00e1nh \u0111\u01b0\u1ee3c t\u00ecnh tr\u1ea1ng t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc. Tuy nhi\u00ean, v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc, ACE-I b\u1ecb l\u1ecdc c\u00f3 th\u1ec3 thay th\u1ebf b\u1eb1ng ARB ho\u1eb7c ACE-I kh\u00f4ng b\u1ecb l\u1ecdc nh\u01b0 fosinopril (29,30). \u0110a s\u1ed1 ACE-I \u0111\u01b0\u1ee3c d\u00f9ng h\u00e0ng ng\u00e0y; tuy nhi\u00ean, lisinopril v\u1eabn c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u1ed1t khi d\u00f9ng 3 l\u1ea7n\/tu\u1ea7n sau m\u1ed7i l\u1ea7n l\u1ecdc m\u00e1u, do lisinopril th\u1ea3i tr\u1eeb ch\u1ee7 y\u1ebfu qua th\u1eadn, n\u00ean th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a lisiniprol s\u1ebd d\u00e0i h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o (16). V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n k\u00e9m tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, c\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn cho b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng lisinopril ngay sau l\u1ecdc m\u00e1u d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t tr\u1ef1c ti\u1ebfp c\u1ee7a b\u00e1c s\u0129.<\/p>\n<p>B\u1ea3ng 2: D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p ch\u1ecdn l\u1ecdc tr\u00ean b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o (15, 68, 69)<\/p>\n<table>\n<tbody>\n<tr>\n<td>Nh\u00f3m thu\u1ed1c<\/td>\n<td>Th\u1eddi gian b\u00e1n th\u1ea3i \u1edf ESRD<\/td>\n<td>Gi\u1edbi h\u1ea1n li\u1ec1u (li\u1ec1u \u0111\u1ea7u \u0111\u1ebfn li\u1ec1u \u00a0th\u01b0\u1eddng d\u00f9ng ho\u1eb7c t\u1ed1i \u0111a<\/td>\n<td>% \u0111\u01b0\u1ee3c l\u1ecdc b\u1ecf khi ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c \u1ee9c ch\u1ebf enzym chuy\u1ec3n angiotensin<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Captopril<\/td>\n<td>20\u201330 h<\/td>\n<td>12.5\u201350 mg q24<\/td>\n<td>C\u00f3<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Benazepril<\/td>\n<td>?<\/td>\n<td>5\u201340 mg q24<\/td>\n<td>20\u201350%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Enalapril<\/td>\n<td>K\u00e9o d\u00e0i<\/td>\n<td>2.5\u201310 mg q24-48<\/td>\n<td>35%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Fosinopril<\/td>\n<td>K\u00e9o d\u00e0i<\/td>\n<td>10\u201380 mg q24<\/td>\n<td>&lt;10%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Lisinopril<\/td>\n<td>54 h<\/td>\n<td>2.5\u201310 mg q24\u201348<\/td>\n<td>50%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Ramipril<\/td>\n<td>K\u00e9o d\u00e0i<\/td>\n<td>2.5\u201310 mg q24<\/td>\n<td>&lt;30%<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotesin<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Losartan<\/td>\n<td>4 h<\/td>\n<td>50\u2013100 mg q24<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Candesartan<\/td>\n<td>5\u20139 h<\/td>\n<td>4\u201332 mg q24<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Eprosartan<\/td>\n<td>?<\/td>\n<td>400\u2013600 mg q24<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Telmisartan<\/td>\n<td>24 h<\/td>\n<td>40\u201380 mg q24<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Valsartan<\/td>\n<td>6 h<\/td>\n<td>80\u2013160 mg q24<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Irbesartan<\/td>\n<td>11\u201315 h<\/td>\n<td>75\u2013300 mg q24<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosteron<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Spironolacton<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/table\/T2\/?report=objectonly#TFN3\" rel=\"noopener\"><sup>a<\/sup><\/a><\/td>\n<td>?<\/td>\n<td>25\u201350 mg qd<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Eplerenon<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/table\/T2\/?report=objectonly#TFN4\" rel=\"noopener\"><sup>b<\/sup><\/a><\/td>\n<td>?<\/td>\n<td>50\u2013100 mg qd<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c \u1ee9c ch\u1ebf renin<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Aliskiren<\/td>\n<td>?<\/td>\n<td>150\u2013300 mg qd<\/td>\n<td>?<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c ch\u1eb9n alpha-beta k\u1ebft h\u1ee3p<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Atenolol<\/td>\n<td>&lt;120 h<\/td>\n<td>25\u201350 mg q48<\/td>\n<td>75%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Metoprolol<\/td>\n<td>3\u20138 h<\/td>\n<td>50\u2013200 mg bid<\/td>\n<td>Cao<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Metoprolol XL<\/td>\n<td>?<\/td>\n<td>50\u2013400 mg qd<\/td>\n<td>Cao<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Propranolol<\/td>\n<td>3\u20136 h<\/td>\n<td>40\u2013120 mg bid<\/td>\n<td>&lt;5%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Carvedilol<\/td>\n<td>7\u201310 h<\/td>\n<td>6.25\u201325 mg bid<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Carvedilol CR<\/td>\n<td>?<\/td>\n<td>20\u201380 mg qd<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Labetalol<\/td>\n<td>6\u20138 h<\/td>\n<td>100\u20131200 mg bid<\/td>\n<td>&lt;1%<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c ch\u1eb9n k\u00eanh calci<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Amlodipin<\/td>\n<td>?<\/td>\n<td>2.5\u201310 mg qd<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Diltiazem<\/td>\n<td>K\u00e9o d\u00e0i<\/td>\n<td>Kh\u00e1c nhau t\u00f9y c\u00f4ng th\u1ee9c<\/td>\n<td>&lt;30%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Nifedipin<\/td>\n<td>~5 h<\/td>\n<td>30\u2013180 mg qd<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/table\/T2\/?report=objectonly#TFN5\" rel=\"noopener\"><sup>c<\/sup><\/a><\/td>\n<td>Th\u1ea5p<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Nicardipin<\/td>\n<td>K\u00e9o d\u00e0i<\/td>\n<td>30\u201360 mg bid<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/table\/T2\/?report=objectonly#TFN5\" rel=\"noopener\"><sup>c<\/sup><\/a><\/td>\n<td>?<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Felodipin<\/td>\n<td>11\u201316<\/td>\n<td>2.5\u201310 mg qd<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/table\/T2\/?report=objectonly#TFN5\" rel=\"noopener\"><sup>c<\/sup><\/a><\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Verapamil<\/td>\n<td>K\u00e9o d\u00e0i<\/td>\n<td>Kh\u00e1c nhau t\u00f9y c\u00f4ng th\u1ee9c<\/td>\n<td>Th\u1ea5p<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c ch\u1eb9n alpha- adrenergic<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Doxazosin<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3061334\/table\/T2\/?report=objectonly#TFN5\" rel=\"noopener\"><sup>c<\/sup><\/a><\/td>\n<td>15\u201322 h<\/td>\n<td>1\u20138 mg qhs<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Terazosin<\/td>\n<td>9\u201312 h<\/td>\n<td>1\u201320 mg qhs<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Prazosin<\/td>\n<td>2\u20134 h<\/td>\n<td>1\u20135 mg bid to tid<\/td>\n<td>?<\/td>\n<\/tr>\n<tr>\n<td><em>Thu\u1ed1c kh\u00e1c<\/em><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Clonidin<\/td>\n<td>18\u201341 h<\/td>\n<td>0.1\u20130.4 mg bid-tid<\/td>\n<td>&lt;5%<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Hydralazin<\/td>\n<td>7\u201316 h<\/td>\n<td>10\u2013100 mg q8 h<\/td>\n<td>Kh\u00f4ng<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Isosorbid dinitrate<\/td>\n<td>?<\/td>\n<td>5\u201340 mg tid<\/td>\n<td>C\u00f3<\/td>\n<\/tr>\n<tr>\n<td>\u00a0\u00a0Minoxidil<\/td>\n<td>?<\/td>\n<td>5\u2013100 mg qd<\/td>\n<td>1 ph\u1ea7n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Qd: m\u1ed7i ng\u00e0y; bid: hai l\u1ea7n m\u1ed9t ng\u00e0y; tid: ba l\u1ea7n m\u1ed9t ng\u00e0y; qhs: l\u00fac \u0111i ng\u1ee7<\/p>\n<p>aKh\u00f4ng khuy\u1ebfn c\u00e1o v\u1edbi CrCl &lt;30 ml \/ ph\u00fat v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh \u1edf b\u1ec7nh nh\u00e2n v\u00f4 ni\u1ec7u.<\/p>\n<p>bCh\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi CrCl &lt;30 ml \/ ph\u00fat.<\/p>\n<p>c D\u1ea1ng gi\u1ea3i ph\u00f3ng k\u00e9o d\u00e0i<\/p>\n<p>V\u1edbi li\u1ec1u 1 l\u1ea7n\/ng\u00e0y, thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0o bu\u1ed5i t\u1ed1i nh\u1eb1m gi\u1ea3m thi\u1ec3u s\u1ef1 t\u0103ng huy\u1ebft \u00e1p v\u1ec1 \u0111\u00eam x\u1ea3y ra \u1edf nhi\u1ec1u b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 tr\u00e1nh t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc (2, 15).<\/p>\n<h4>Thu\u1ed1c ch\u1eb9n th\u1ee7 th\u1ec3 angiotensin<\/h4>\n<p>C\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 angiotensin \u0111\u00e3 minh ch\u1ee9ng ARB l\u00e0 an to\u00e0n v\u00e0 dung n\u1ea1p t\u1ed1t \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o. Trong 2 th\u1eed nghi\u1ec7m nh\u1ecf, vi\u1ec7c d\u00f9ng ARB (so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c ho\u1eb7c li\u1ec7u ph\u00e1p th\u00f4ng th\u01b0\u1eddng) kh\u00f4ng l\u00e0m t\u0103ng kali m\u00e1u ho\u1eb7c t\u0103ng nhu c\u1ea7u ESA (13,14). T\u00e1c d\u1ee5ng c\u1ee7a ARB \u0111\u1ed1i v\u1edbi huy\u1ebft \u00e1p thay \u0111\u1ed5i trong c\u00e1c nghi\u00ean c\u1ee9u kh\u00e1c nhau v\u00e0 \u0111i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 do s\u1ef1 kh\u00e1c nhau trong c\u00e1ch \u0111o huy\u1ebft \u00e1p (d\u00f9 l\u00e0 th\u00f4ng qua b\u1ed9 \u0111o huy\u1ebft \u00e1p c\u1ee7a m\u00e1y l\u1ecdc hay ti\u00eau chu\u1ea9n v\u00e0ng l\u00e0 \u0111o huy\u1ebft \u00e1p l\u01b0u \u0111\u1ed9ng 24h). Trong 1 nghi\u00ean c\u1ee9u c\u1ee7a Takahashi v\u00e0 c\u1ed9ng s\u1ef1, vi\u1ec7c s\u1eed d\u1ee5ng candesartan (4-8 mg\/ng\u00e0y) kh\u00f4ng c\u00f3 t\u00e1c d\u1ee5ng tr\u00ean huy\u1ebft \u00e1p \u0111o qua b\u1ed9 \u0111o \u1edf m\u00e1y l\u1ecdc m\u00e1u trong su\u1ed1t 3 n\u0103m theo d\u00f5i (huy\u1ebft \u00e1p n\u1ec1n l\u00e0 153\/82 v\u00e0 trong qu\u00e1 tr\u00ecnh theo d\u00f5i l\u00e0 153\/83 mHg), tuy nhi\u00ean huy\u1ebft \u00e1p \u0111o t\u1ea1i nh\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c ghi nh\u1eadn (13).<\/p>\n<p>Trong 1 th\u1eed nghi\u1ec7m c\u1ee7a Suzuki v\u00e0 c\u1ed9ng s\u1ef1, c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng thu\u1ed1c ARB c\u00f3 huy\u1ebft \u00e1p t\u00e2m thu gi\u1ea3m g\u1ea7n 14 mmHg trong 3 n\u0103m theo d\u00f5i ( t\u1eeb 154\/81 xu\u1ed1ng 140\/80 mmHg) v\u00e0 thu \u0111\u01b0\u1ee3c k\u1ebft qu\u1ea3 t\u01b0\u01a1ng t\u1ef1 nh\u01b0 nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c (14). Trong 1 nghi\u00ean c\u1ee9u nh\u1ecf ri\u00eang bi\u1ec7t v\u1ec1 valsartan ho\u1eb7c candesartan \u1edf 11 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, huy\u1ebft \u00e1p t\u00e2m thu \u0111\u00e3 gi\u1ea3m \u0111\u00e1ng k\u1ec3 g\u1ea7n 30 mmHg khi s\u1eed d\u1ee5ng ARB sau 8 th\u00e1ng (31). Do \u0111\u00f3, ARB t\u01b0\u01a1ng \u0111\u1ed1i hi\u1ec7u qu\u1ea3 trong vi\u1ec7c h\u1ea1 huy\u1ebft \u00e1p v\u00e0 \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t.<\/p>\n<p>C\u00e1c th\u1eed nghi\u1ec7m nh\u1ecf v\u1edbi c\u00e1c k\u1ebft \u0111i\u1ec3m \u0111\u1ea1i di\u1ec7n \u0111\u00e3 ch\u1ec9 ra ARB c\u00f3 th\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh tim m\u1ea1ch b\u1eb1ng c\u1ea3i thi\u1ec7n v\u1eadn t\u1ed1c s\u00f3ng m\u1ea1ch v\u00e0 gi\u1ea3m ch\u1ee9ng ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i (B\u1ea3ng 1). Hai nghi\u00ean c\u1ee9u l\u1edbn c\u0169ng cho th\u1ea5y ARB c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n c\u00e1c ch\u1ec9 ti\u00eau l\u00e2m s\u00e0ng nh\u01b0 c\u00e1c bi\u1ebfn c\u1ed1 v\u1ec1 tim m\u1ea1ch. Trong 1 nghi\u00ean c\u1ee9u c\u1ee7a Takahashi v\u00e0 c\u1ed9ng s\u1ef1, 80 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c ch\u1ecdn ng\u1eabu nhi\u00ean v\u00e0 cho d\u00f9ng candesartan 4-8mg so v\u1edbi \u0111i\u1ec1u tr\u1ecb th\u00f4ng th\u01b0\u1eddng v\u00e0 theo d\u00f5i trong 3 n\u0103m v\u1edbi k\u1ebft \u0111i\u1ec3m ph\u1ed1i h\u1ee3p gi\u1eefa nh\u1ed3i m\u00e1u c\u01a1 tim g\u00e2y t\u1eed vong ho\u1eb7c kh\u00f4ng t\u1eed vong, \u0111au th\u1eaft ng\u1ef1c kh\u00f4ng \u1ed5n \u0111\u1ecbnh, suy tim ph\u1ea3i nh\u1eadp vi\u1ec7n, nh\u1ecbp nhanh th\u1ea5t ho\u1eb7c rung th\u1ea5t ho\u1eb7c \u0111\u1ed9t t\u1eed. Tuy nhi\u00ean nghi\u00ean c\u1ee9u \u0111\u00e3 b\u1ecb d\u1eebng l\u1ea1i s\u1edbm b\u1edfi h\u1ed9i \u0111\u1ed3ng gi\u00e1m s\u00e1t an to\u00e0n d\u1eef li\u1ec7u v\u00e0 ph\u00e2n t\u00edch cu\u1ed1i c\u00f9ng \u0111\u00e3 ch\u1ee9ng minh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng candesartan l\u00e0m gi\u1ea3m \u0111\u00e1ng k\u1ec3 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00e0 t\u1ef7 l\u1ec7 t\u1eed vong trong th\u1eed nghi\u1ec7m n\u00e0y (13). Trong 1 nghi\u00ean c\u1ee9u nh\u00e3n m\u1edf c\u1ee7a Suzuki v\u00e0 c\u1ed9ng s\u1ef1, 366 b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 t\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o 1 trong 3 nh\u00f3m: s\u1eed d\u1ee5ng valsartan, candesartan v\u00e0 losartan 1 l\u1ea7n\/ng\u00e0y v\u00e0 so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c. Sau \u0111\u00f3 theo d\u00f5i trong 36 th\u00e1ng cho \u0111\u1ebfn khi g\u1eb7p c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch g\u00e2y t\u1eed vong ho\u1eb7c kh\u00f4ng (\u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh l\u00e0 t\u1ed5ng h\u1ee3p c\u00e1c tr\u01b0\u1eddng h\u1ee3p t\u1eed vong do b\u1ec7nh tim m\u1ea1ch (CVD), nh\u1ed3i m\u00e1u c\u01a1 tim, \u0111\u1ed9t qu\u1ef5, suy tim sung huy\u1ebft, ph\u1eabu thu\u1eadt b\u1eafc c\u1ea7u \u0111\u1ed9ng m\u1ea1ch v\u00e0nh ho\u1eb7c can thi\u1ec7p m\u1ea1ch v\u00e0nh qua da). Trong nghi\u00ean c\u1ee9u n\u00e0y, vi\u1ec7c d\u00f9ng ARB l\u00e0m gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 CVD kh\u00f4ng g\u00e2y t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o d\u00e0i ng\u00e0y nh\u01b0ng kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1ef7 l\u1ec7 t\u1eed vong chung (14).<\/p>\n<p>\u0110i\u1ec1u quan tr\u1ecdng c\u1ea7n l\u01b0u \u00fd, kh\u00f4ng c\u00f3 ARB n\u00e0o b\u1ecb lo\u1ea1i b\u1ecf b\u1eb1ng th\u1ea9m t\u00e1ch m\u00e1u (B\u1ea3ng 2). H\u01a1n n\u1eefa, vi\u1ec7c d\u00f9ng ARB 1 l\u1ea7n\/ng\u00e0y c\u00f9ng chi ph\u00ed ch\u1ea5p nh\u1eadn \u0111\u01b0\u1ee3c \u0111\u00e3 l\u00e0m cho thu\u1ed1c n\u00e0y \u0111\u01b0\u1ee3c coi l\u00e0 l\u1ef1a ch\u1ecdn \u01b0u ti\u00ean \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p.<\/p>\n<p>Li\u1ec7u ph\u00e1p k\u1ebft h\u1ee3p ACE-I v\u00e0 ARB:<\/p>\n<p>V\u1ec1 vi\u1ec7c ph\u1ed1i h\u1ee3p nhi\u1ec1u h\u01a1n m\u1ed9t thu\u1ed1c t\u00e1c \u0111\u1ed9ng tr\u00ean h\u1ec7 RAAS, m\u1ed9t nghi\u00ean c\u1ee9u nh\u1ecf tr\u00ean 33 b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o \u0111\u00e3 cho th\u1ea5y l\u1ee3i \u00edch khi k\u1ebft h\u1ee3p gi\u1eefa ACE-I v\u00e0 ARB. Nghi\u00ean c\u1ee9u s\u01a1 b\u1ed9 n\u00e0y ph\u00e2n ng\u1eabu nhi\u00ean c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng g\u1eb7p bi\u1ebfn c\u1ed1 ph\u1ea3i ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u00e0o c\u00e1c nh\u00f3m: s\u1eed d\u1ee5ng ACE-I, s\u1eed d\u1ee5ng ARB v\u00e0 ph\u1ed1i h\u1ee3p ACE-I v\u1edbi ARB. C\u00e1c nh\u00f3m \u0111\u1ec1u \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p t\u1ed1t (huy\u1ebft \u00e1p t\u00e2m thu &lt;140 mmHg) v\u00e0 ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ea5t tr\u00e1i (LVMI) sau 1 n\u0103m. Tuy nhi\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p ACE-I v\u00e0 ARB c\u00f3 bi\u1ec3u hi\u1ec7n gi\u1ea3m 28% LVMI so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng thu\u1ed1c \u1ee9c ch\u1ebf RAAS \u0111\u01a1n tr\u1ecb li\u1ec7u (32). Trong khi nghi\u00ean c\u1ee9u nh\u1ecf n\u00e0y cho th\u1ea5y l\u1ee3i \u00edch khi d\u00f9ng ph\u1ed1i h\u1ee3p thu\u1ed1c th\u00ec c\u00e1c th\u1eed nghi\u1ec7m \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng m\u1eafc ESRD c\u00f3 nguy c\u01a1 tim m\u1ea1ch cao \u0111\u00e3 kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c s\u1ef1 c\u1ea3i thi\u1ec7n v\u1ec1 tim m\u1ea1ch khi k\u1ebft h\u1ee3p c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf RAAS (33). Do \u0111\u00f3 c\u1ea7n c\u00f3 c\u00e1c nghi\u00ean c\u1ee9u l\u1edbn h\u01a1n \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh li\u1ec7u s\u1ef1 k\u1ebft h\u1ee3p ARB v\u00e0 ACE-I c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 gi\u1ea3m LVH so v\u1edbi vi\u1ec7c d\u00f9ng \u0111\u01a1n tr\u1ecb li\u1ec7u hay kh\u00f4ng.<\/p>\n<h4>Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosteron<\/h4>\n<p>M\u1eb7c d\u00f9 thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosteron l\u00e0 1 l\u1ef1a ch\u1ecdn t\u1ed1t \u0111\u1ec3 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 tim m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n suy tim (34) th\u00ec vi\u1ec7c d\u00f9ng thu\u1ed1c n\u00e0y \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u \u0111\u1ea7y \u0111\u1ee7. H\u01a1n n\u1eefa, vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c n\u00e0y tr\u00ean l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 b\u1ecb h\u1ea1n ch\u1ebf do nguy c\u01a1 t\u0103ng kali m\u00e1u. M\u00e0 h\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn l\u00e0 v\u00f4 ni\u1ec7u, n\u00ean t\u0103ng kali m\u00e1u do thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosteron c\u00f3 th\u1ec3 x\u1ea3y ra do \u1ea3nh h\u01b0\u1edfng c\u1ee7a n\u00f3 t\u1edbi th\u1ea3i tr\u1eeb kali ngo\u00e0i th\u1eadn (nh\u01b0 \u1ee9c ch\u1ebf \u0111\u00e0o th\u1ea3i kali \u1edf ru\u1ed9t).<\/p>\n<p>Trong 2 nghi\u00ean c\u1ee9u nh\u1ecf, nh\u00e3n m\u1edf v\u1edbi spironolacton li\u1ec1u th\u1ea5p, kh\u00f4ng c\u00f3 t\u0103ng kali m\u00e1u \u1edf 14 b\u1ec7nh nh\u00e2n sau 6 tu\u1ea7n d\u00f9ng spironolacton 3 l\u1ea7n\/tu\u1ea7n ( 25mg) nh\u01b0ng 1\/15 b\u1ec7nh nh\u00e2n d\u00f9ng spironolacton 25mg h\u00e0ng ng\u00e0y \u0111\u00e3 ph\u1ea3i d\u1eebng thu\u1ed1c v\u00ec t\u0103ng kali m\u00e1u (kali 7,6 mEq\/l sau 20 ng\u00e0y \u0111i\u1ec1u tr\u1ecb) (35, 36). Trong 1 nghi\u00ean c\u1ee9u b\u1eaft ch\u00e9o, m\u00f9 \u0111\u00f4i, ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng v\u1edbi gi\u1ea3 d\u01b0\u1ee3c tr\u00ean 8 b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o, vi\u1ec7c d\u00f9ng 50 mg spironolacton 2 l\u1ea7n\/ng\u00e0y \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 thi\u1ec3u ni\u1ec7u c\u00f3 hi\u1ec7u qu\u1ea3 trong gi\u1ea3m huy\u1ebft \u00e1p t\u00e2m thu &gt; 11 mmHg v\u00e0 kh\u00f4ng c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 kali huy\u1ebft t\u01b0\u01a1ng tr\u01b0\u1edbc v\u00e0 sau l\u1ecdc m\u00e1u trong 2 tu\u1ea7n.<\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u l\u1edbn h\u01a1n, nh\u00e3n m\u1edf v\u1ec1 spironolacton li\u1ec1u th\u1ea5p (25 mg \/ ng\u00e0y) d\u00f9ng cho 61 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 thi\u1ec3u ni\u1ec7u trong 8 th\u00e1ng, 11 b\u1ec7nh nh\u00e2n \u0111\u00e3 ng\u1eebng s\u1eed d\u1ee5ng v\u00ec t\u00e1c d\u1ee5ng ph\u1ee5 (t\u00e1c d\u1ee5ng ph\u1ee5 kh\u00e1c kh\u00f4ng ph\u1ea3i t\u0103ng kali m\u00e1u) v\u00e0 n\u1ed3ng \u0111\u1ed9 kali t\u0103ng t\u1ed5ng th\u1ec3 (4,6 \u0111\u1ebfn 5,0 mEq\/l) ; tuy nhi\u00ean kh\u00f4ng c\u00f3 b\u1ec7nh nh\u00e2n n\u00e0o c\u00f3 kali&gt; 6,8 mEq\/l ho\u1eb7c c\u1ea7n d\u00f9ng li\u1ec7u ph\u00e1p nh\u1ef1a trao \u0111\u1ed5i ion (38). M\u1eb7c d\u00f9 c\u00e1c nghi\u00ean c\u1ee9u n\u00e0y cho th\u1ea5y thu\u1ed1c \u0111\u1ed1i kh\u00e1ng aldosteron c\u00f3 th\u1ec3 t\u01b0\u01a1ng \u0111\u1ed1i an to\u00e0n nh\u01b0ng c\u1ea7n nghi\u00ean c\u1ee9u s\u00e2u h\u01a1n \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n<p>Thu\u1ed1c \u1ee9c ch\u1ebf renin<\/p>\n<p>Aliskiren thu\u1ed9c nh\u00f3m thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p m\u1edbi v\u00e0 \u1ee9c ch\u1ebf qu\u00e1 tr\u00ecnh chuy\u1ec3n angiotensinogen th\u00e0nh angiotensin I (v\u00e0 do \u0111\u00f3 l\u00e0m gi\u1ea3m s\u1ef1 h\u00ecnh th\u00e0nh angiontensin II) b\u1eb1ng c\u00e1ch \u1ee9c ch\u1ebf tr\u1ef1c ti\u1ebfp renin. Do \u0111\u00f3, c\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf renin ng\u0103n ch\u1eb7n c\u00e1c t\u00e1c d\u1ee5ng x\u1ea5u c\u1ee7a angiotensin II m\u00e0 kh\u00f4ng l\u00e0m t\u0103ng n\u1ed3ng \u0111\u1ed9 renin. Thu\u1ed1c n\u00e0y h\u1ee9a h\u1eb9n l\u00e0m c\u1ea3i thi\u1ec7n t\u00ecnh tr\u1ea1ng th\u1eadn \u1edf b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh v\u00e0 b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng (39). Aliskiren \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a \u1edf gan v\u00e0 \u0111\u00e0o th\u1ea3i qua th\u1eadn. Thu\u1ed1c n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, do \u0111\u00f3 c\u0169ng ch\u01b0a r\u00f5 li\u1ec7u n\u00f3 c\u00f3 b\u1ecb th\u1ea9m t\u00e1ch hay kh\u00f4ng. V\u00ec v\u1eady, vai tr\u00f2 c\u1ee7a thu\u1ed1c m\u1edbi n\u00e0y \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh khi c\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e1nh gi\u00e1 hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 an to\u00e0n c\u1ee7a n\u00f3 ch\u01b0a \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n cho \u0111\u1ebfn nay.<\/p>\n<h3>Thu\u1ed1c ch\u1eb9n beta- adrenergic<\/h3>\n<p>Thu\u1ed1c ch\u1eb9n beta- adrenergic l\u00e0 thu\u1ed1c quan tr\u1ecdng trong ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 l\u00e0 l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u \u1edf b\u1ec7nh nh\u00e2n m\u1edbi m\u1eafc h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p (15). Ngo\u00e0i ra, c\u00e1c thu\u1ed1c n\u00e0y n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t, gi\u1ed1ng nh\u01b0 thu\u1ed1c \u1ee9c ch\u1ebf RAAS, l\u00e0 thu\u1ed1c n\u00ean \u01b0u ti\u00ean d\u00f9ng cho b\u1ec7nh nh\u00e2n suy tim. Trong m\u1ed9t nghi\u00ean c\u1ee9u nh\u1ecf tr\u00ean 8 b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 t\u0103ng huy\u1ebft \u00e1p, d\u00f9ng atenolol sau ch\u1ea1y th\u1eadn (d\u00f9ng thu\u1ed1c d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t tr\u1ef1c ti\u1ebfp 3 l\u1ea7n\/tu\u1ea7n) gi\u00fap h\u1ea1 huy\u1ebft \u00e1p t\u00e2m thu tr\u00ean holter 24h g\u1ea7n 17 mmHg (t\u1eeb 144\/80 xu\u1ed1ng 127\/69 mmHg) v\u00e0 kh\u00f4ng l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 t\u1ef7 l\u1ec7 t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u ho\u1eb7c t\u0103ng kali m\u00e1u (40). C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 c\u1ea7n l\u01b0u \u00fd g\u1ed3m: ch\u1eadm nh\u1ecbp tim, r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng, m\u1ec7t m\u1ecfi v\u00e0 c\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 chuy\u1ec3n ho\u00e1 lipid v\u00e0 glucose. \u1ede b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, thu\u1ed1c ch\u1eb9n beta-adrenergic kh\u00f4ng ch\u1ecdn l\u1ecdc (nh\u01b0 propranolol v\u00e0 nadolol) c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u0103ng kali m\u00e1u do v\u1eadn \u0111\u1ed9ng g\u1eafng s\u1ee9c ho\u1eb7c nh\u1ecbn \u0103n c\u00f2n thu\u1ed1c ch\u1eb9n beta-adrenergic c\u00f3 ch\u1ecdn l\u1ecdc (nh\u01b0 metoprolol) th\u00ec kh\u00f4ng g\u00e2y n\u00ean t\u00ecnh tr\u1ea1ng tr\u00ean. Nh\u00ecn chung, thu\u1ed1c ch\u1eb9n beta-adrenergic c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 dung n\u1ea1p kh\u00e1 t\u1ed1t \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u cho th\u1ea5y vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m c\u00f3 th\u1ec3 c\u1ea3i thi\u1ec7n bi\u1ebfn c\u1ed1 tim m\u1ea1ch \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. Trong m\u1ed9t ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p tr\u00ean 2.550 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, vi\u1ec7c s\u1eed d\u1ee5ng thu\u1ed1c ch\u1eb9n beta-adrenergic \u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ti\u1ec1n s\u1eed suy tim l\u00e0m gi\u1ea3m nguy c\u01a1 m\u1eafc suy tim m\u1edbi, t\u1eed vong do b\u1ec7nh tim v\u00e0 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n. Tuy nhi\u00ean, trong nh\u00f3m k\u1ec3 tr\u00ean ch\u1ec9 c\u00f3 20% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng thu\u1ed1c n\u00e0y (43). Foley v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ph\u00e2n t\u00edch trong 1 ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p tr\u00ean 11142 b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o (c\u00f3 th\u00f4ng tin trong h\u1ec7 th\u1ed1ng d\u1eef li\u1ec7u th\u1eadn Hoa K\u1ef3) \u0111\u00e3 x\u00e1c \u0111\u1ecbnh ch\u1ec9 8,5% s\u1ed1 b\u1ec7nh nh\u00e2n n\u00e0y \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n thu\u1ed1c ch\u1eb9n beta- adrenergic nh\u01b0ng l\u1ea1i l\u00e0m gi\u1ea3m \u0111\u1ebfn 16% nguy c\u01a1 t\u1eed vong sau hi\u1ec7u ch\u1ec9nh (44). H\u01a1n n\u1eefa 2 ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p cho th\u1ea5y vi\u1ec7c d\u00f9ng thu\u1ed1c ch\u1eb9n beta-adrenergic c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c l\u00e0m gi\u1ea3m nguy c\u01a1 t\u1eed vong sau ng\u1eebng tim v\u00e0 nh\u1ed3i m\u00e1u c\u01a1 tim c\u1ea5p (26, 28).<\/p>\n<p>C\u00e1c thu\u1ed1c ch\u1eb9n beta-adrenergic tan trong n\u01b0\u1edbc nh\u01b0 atenolol v\u00e0 metoprolol c\u00f3 th\u1ec3 b\u1ecb th\u1ea9m t\u00e1ch v\u00e0 c\u1ea7n d\u00f9ng b\u1ed5 sung \u0111\u1ec3 tr\u00e1nh c\u01a1n lo\u1ea1n nh\u1ecbp tim sau l\u1ecdc m\u00e1u (B\u1ea3ng 2). Metoprolol \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a ch\u1ee7 y\u1ebfu \u1edf gan, do \u0111\u00f3 kh\u00f4ng c\u1ea7n \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u trong khi atenolol \u0111\u00e0o th\u1ea3i ch\u1ee7 y\u1ebfu qua th\u1eadn n\u00ean k\u00e9o d\u00e0i th\u1eddi gian b\u00e1n th\u1ea3i c\u1ee7a thu\u1ed1c \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o. Tuy nhi\u00ean b\u1ec7nh nh\u00e2n kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 cho d\u00f9ng atenolol (d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t tr\u1ef1c ti\u1ebfp) sau ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p gi\u1eefa c\u00e1c l\u1ea7n l\u1ecdc hi\u1ec7u qu\u1ea3 (40).<\/p>\n<p>Trong khi atenolol c\u00f3 th\u1ec3 hi\u1ec7u qu\u1ea3 v\u1edbi b\u1ec7nh nh\u00e2n kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb th\u00ec nh\u1eefng thu\u1ed1c \u1ee9c ch\u1ebf ch\u1ecdn l\u1ecdc beta-1-adrenergic nh\u01b0 metoprolol v\u00e0 k\u1ebft h\u1ee3p thu\u1ed1c ch\u1eb9n alpha v\u00e0 beta nh\u01b0 carvediol n\u00ean \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn v\u00ec kh\u1ea3 n\u0103ng b\u1ea3o v\u1ec7 tim m\u1ea1ch, \u0111\u1eb7c bi\u1ec7t \u1edf b\u1ec7nh nh\u00e2n suy tim (45-47).<\/p>\n<h3>Thu\u1ed1c ch\u1eb9n alpha-beta k\u1ebft h\u1ee3p<\/h3>\n<p>Thu\u1ed1c ch\u1eb9n alpha-beta k\u1ebft h\u1ee3p ng\u00e0y c\u00e0ng tr\u1edf n\u00ean ph\u1ed5 bi\u1ebfn \u0111\u1ec3 s\u1eed d\u1ee5ng cho b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o v\u00ec t\u00ednh hi\u1ec7u qu\u1ea3, chi ph\u00ed th\u1ea5p v\u00e0 c\u00f3 l\u1ee3i cho b\u1ec7nh nh\u00e2n m\u1eafc c\u01a1 tim gi\u00e3n. Trong 1 th\u1eed nghi\u1ec7m nh\u1ecf ng\u1eabu nhi\u00ean \u1edf b\u1ec7nh nh\u00e2n d\u00f9ng carvediol so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c, carvediol h\u1ea1 huy\u1ebft \u00e1p t\u00e2m thu g\u1ea7n 11 mmHg (t\u1eeb 134\/75 xu\u1ed1ng 123\/67 mmHg sau 12 th\u00e1ng). M\u1ed9t l\u01b0u \u00fd l\u00e0 th\u1eed nghi\u1ec7m n\u00e0y c\u00f3 t\u1ef7 l\u1ec7 b\u1ecf cu\u1ed9c kh\u00e1 cao do kh\u00f4ng dung n\u1ea1p thu\u1ed1c v\u1edbi c\u00e1c nguy\u00ean nh\u00e2n: t\u1ee5t huy\u1ebft \u00e1p, co th\u1eaft ph\u1ebf qu\u1ea3n v\u00e0 ch\u1eadm nh\u1ecbp tim (20% \u1edf nh\u00f3m d\u00f9ng carvediol so v\u1edbi 13% \u1edf nh\u00f3m gi\u1ea3 d\u01b0\u1ee3c). Ngo\u00e0i ra, carvediol v\u00e0 labetolol \u0111\u1ec1u l\u00e0 ch\u1ea5t \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3 beta-adrenergic kh\u00f4ng ch\u1ecdn l\u1ecdc v\u00e0 v\u1ec1 l\u00fd thuy\u1ebft, c\u00f3 th\u1ec3 l\u00e0m t\u0103ng nguy c\u01a1 t\u0103ng kali m\u00e1u khi \u0111\u00f3i, tr\u01b0\u1edbc l\u1ecdc gi\u1ed1ng nh\u01b0 propanolol v\u00e0 nadolol. Tuy nhi\u00ean, m\u1ed9t nghi\u00ean c\u1ee9u nh\u1ecf, thi\u1ebft k\u1ebf b\u1eaft ch\u00e9o so s\u00e1nh carvedilol v\u1edbi gi\u1ea3 d\u01b0\u1ee3c \u1edf 17 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o cho th\u1ea5y carvedilol kh\u00f4ng g\u00e2y ra t\u0103ng kali m\u00e1u sau luy\u1ec7n t\u1eadp g\u1eafng s\u1ee9c (48). Do \u0111\u00f3, c\u00e1c thu\u1ed1c ch\u1eb9n alpha-beta k\u1ebft h\u1ee3p l\u00e0 m\u1ed9t l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o m\u1eb7c d\u00f9 ph\u1ea3i l\u01b0u \u00fd \u1ea3nh h\u01b0\u1edfng ti\u1ec1m t\u00e0ng \u0111\u1ed1i v\u1edbi kali m\u00e1u.<\/p>\n<p>Trong 1 th\u1eed nghi\u1ec7m nh\u1ecf \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o b\u1ecb suy tim, carvediol \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u1ea3i thi\u1ec7n c\u00e1c ti\u00eau ch\u00ed tim m\u1ea1ch. Trong nghi\u00ean c\u1ee9u n\u00e0y, 132 b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 NYHA II ho\u1eb7c III \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m d\u00f9ng carvediol ho\u1eb7c gi\u1ea3 d\u01b0\u1ee3c r\u1ed3i theo d\u00f5i trong 12 th\u00e1ng v\u1edbi ti\u00eau ch\u00ed ch\u00ednh l\u00e0 s\u1ef1 thay \u0111\u1ed5i th\u1ec3 t\u00edch th\u1ea5t tr\u00e1i (LV) (B\u1ea3ng 1). Sau 12 th\u00e1ng, carvedilol \u0111\u00e3 gi\u1ea3m th\u1ec3 t\u00edch th\u1ea5t tr\u00e1i v\u00e0 gi\u00fap c\u1ea3i thi\u1ec7n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i v\u00e0 t\u00ecnh tr\u1ea1ng l\u00e2m s\u00e0ng khi so s\u00e1nh v\u1edbi gi\u1ea3 d\u01b0\u1ee3c (49). Theo d\u00f5i th\u00eam sau khi ho\u00e0n th\u00e0nh nghi\u00ean c\u1ee9u, c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng carvedilol gi\u1ea3m t\u1ef7 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n c\u0169ng nh\u01b0 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch kh\u00e1c (46).<\/p>\n<p>C\u00e1c thu\u1ed1c ch\u1eb9n alpha-beta (labetolol v\u00e0 carvedilol) kh\u00f4ng \u0111\u01b0\u1ee3c l\u1ecdc ho\u00e0n to\u00e0n kh\u1ecfi m\u00e1u v\u00e0 do \u0111\u00f3 kh\u00f4ng c\u1ea7n d\u00f9ng th\u00eam li\u1ec1u sau ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n<p>Li\u1ec1u d\u00f9ng c\u1ee7a c\u00e1c thu\u1ed1c ch\u1eb9n alpha-beta k\u1ebft h\u1ee3p th\u01b0\u1eddng l\u00e0 2 l\u1ea7n\/ng\u00e0y, tuy nhi\u00ean nay \u0111\u00e3 c\u00f3 lo\u1ea1i m\u1edbi h\u01a1n d\u00f9ng 1 l\u1ea7n\/ng\u00e0y (v\u00ed d\u1ee5, Coreg CR) v\u00e0 t\u1ed1t nh\u1ea5t n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb th\u01b0\u1eddng xuy\u00ean.<\/p>\n<h3>Thu\u1ed1c ch\u1eb9n k\u00eanh calci<\/h3>\n<p>Thu\u1ed1c ch\u1eb9n k\u00eanh calci (CCB) c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m huy\u1ebft \u00e1p hi\u1ec7u qu\u1ea3 \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 b\u1ec7nh nh\u00e2n b\u1ecb ph\u00f9 (50). M\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng g\u1ea7n \u0111\u00e2y \u0111\u00e3 cho th\u1ea5y amlodipin (CCB nh\u00f3m dihydropyridin) h\u1ea1 huy\u1ebft \u00e1p t\u00e2m thu g\u1ea7n 10 mmHg m\u00e0 kh\u00f4ng t\u0103ng nguy c\u01a1 t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc so v\u1edbi gi\u1ea3 d\u01b0\u1ee3c (t\u01b0\u01a1ng \u1ee9ng 7% so v\u1edbi 13%) (52). CCB nh\u00f3m dihydropyridin (v\u00ed d\u1ee5 g\u1ed3m amlodipin, felodipin v\u00e0 nicardipin) l\u00e0 nh\u1eefng thu\u1ed1c \u1ee9c ch\u1ebf \u01b0u ti\u00ean k\u00eanh calci t\u1ea1i c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u, do \u0111\u00f3 gi\u1ea3m \u0111\u01b0\u1ee3c s\u1ee9c c\u1ea3n m\u1ea1ch m\u00e1u to\u00e0n th\u00e2n. CCB kh\u00f4ng ph\u1ea3i nh\u00f3m dihyropyridin (diltiazem v\u00e0 verapamil) t\u00e1c \u0111\u1ed9ng \u01b0u ti\u00ean tr\u00ean c\u01a1 tim v\u00e0 khi ph\u1ed1i h\u1ee3p nh\u00f3m n\u00e0y v\u1edbi thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m c\u1ea7n l\u01b0u \u00fd t\u00e1c d\u1ee5ng hi\u1ec7p \u0111\u1ed3ng \u1ee9c ch\u1ebf co b\u00f3p c\u01a1 tim v\u00e0 t\u0103ng nguy c\u01a1 ch\u1eadm nh\u1ecbp tim v\u00e0 \u1ee9c ch\u1ebf d\u1eabn truy\u1ec1n (51).<\/p>\n<p>Hai ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u cho th\u1ea5y CCB l\u00e0m gi\u1ea3m t\u1ec9 l\u1ec7 t\u1eed vong \u1edf b\u1ec7nh nh\u00e2n th\u1eadn nh\u00e2n t\u1ea1o (52, 53). Tuy nhi\u00ean, m\u1ed9t th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng nh\u1ecf so s\u00e1nh CCB (nitrendipin) v\u1edbi ACE-I (perindopril) l\u1ea1i cho k\u1ebft qu\u1ea3 r\u1eb1ng CCB kh\u00f4ng l\u00e0m gi\u1ea3m ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i m\u1eb7c d\u00f9 hi\u1ec7u qu\u1ea3 h\u1ea1 huy\u1ebft \u00e1p t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi ACE-I (B\u1ea3ng 1) (54). Tepel v\u00e0 c\u1ed9ng s\u1ef1 g\u1ea7n \u0111\u00e2y \u0111\u00e3 c\u00f4ng b\u1ed1 k\u1ebft qu\u1ea3 c\u1ee7a m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng, so s\u00e1nh amlodipin v\u1edbi gi\u1ea3 d\u01b0\u1ee3c tr\u00ean 251 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o c\u00f3 t\u0103ng huy\u1ebft \u00e1p. Ti\u00eau ch\u00ed ch\u00ednh l\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n v\u1edbi ti\u00eau ch\u00ed ph\u1ee5 l\u00e0 \u0111\u00e1nh gi\u00e1 k\u1ebft h\u1ee3p t\u1ec9 l\u1ec7 t\u1eed vong do m\u1ecdi nguy\u00ean nh\u00e2n v\u00e0 bi\u1ebfn c\u1ed1 tim m\u1ea1ch. Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 t\u1eed l\u1ec7 t\u1eed vong chung sau 30 th\u00e1ng \u1edf c\u1ea3 2 nh\u00f3m, nh\u01b0ng amlodipin l\u00e0m gi\u1ea3m r\u00f5 r\u1ec7t khi \u0111\u00e1nh gi\u00e1 ti\u00eau ch\u00ed ph\u1ee5 ph\u1ed1i h\u1ee3p gi\u1eefa t\u1ec9 l\u1ec7 t\u1eed vong do chung v\u00e0 bi\u1ebfn c\u1ed1 tim m\u1ea1ch (51).<\/p>\n<p>Thu\u1ed1c ch\u1eb9n k\u00eanh calci kh\u00f4ng \u0111\u01b0\u1ee3c lo\u1ea1i b\u1ecf b\u1eb1ng th\u1ea9m t\u00e1ch m\u00e1u v\u00e0 do \u0111\u00f3 kh\u00f4ng c\u1ea7n d\u00f9ng th\u00eam li\u1ec1u sau l\u1ecdc (B\u1ea3ng 2). Ngo\u00e0i ra, li\u1ec1u d\u00f9ng 1 l\u1ea7n\/ng\u00e0y c\u1ee7a h\u1ea7u h\u1ebft CCB l\u00e0 ph\u00f9 h\u1ee3p \u0111\u1ec3 s\u1eed d\u1ee5ng v\u1edbi b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n<h3>Thu\u1ed1c ch\u1eb9n alpha-adrenergic<\/h3>\n<p>Thu\u1ed1c ch\u1eb9n alpha-adrenergic nh\u01b0 doxazosin, prazosin v\u00e0 terazosin \u00edt \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng xuy\u00ean \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p sau khi k\u1ebft qu\u1ea3 c\u1ee7a nghi\u00ean c\u1ee9u ALLHAT \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 (55). \u1ede nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 t\u0103ng huy\u1ebft \u00e1p \u0111\u01b0\u1ee3c ph\u00e2n ng\u1eabu nhi\u00ean v\u00e0o nh\u00f3m d\u00f9ng doxazosin \u0111\u1ec3 so s\u00e1nh v\u1edbi l\u1ee3i ti\u1ec3u trong nghi\u00ean c\u1ee9u ALLHAT, th\u00ec t\u1ef7 l\u1ec7 bi\u1ebfn c\u1ed1 tim m\u1ea1ch cao h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng doxazosin. Tuy nhi\u00ean, \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o c\u1ea7n s\u1eed d\u1ee5ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p, nh\u1eefng thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng m\u1ed9t c\u00e1ch an to\u00e0n v\u00e0 kh\u00f4ng c\u1ea7n d\u00f9ng th\u00eam li\u1ec1u sau khi ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. \u0110\u1ed1i v\u1edbi c\u00e1c d\u1ea1ng b\u00e0o ch\u1ebf t\u00e1c d\u1ee5ng k\u00e9o d\u00e0i, li\u1ec1u d\u00f9ng bu\u1ed5i t\u1ed1i \u0111\u01b0\u1ee3c \u01b0u ti\u00ean \u0111\u1ec3 gi\u1ea3m thi\u1ec3u h\u1ea1 huy\u1ebft \u00e1p t\u01b0 th\u1ebf \u0111\u1ee9ng. Nh\u1eefng thu\u1ed1c n\u00e0y n\u00ean tr\u00e1nh d\u00f9ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc v\u00e0 kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p v\u1edbi midodrin v\u00ec t\u00e1c d\u1ee5ng \u0111\u1ed1i kh\u00e1ng c\u1ee7a n\u00f3 tr\u00ean receptor alpha adrenergic.<\/p>\n<h3>Ch\u1ea5t ch\u1ee7 v\u1eadn giao c\u1ea3m<\/h3>\n<p>C\u00e1c ch\u1ea5t ch\u1ee7 v\u1eadn giao c\u1ea3m tr\u00ean h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng, nh\u01b0 methyldopa, guanabenz, guanfacin v\u00e0 clonidin, \u00edt \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p v\u00ec t\u1ef7 l\u1ec7 t\u00e1c d\u1ee5ng ph\u1ee5 cao. Nh\u1eefng t\u00e1c d\u1ee5ng ph\u1ee5 n\u00e0y bao g\u1ed3m kh\u00f4 mi\u1ec7ng, r\u1ed1i lo\u1ea1n c\u01b0\u01a1ng d\u01b0\u01a1ng, m\u1ec7t m\u1ecfi v\u00e0 t\u0103ng huy\u1ebft \u00e1p d\u1ed9i ng\u01b0\u1ee3c. Clonidin l\u00e0 ch\u1ea5t ch\u1ee7 v\u1eadn giao c\u1ea3m ch\u00ednh v\u1eabn \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u1edbi b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ng\u01b0\u1eddi kh\u00f3 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p v\u00e0 nh\u1eefng ng\u01b0\u1eddi b\u1ecb t\u0103ng huy\u1ebft \u00e1p \u0111\u00e1ng k\u1ec3 trong qu\u00e1 tr\u00ecnh ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. M\u1ed9t s\u1ed1 b\u00e1c s\u0129 chuy\u00ean khoa th\u1eadn nh\u1eadn th\u1ea5y mi\u1ebfng d\u00e1n clonidin c\u00f3 hi\u1ec7u qu\u1ea3 v\u00e0 dung n\u1ea1p t\u1ed1t m\u00e0 kh\u00f4ng ph\u1ea3i d\u00f9ng li\u1ec1u th\u01b0\u1eddng xuy\u00ean nh\u01b0 thu\u1ed1c \u0111\u01b0\u1eddng u\u1ed1ng (56). M\u1eb7c d\u00f9 mi\u1ebfng d\u00e1n clonidin \u0111\u01b0\u1ee3c m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n \u01b0a d\u00f9ng, nh\u01b0ng ch\u00fang kh\u00f4ng hi\u1ec7u qu\u1ea3 ho\u00e0n to\u00e0n v\u00e0 m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u1ea3m th\u1ea5y kh\u00f3 gi\u1eef ch\u00fang trong khi ho\u1ea1t \u0111\u1ed9ng g\u1eafng s\u1ee9c v\u00e0 khi t\u1eafm.<\/p>\n<h3>Thu\u1ed1c gi\u00e3n m\u1ea1ch tr\u1ef1c ti\u1ebfp<\/h3>\n<p>Hydralazin v\u00e0 isosorbid dinitrat l\u00e0 nh\u1eefng thu\u1ed1c gi\u00e3n m\u1ea1ch m\u1ea1nh v\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c h\u1ea1 huy\u1ebft \u00e1p \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng tr\u1ecb. Hydralazin k\u1ebft h\u1ee3p v\u1edbi c\u00e1c thu\u1ed1c nh\u00f3m nitrat s\u1eed d\u1ee5ng th\u00eam trong \u0111i\u1ec1u tr\u1ecb ti\u00eau chu\u1ea9n (bao g\u1ed3m thu\u1ed1c ch\u1eb9n ACE-I v\u00e0 ch\u1eb9n beta giao c\u1ea3m) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u1ea3i thi\u1ec7n k\u1ebft qu\u1ea3 \u1edf b\u1ec7nh nh\u00e2n ng\u01b0\u1eddi M\u1ef9 g\u1ed1c Phi b\u1ecb suy tim (57). Tuy nhi\u00ean, s\u1ef1 k\u1ebft h\u1ee3p thu\u1ed1c n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. Trong khi s\u1ef1 k\u1ebft h\u1ee3p thu\u1ed1c n\u00e0y c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3, \u0111i\u1ec3m h\u1ea1n ch\u1ebf l\u1edbn nh\u1ea5t l\u00e0 li\u1ec1u d\u00f9ng 3 l\u1ea7n m\u1ed7i ng\u00e0y v\u00e0 ph\u1ea3i d\u00f9ng \u00edt nh\u1ea5t l\u00e0 6 vi\u00ean thu\u1ed1c m\u1ed9t ng\u00e0y. Do \u0111\u00f3, \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u00e3 \u0111\u01b0\u1ee3c k\u00ea thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p v\u00e0 ch\u1ea5t k\u1ebft d\u00ednh ph\u1ed1t pho kh\u00e1c, ch\u1ebf \u0111\u1ed9 li\u1ec1u n\u00e0y l\u00e0 kh\u00f4ng th\u1ef1c t\u1ebf. Hydralazin kh\u00f4ng b\u1ecb lo\u1ea1i b\u1ecf b\u1eb1ng th\u1ea9m t\u00e1ch m\u00e1u, nh\u01b0ng isosorbid dinitrate th\u00ec b\u1ecb lo\u1ea1i b\u1ecf trong qu\u00e1 tr\u00ecnh th\u1ea9m t\u00e1ch m\u00e1u v\u00e0 c\u1ea7n th\u00eam li\u1ec1u khi l\u1ecdc m\u00e1u (B\u1ea3ng 2). Do ph\u1ea3n x\u1ea1 k\u00edch th\u00edch c\u1ee7a h\u1ec7 th\u1ea7n kinh giao c\u1ea3m khi d\u00f9ng thu\u1ed1c gi\u00e3n m\u1ea1ch, nh\u1eefng thu\u1ed1c n\u00e0y n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ed3ng th\u1eddi v\u1edbi thu\u1ed1c ch\u1eb9n beta giao c\u1ea3m \u0111\u1ec3 tr\u00e1nh nh\u1ecbp tim nhanh. C\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5 ch\u1ee7 y\u1ebfu c\u1ee7a hydralazin l\u00e0 gi\u1eef n\u01b0\u1edbc (\u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng l\u1ecdc m\u00e1u) v\u00e0 \u00edt g\u1eb7p h\u01a1n l\u00e0 h\u1ed9i ch\u1ee9ng gi\u1ed1ng lupus do thu\u1ed1c bao g\u1ed3m \u0111au kh\u1edbp, \u0111au c\u01a1, s\u01b0ng kh\u1edbp, vi\u00eam m\u00e0ng ngo\u00e0i tim\/vi\u00eam m\u00e0ng ph\u1ed5i, ph\u00e1t ban ho\u1eb7c s\u1ed1t.<\/p>\n<p>Minoxidil l\u00e0 thu\u1ed1c gi\u00e3n m\u1ea1ch m\u1ea1nh h\u01a1n hydralazin v\u00e0 \u0111\u01b0\u1ee3c d\u00e0nh ri\u00eang cho nh\u1eefng b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p kh\u00f4ng \u0111\u00e1p \u1ee9ng v\u1edbi c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c kh\u00e1c. L\u1ee3i \u00edch c\u1ee7a minoxidil so v\u1edbi hydralazin\/thu\u1ed1c nh\u00f3m nitrat l\u00e0 li\u1ec1u d\u00f9ng thu\u1ed1c 1-2 l\u1ea7n\/ng\u00e0y (B\u1ea3ng 2). M\u1eb7c d\u00f9 minoxidil kh\u00e1 hi\u1ec7u qu\u1ea3 v\u00e0 kh\u00f4ng b\u1ecb lo\u1ea1i b\u1ecf ho\u00e0n to\u00e0n b\u1eb1ng th\u1ea9m t\u00e1ch m\u00e1u, nh\u01b0ng t\u00ecnh tr\u1ea1ng \u1ee9 d\u1ecbch \u0111\u00e1ng k\u1ec3 bao g\u1ed3m tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i v\u00e0 m\u00e0ng ngo\u00e0i tim c\u00f3 th\u1ec3 x\u1ea3y ra trong qu\u00e1 tr\u00ecnh tr\u1ecb li\u1ec7u v\u00e0 c\u00f3 th\u1ec3 ph\u1ea3i ng\u1eebng thu\u1ed1c n\u1ebfu kh\u00f4ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t b\u1eb1ng l\u1ecdc m\u00e1u.<\/p>\n<h3>Thu\u1ed1c l\u1ee3i ti\u1ec3u<\/h3>\n<p>Thu\u1ed1c l\u1ee3i ti\u1ec3u kh\u00f4ng \u0111\u01b0\u1ee3c d\u00f9ng th\u01b0\u1eddng xuy\u00ean \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o. M\u1ed9t nghi\u00ean c\u1ee9u nh\u1eadn \u0111\u1ecbnh t\u1ec9 l\u1ec7 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c l\u1ee3i ti\u1ec3u trong 30 ng\u00e0y \u0111\u1ea7u \u0111\u00e3 gi\u1ea3m t\u1eeb 32% th\u1eddi \u0111i\u1ec3m \u0111\u1ea7u nghi\u00ean c\u1ee9u xu\u1ed1ng c\u00f2n 10% sau 2 n\u0103m (58). Trong m\u1ed9t ph\u00e2n t\u00edch th\u1ee9 c\u1ea5p tr\u00ean 16.420 b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o, s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u l\u00e0m gi\u1ea3m t\u0103ng c\u00e2n gi\u1eefa c\u00e1c l\u1ea7n ch\u1ea1y th\u1eadn v\u00e0 gi\u1ea3m nguy c\u01a1 t\u1eed vong do b\u1ec7nh tim, tuy nhi\u00ean k\u1ebft qu\u1ea3 n\u00e0y c\u00f3 th\u1ec3 do y\u1ebfu t\u1ed1 nhi\u1ec5u khi m\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh d\u00f9ng l\u1ee3i ti\u1ec3u c\u00f3 ch\u1ee9c n\u0103ng th\u1eadn t\u1ed1t h\u01a1n. Tuy nhi\u00ean, k\u1ebft qu\u1ea3 n\u00e0y \u1ee7ng h\u1ed9 c\u00e1c kinh nghi\u1ec7m l\u00e2m s\u00e0ng l\u00e0 \u1edf m\u1ed9t s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f2n ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 v\u1eabn ti\u1ec3u ti\u1ec7n \u0111\u01b0\u1ee3c, thu\u1ed1c l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 h\u1eefu \u00edch trong vi\u1ec7c ki\u1ec3m so\u00e1t t\u0103ng c\u00e2n gi\u1eefa c\u00e1c l\u1ea7n ch\u1ea1y th\u1eadn v\u00e0 huy\u1ebft \u00e1p m\u00e0 kh\u00f4ng c\u1ea7n thi\u1ebft ph\u1ea3i d\u1eebng thu\u1ed1c khi b\u1eaft \u0111\u1ea7u ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o.<\/p>\n<h3>Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng endothelin- 1<\/h3>\n<p>C\u00e1c b\u1eb1ng ch\u1ee9ng cho th\u1ea5y ch\u1ea5t co m\u1ea1ch nh\u01b0 endothelin c\u00f3 vai tr\u00f2 trong sinh b\u1ec7nh h\u1ecdc c\u1ee7a t\u0103ng huy\u1ebft \u00e1p (59). Endothelin (ET) g\u00e2y co m\u1ea1ch b\u1eb1ng c\u00e1ch g\u1eafn v\u00e0 k\u00edch ho\u1ea1t th\u1ee5 th\u1ec3 ETA \u1edf c\u00e1c t\u1ebf b\u00e0o c\u01a1 tr\u01a1n m\u1ea1ch m\u00e1u (60). Hi\u1ec7u qu\u1ea3 co m\u1ea1ch n\u00e0y b\u1ecb gi\u1edbi h\u1ea1n b\u1edfi endothelin c\u0169ng g\u1eafn v\u1edbi th\u1ee5 th\u1ec3 ETB tr\u00ean c\u00e1c t\u1ebf b\u00e0o n\u1ed9i m\u00f4, l\u00e0m gi\u1ea3i ph\u00f3ng nitric oxide \u2013 l\u00e0 ch\u1ea5t trung gian ho\u00e1 h\u1ecdc g\u00e2y gi\u00e3n m\u1ea1ch (61).<\/p>\n<p>Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, m\u1ed9t s\u1ed1 ch\u1ea5t \u0111\u1ed1i kh\u00e1ng v\u1edbi th\u1ee5 th\u1ec3 endothelin \u0111\u00e3 \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n v\u00e0 \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng v\u1ec1 t\u0103ng huy\u1ebft \u00e1p nguy\u00ean ph\u00e1t. Trong m\u1ed9t th\u1eed nghi\u1ec7m so s\u00e1nh hi\u1ec7u qu\u1ea3 c\u1ee7a bosentan, m\u1ed9t ch\u1ea5t \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 ETA\/ETB kh\u00f4ng ch\u1ecdn l\u1ecdc, v\u1edbi thu\u1ed1c ACE-I v\u00e0 gi\u1ea3 d\u01b0\u1ee3c \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p nguy\u00ean ph\u00e1t, bosentin c\u00f3 hi\u1ec7u qu\u1ea3 t\u01b0\u01a1ng \u0111\u01b0\u01a1ng ACE-I trong \u0111i\u1ec1u tr\u1ecb huy\u1ebft \u00e1p (62). Darusentan, thu\u1ed1c \u0111\u1ed1i kh\u00e1ng ch\u1ecdn l\u1ecdc ETA, \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 c\u00f3 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c h\u1ea1 huy\u1ebft \u00e1p trong 2 th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng giai \u0111o\u1ea1n II \u1edf b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p nguy\u00ean ph\u00e1t v\u00e0 t\u0103ng huy\u1ebft \u00e1p kh\u00e1ng thu\u1ed1c (63,64).<\/p>\n<p>M\u1eb7c d\u00f9 thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 ET th\u01b0\u1eddng dung n\u1ea1p t\u1ed1t trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, nh\u01b0ng t\u00e1c d\u1ee5ng ph\u1ee5 ch\u1ee7 y\u1ebfu l\u00e0 ph\u00f9 ngo\u1ea1i bi\u00ean, gi\u1ea3m hemoglobin nh\u1eb9 (\u0111\u01b0\u1ee3c cho l\u00e0 c\u00f3 li\u00ean quan \u0111\u1ebfn pha lo\u00e3ng m\u00e1u th\u1ee9 ph\u00e1t do t\u0103ng d\u1ecbch ngo\u1ea1i b\u00e0o), \u0111au \u0111\u1ea7u v\u00e0 hi\u1ec7n t\u01b0\u1ee3ng b\u1ed1c ho\u1ea3. V\u00ec c\u00e1c thu\u1ed1c n\u00e0y ch\u1ee7 y\u1ebfu \u0111\u01b0\u1ee3c chuy\u1ec3n h\u00f3a v\u00e0 \u0111\u00e0o th\u1ea3i \u1edf gan n\u00ean t\u00e1c d\u1ee5ng ph\u1ee5 \u0111\u00e1ng l\u01b0u \u00fd l\u00e0 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng gan, ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u v\u00e0 h\u1ed3i ph\u1ee5c ho\u00e0n to\u00e0n khi ng\u1eebng thu\u1ed1c.<\/p>\n<p>Vai tr\u00f2 c\u1ee7a thu\u1ed1c \u0111\u1ed1i kh\u00e1ng endothelin trong vi\u1ec7c ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh do nh\u1eefng thu\u1ed1c n\u00e0y ch\u01b0a \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m trong qu\u1ea7n th\u1ec3 b\u1ec7nh nh\u00e2n n\u00e0y. C\u00e1c thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 ET c\u00f3 th\u1ec3 c\u00f3 vai tr\u00f2 trong t\u0103ng huy\u1ebft \u00e1p do ESA. Thu\u1ed1c \u0111\u1ed1i kh\u00e1ng th\u1ee5 th\u1ec3 ETA ch\u1ecdn l\u1ecdc darusentan (LU 135252) (kh\u00f4ng ph\u1ea3i l\u00e0 thu\u1ed1c \u0111\u1ed1i kh\u00e1ng c\u1ea3 hai th\u1ee5 th\u1ec3 ETA v\u00e0 ETB nh\u01b0 bosentan) gi\u00fap h\u1ea1n ch\u1ebf t\u00ecnh tr\u1ea1ng n\u1eb7ng th\u00eam t\u0103ng huy\u1ebft \u00e1p \u1edf chu\u1ed9t suy th\u1eadn d\u00f9ng ESA (65).<\/p>\n<h2>K\u1ebft lu\u1eadn<\/h2>\n<p>T\u0103ng huy\u1ebft \u00e1p hay g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 th\u01b0\u1eddng kh\u00f3 ki\u1ec3m so\u00e1t. G\u00e1nh n\u1eb7ng tim m\u1ea1ch l\u00e0 kh\u00e1 cao \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y n\u00ean ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p l\u00e0 r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 c\u1ea3i thi\u1ec7n hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb (8). C\u00e1c bi\u1ec7n ph\u00e1p can thi\u1ec7p \u0111\u1ea7u tay \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p n\u00ean t\u1eadp trung v\u00e0o vi\u1ec7c h\u1ea1n ch\u1ebf natri, c\u00e2n b\u1eb1ng v\u1edbi l\u01b0\u1ee3ng natri b\u1ecb l\u1ecdc b\u1ecf trong qu\u00e1 tr\u00ecnh ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 \u0111\u1ea1t \u0111\u01b0\u1ee3c tr\u1ecdng l\u01b0\u1ee3ng th\u00edch h\u1ee3p. B\u00ean c\u1ea1nh c\u00e1c can thi\u1ec7p tr\u00ean, \u0111\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p m\u1ee5c ti\u00eau khi b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn 3 l\u1ea7n\/tu\u1ea7n th\u00ec c\u1ea7n d\u00f9ng th\u00eam c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb huy\u1ebft \u00e1p. C\u00e1c thu\u1ed1c h\u00e0ng \u0111\u1ea7u \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o l\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf RAAS (c\u00f3 th\u1ec3 l\u00e0 ACE-I ho\u1eb7c ARB) v\u00ec l\u1ee3i \u00edch \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn c\u1ee7a ch\u00fang tr\u00ean ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, v\u1eadn t\u1ed1c s\u00f3ng m\u1ea1ch v\u00e0 c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch. C\u00e1c thu\u1ed1c h\u00e0ng th\u1ee9 hai bao g\u1ed3m c\u00e1c thu\u1ed1c ch\u1eb9n beta (\u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n m\u1eafc b\u1ec7nh m\u1ea1ch v\u00e0nh), c\u00e1c thu\u1ed1c ch\u1eb9n c\u1ea3 alpha v\u00e0 beta \u1edf b\u1ec7nh nh\u00e2n suy tim, CCB v\u00e0 c\u00e1c thu\u1ed1c thay th\u1ebf nh\u01b0 thu\u1ed1c gi\u00e3n m\u1ea1ch tr\u1ef1c ti\u1ebfp. H\u1ea7u h\u1ebft b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u00f2i h\u1ecfi c\u1ea7n k\u1ebft h\u1ee3p c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p \u0111\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c huy\u1ebft \u00e1p m\u1ee5c ti\u00eau. C\u0169ng c\u1ea7n xem x\u00e9t t\u1edbi g\u00e1nh n\u1eb7ng s\u1eed d\u1ee5ng thu\u1ed1c \u1edf b\u1ec7nh nh\u00e2n v\u00e0 t\u1ef7 l\u1ec7 cao b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o kh\u00f4ng tu\u00e2n th\u1ee7 s\u1eed d\u1ee5ng thu\u1ed1c, v\u00ec v\u1eady n\u00ean s\u1eed d\u1ee5ng li\u1ec1u 1 l\u1ea7n\/ng\u00e0y (ho\u1eb7c 3 l\u1ea7n m\u1ed7i tu\u1ea7n) \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y. N\u00ean d\u00f9ng thu\u1ed1c h\u1ea1 huy\u1ebft \u00e1p v\u00e0o bu\u1ed5i t\u1ed1i n\u1ebfu d\u00f9ng li\u1ec1u 1 l\u1ea7n\/ng\u00e0y \u0111\u1ec3 ki\u1ec3m so\u00e1t t\u0103ng huy\u1ebft \u00e1p v\u1ec1 \u0111\u00eam \u1edf nhi\u1ec1u b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o v\u00e0 \u0111\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 t\u1ee5t huy\u1ebft \u00e1p trong qu\u00e1 tr\u00ecnh l\u1ecdc m\u00e1u. C\u00e1c thu\u1ed1c ch\u1ed1ng t\u0103ng huy\u1ebft \u00e1p m\u1edbi h\u01a1n, nh\u01b0 thu\u1ed1c \u1ee9c ch\u1ebf renin tr\u1ef1c ti\u1ebfp, l\u00e0 c\u00e1c l\u1ef1a ch\u1ecdn thay th\u1ebf \u0111\u1ec3 ki\u1ec3m so\u00e1t huy\u1ebft \u00e1p nh\u01b0ng c\u1ea7n \u0111\u01b0\u1ee3c th\u1eed nghi\u1ec7m \u1edf b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh t\u00ednh an to\u00e0n v\u00e0 hi\u1ec7u qu\u1ea3 c\u1ee7a ch\u00fang tr\u01b0\u1edbc khi \u0111\u01b0a v\u00e0o \u00e1p d\u1ee5ng r\u1ed9ng r\u00e3i.<\/p>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p>Agarwal R, Nissenson AR, Battle D, Coyne DW, Trout JR, Warnock DG. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States.Am J Med. 2003;115:291\u2013297.<br \/>\nAmar J, Vernier I, Rossignol E, Bongard V, Arnaud C, Conte JJ, Salvador M, Chamontin B. 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Available at:http:\/\/www.ckdinsights.com\/downloads\/DialysisDrugs2008.pdf.<br \/>\nRose BD, editor.UpToDate. Waltham, MA: 2010. UpToDate Drug Information. UpToDate.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c \u0111i\u1ec1u tr\u1ecb t\u0103ng huy\u1ebft \u00e1p cho b\u1ec7nh nh\u00e2n ch\u1ea1y th\u1eadn nh\u00e2n t\u1ea1o: Quan \u0111i\u1ec3m hi\u1ec7n t\u1ea1i Ng\u01b0\u1eddi d\u1ecbch: Ho\u00e0ng Th\u1ecb B\u00edch Ng\u1ecdc, \u0110\u1ea1i h\u1ecdc Y D\u01b0\u1ee3c Th\u00e1i Nguy\u00ean. Email: ngochbn94@gmail.com Hi\u1ec7u \u0111\u00ednh: \u0110\u1eb7ng Th\u1ecb Ng\u1ecdc Mai \u2013 Trung t\u00e2m D\u01b0\u1ee3c l\u00fd l\u00e2m s\u00e0ng \u0110\u1ea1i h\u1ecdc Y H\u00e0 N\u1ed9i. Email: dangngocmai.hmu@gmail.com Nh\u1ecbp C\u1ea7u D\u01b0\u1ee3c L\u00e2m [&#8230;]\n","protected":false},"author":1,"featured_media":5749,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-5748","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5748","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=5748"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/5748\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/5749"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=5748"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=5748"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=5748"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}