{"id":7846,"date":"2010-04-21T03:14:17","date_gmt":"2010-04-20T20:14:17","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=7846"},"modified":"2019-04-25T11:49:28","modified_gmt":"2019-04-25T04:49:28","slug":"spironolacton","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/spironolacton\/","title":{"rendered":"T\u01af\u01a0NG T\u00c1C GI\u1eeeA SPIRONOLACTON V\u00c0 THU\u1ed0C \u1ee8C CH\u1ebe H\u1ec6 RENIN-ANGIOTENSIN"},"content":{"rendered":"<h2>T\u01af\u01a0NG T\u00c1C GI\u1eeeA SPIRONOLACTON V\u00c0 THU\u1ed0C \u1ee8C CH\u1ebe H\u1ec6 RENIN-ANGIOTENSIN TRONG \u0110I\u1ec0U TR\u1eca SUY TIM: NGUY C\u01a0 T\u0102NG KALI M\u00c1U \u0110E D\u1eccA T\u00cdNH M\u1ea0NG.<\/h2>\n<p>T\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. B\u1ec7nh nh\u00e2n tim m\u1ea1ch c\u00f3 kh\u1ea3 n\u0103ng g\u1eb7p t\u01b0\u01a1ng t\u00e1c thu\u1ed1c cao v\u00e0 nh\u1ea1y c\u1ea3m v\u1edbi h\u1eadu qu\u1ea3 c\u1ee7a t\u01b0\u01a1ng t\u00e1c thu\u1ed1c do \u0111a s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u1ec1u cao tu\u1ed5i v\u00e0 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng nhi\u1ec1u lo\u1ea1i thu\u1ed1c [1]. M\u1ed9t kh\u1ea3o s\u00e1t tr\u00ean 165 b\u1ec7nh \u00e1n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa t\u1ea1i Khoa N\u1ed9i tim m\u1ea1ch c\u1ee7a m\u1ed9t b\u1ec7nh vi\u1ec7n \u0111a khoa tuy\u1ebfn t\u1ec9nh cho th\u1ea5y 70,3% s\u1ed1 b\u1ec7nh \u00e1n \u0111\u01b0a v\u00e0o kh\u1ea3o s\u00e1t c\u00f3 t\u01b0\u01a1ng t\u00e1c li\u00ean quan \u0111\u1ebfn 45 c\u1eb7p t\u01b0\u01a1ng t\u00e1c thu\u1ed1c &#8211; thu\u1ed1c kh\u00e1c nhau. S\u1ed1 t\u01b0\u01a1ng t\u00e1c c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng chi\u1ebfm 58,5% t\u1ed5ng s\u1ed1 b\u1ec7nh \u00e1n; trong \u0111\u00f3, m\u1ed9t trong nh\u1eefng c\u1eb7p t\u01b0\u01a1ng t\u00e1c c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng \u0111\u00e1ng ch\u00fa \u00fd l\u00e0 t\u01b0\u01a1ng t\u00e1c gi\u1eefa spironolacton v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin [2]. \u0110\u00e2y l\u00e0 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c theo c\u01a1 ch\u1ebf d\u01b0\u1ee3c l\u1ef1c h\u1ecdc d\u1eabn \u0111\u1ebfn h\u1eadu qu\u1ea3 t\u0103ng kali m\u00e1u v\u1edbi m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng t\u00e1c nghi\u00eam tr\u1ecdng v\u00e0 th\u1eddi gian ti\u1ec1m t\u00e0ng xu\u1ea5t hi\u1ec7n ch\u1eadm [3].<\/p>\n<figure id=\"attachment_7848\" aria-describedby=\"caption-attachment-7848\" style=\"width: 450px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-7848\" src=\"https:\/\/www.vnras.com\/drug\/wp-content\/uploads\/2019\/04\/SPIRONOLACTON_1.jpg\" alt=\"SPIRONOLACTON\" width=\"450\" height=\"450\" title=\"\" srcset=\"https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/SPIRONOLACTON_1.jpg 450w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/SPIRONOLACTON_1-280x280.jpg 280w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/SPIRONOLACTON_1-400x400.jpg 400w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/SPIRONOLACTON_1-350x350.jpg 350w, https:\/\/vnras.com\/drug\/wp-content\/uploads\/2019\/04\/SPIRONOLACTON_1-100x100.jpg 100w\" sizes=\"auto, (max-width: 450px) 100vw, 450px\" \/><figcaption id=\"caption-attachment-7848\" class=\"wp-caption-text\">C\u00f4ng th\u1ee9c c\u1ea5u t\u1ea1o c\u1ee7a SPIRONOLACTON<\/figcaption><\/figure>\n<p><a href=\"https:\/\/www.vnras.com\/drug\/2010\/04\/spironolacton.html\"><strong>Spironolacton<\/strong><\/a> \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh trong \u0111i\u1ec1u tr\u1ecb suy tim sung huy\u1ebft. Thu\u1ed1c \u1ee9c ch\u1ebf c\u1ea1nh tranh t\u00e1c d\u1ee5ng sinh l\u00fd c\u1ee7a aldosteron tr\u00ean \u1ed1ng l\u01b0\u1ee3n xa l\u00e0m t\u0103ng th\u1ea3i tr\u1eeb natri v\u00e0 l\u00e0m gi\u1ea3m b\u00e0i ti\u1ebft kali g\u00e2y t\u0103ng kali m\u00e1u. C\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin l\u00e0 thu\u1ed1c quan tr\u1ecdng cho b\u1ec7nh nh\u00e2n t\u0103ng huy\u1ebft \u00e1p ho\u1eb7c suy tim. C\u00e1c thu\u1ed1c n\u00e0y c\u0169ng l\u00e0m gi\u1ea3m b\u00e0i ti\u1ebft aldosteron, t\u1eeb \u0111\u00f3 g\u00e2y t\u0103ng kali m\u00e1u [4], [5]. Ngo\u00e0i ra, nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea7n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng c\u00e1c thu\u1ed1c n\u00e0y th\u01b0\u1eddng c\u00f3 s\u1eb5n c\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y t\u0103ng kali m\u00e1u bao g\u1ed3m suy th\u1eadn, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, gi\u1ea3m kh\u1ed1i l\u01b0\u1ee3ng tu\u1ea7n ho\u00e0n (g\u00e2y suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, t\u1eeb \u0111\u00f3 d\u1eabn \u0111\u1ebfn t\u0103ng kali m\u00e1u), &#8230; T\u1ef7 l\u1ec7 t\u0103ng kali m\u00e1u ghi nh\u1eadn tr\u00ean b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n\/ch\u1eb9n th\u1ee5 th\u1ec3 AT1 l\u00e0 1\/1000-1\/100 [4].<br \/>\nM\u1ed9t t\u1ed5ng k\u1ebft t\u1ea1i Anh trong giai \u0111o\u1ea1n t\u1eeb th\u00e1ng 01\/1998 \u0111\u1ebfn th\u00e1ng 12\/2015 \u0111\u00e3 ghi nh\u1eadn 82 b\u00e1o c\u00e1o r\u1ed1i lo\u1ea1n kali m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p spironolacton c\u00f9ng m\u1ed9t thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n (63 b\u00e1o c\u00e1o) ho\u1eb7c ch\u1eb9n th\u1ee5 th\u1ec3 AT1 (25 b\u00e1o c\u00e1o); trong \u0111\u00f3 c\u00f3 70 tr\u01b0\u1eddng h\u1ee3p c\u00f3 m\u00f4 t\u1ea3 t\u0103ng kali m\u00e1u. T\u1ed5ng k\u1ebft n\u00e0y c\u0169ng ghi nh\u1eadn 3 tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n t\u1eed vong c\u00f3 s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p spironolacton v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n. S\u1ed1 b\u00e1o c\u00e1o ghi nh\u1eadn bi\u1ebfn c\u1ed1 li\u00ean quan \u0111\u1ebfn vi\u1ec7c s\u1eed d\u1ee5ng \u0111\u1ed3ng th\u1eddi spironolacton v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n b\u1eaft \u0111\u1ea7u t\u0103ng t\u1eeb n\u0103m 1999, \u0111\u1ea1t \u0111\u1ec9nh trong giai \u0111o\u1ea1n 2001-2005 v\u00e0 t\u0103ng tr\u1edf l\u1ea1i trong v\u00f2ng 2 n\u0103m g\u1ea7n \u0111\u00e2y (2014-2015). S\u1ef1 t\u0103ng tr\u1edf l\u1ea1i g\u1ea7n \u0111\u00e2y s\u1ed1 l\u01b0\u1ee3ng c\u00e1c b\u00e1o c\u00e1o li\u00ean quan \u0111\u1ebfn ph\u1ed1i h\u1ee3p spironolacton v\u00e0 2 thu\u1ed1c t\u00e1c d\u1ee5ng tr\u00ean h\u1ec7 renin-angiotensin \u0111\u01b0\u1ee3c cho l\u00e0 li\u00ean quan \u0111\u1ebfn gia t\u0103ng t\u1ef7 l\u1ec7 s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p thu\u1ed1c n\u00e0y sau khi C\u01a1 quan Qu\u1ea3n l\u00fd D\u01b0\u1ee3c ph\u1ea9m ch\u00e2u \u00c2u (EMA) \u0111\u01b0a ra khuy\u1ebfn c\u00e1o n\u0103m 2014 v\u1ec1 vi\u1ec7c h\u1ea1n ch\u1ebf ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c c\u00f9ng t\u00e1c \u0111\u1ed9ng tr\u00ean h\u1ec7 renin-angiotensin. Khuy\u1ebfn c\u00e1o c\u1ee7a EMA \u0111\u01b0\u1ee3c \u0111\u01b0a ra sau khi r\u00e0 so\u00e1t d\u1eef li\u1ec7u t\u1eeb m\u1ed9t s\u1ed1 nghi\u00ean c\u1ee9u l\u1edbn tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n tim m\u1ea1ch ho\u1eb7c \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng typ 2 cho th\u1ea5y vi\u1ec7c ph\u1ed1i h\u1ee3p thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 ch\u1eb9n th\u1ee5 th\u1ec3 AT1 l\u00e0m t\u0103ng nguy c\u01a1 t\u0103ng kali m\u00e1u, t\u1ed5n th\u01b0\u01a1ng th\u1eadn ho\u1eb7c h\u1ea1 huy\u1ebft \u00e1p so v\u1edbi s\u1eed d\u1ee5ng t\u1eebng thu\u1ed1c \u0111\u01a1n \u0111\u1ed9c. M\u1eb7t kh\u00e1c, l\u1ee3i \u00edch c\u1ee7a ph\u1ed1i h\u1ee3p thu\u1ed1c n\u00e0y ch\u1ec9 v\u01b0\u1ee3t tr\u1ed9i so v\u1edbi nguy c\u01a1 tr\u00ean nh\u00f3m b\u1ec7nh nh\u00e2n suy tim trong tr\u01b0\u1eddng h\u1ee3p kh\u00f4ng c\u00f3 li\u1ec7u ph\u00e1p thay th\u1ebf. Ngo\u00e0i ra, s\u1ed1 l\u01b0\u1ee3ng c\u00e1c b\u00e1o c\u00e1o li\u00ean quan \u0111\u1ebfn ph\u1ed1i h\u1ee3p spironolacton v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 ch\u1eb9n th\u1ee5 th\u1ec3 AT1 t\u0103ng l\u00ean c\u0169ng \u0111\u01b0\u1ee3c cho l\u00e0 do c\u00e1n b\u1ed9 y t\u1ebf \u0111\u00e3 quan t\u00e2m bi\u1ebft \u0111\u1ebfn nhi\u1ec1u h\u01a1n, t\u1eeb \u0111\u00f3 t\u0103ng t\u1ef7 l\u1ec7 b\u00e1o c\u00e1o v\u1ec1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c n\u00e0y [4], [6].<\/p>\n<p>\u0110\u1ec3 gi\u1ea3m thi\u1ec3u nguy c\u01a1 t\u0103ng kali m\u00e1u do t\u01b0\u01a1ng t\u00e1c gi\u1eefa spironolacton v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n v\u00e0 ch\u1eb9n th\u1ee5 th\u1ec3 AT1, c\u00e1n b\u1ed9 y t\u1ebf c\u1ea7n l\u01b0u \u00fd:<\/p>\n<ul>\n<li>C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y t\u0103ng kali m\u00e1u tr\u00ean b\u1ec7nh nh\u00e2n suy tim bao g\u1ed3m suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1eadn, tu\u1ed5i cao, m\u1eafc k\u00e8m \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng v\u00e0 s\u1eed d\u1ee5ng li\u1ec1u spironolacton &gt;25 mg\/ng\u00e0y.<\/li>\n<li>Th\u1eadn tr\u1ecdng c\u00e2n nh\u1eafc l\u1ee3i \u00edch\/nguy c\u01a1 khi s\u1eed d\u1ee5ng ph\u1ed1i h\u1ee3p spironolacton v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n ho\u1eb7c thu\u1ed1c ch\u1eb9n th\u1ee5 th\u1ec3 angiotensin trong \u0111i\u1ec1u tr\u1ecb suy tim do nguy c\u01a1 t\u0103ng kali m\u00e1u nghi\u00eam tr\u1ecdng, \u0111\u1eb7c bi\u1ec7t tr\u00ean b\u1ec7nh nh\u00e2n suy th\u1eadn v\u00e0 khi li\u1ec1u d\u00f9ng spironolacton v\u01b0\u1ee3t qu\u00e1 25 mg\/ng\u00e0y.<\/li>\n<li>Trong tr\u01b0\u1eddng h\u1ee3p b\u1eaft bu\u1ed9c ph\u1ea3i ph\u1ed1i h\u1ee3p spironolacton v\u00e0 thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n\/ch\u1eb9n th\u1ee5 th\u1ec3 AT1, c\u1ea7n d\u00f9ng thu\u1ed1c v\u1edbi li\u1ec1u th\u1ea5p nh\u1ea5t c\u00f3 hi\u1ec7u qu\u1ea3.<\/li>\n<li>Th\u01b0\u1eddng xuy\u00ean theo d\u00f5i n\u1ed3ng \u0111\u1ed9 kali m\u00e1u v\u00e0 ch\u1ee9c n\u0103ng th\u1eadn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n<li>Khi x\u1ea3y ra t\u0103ng kali m\u00e1u, vi\u1ec7c ng\u1eebng t\u1ea1m th\u1eddi m\u1ed9t thu\u1ed1c c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3 gi\u00fap gi\u1ea3m kali. N\u1ebfu n\u1ed3ng \u0111\u1ed9 kali v\u1eabn cao tr\u00ean 5,5 mmol\/l, n\u00ean ng\u1eebng t\u1ea5t c\u1ea3 c\u00e1c thu\u1ed1c c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u0103ng K+.<\/li>\n<li>\u0110\u1eb7c bi\u1ec7t ch\u00fa \u00fd tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n d\u1eabn truy\u1ec1n tim, vi\u1ec7c t\u0103ng nh\u1eb9 kali m\u00e1u \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ng\u1eebng tim.<\/li>\n<li>T\u0103ng c\u01b0\u1eddng b\u00e1o c\u00e1o c\u00e1c ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i t\u0103ng kali m\u00e1u li\u00ean quan \u0111\u1ebfn spironolacton, thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n\/ch\u1eb9n th\u1ee5 th\u1ec3 AT1 v\u00e0 ph\u1ed1i h\u1ee3p c\u00e1c thu\u1ed1c n\u00e0y cho Trung t\u00e2m Qu\u1ed1c gia\/Trung t\u00e2m khu v\u1ef1c v\u1ec1 Th\u00f4ng tin thu\u1ed1c v\u00e0 Theo d\u00f5i ph\u1ea3n \u1ee9ng c\u00f3 h\u1ea1i c\u1ee7a thu\u1ed1c [4], [7], [8], [9].<\/li>\n<\/ul>\n<h2>T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h2>\n<p>1. Opie LH (2000), &#8220;Adverse cardiovascular drug interactions&#8221;, Current Problems in Cardiology, 25:622-676.<\/p>\n<p>2. Nguy\u1ec5n Ho\u00e0ng Anh v\u00e0 c\u1ed9ng s\u1ef1 (2012), &#8220;\u0110\u00e1nh gi\u00e1 t\u01b0\u01a1ng t\u00e1c thu\u1ed1c b\u1ea5t l\u1ee3i tr\u00ean b\u1ec7nh \u00e1n \u0111i\u1ec1u tr\u1ecb n\u1ed9i tr\u00fa t\u1ea1i Khoa N\u1ed9i tim m\u1ea1ch B\u1ec7nh vi\u1ec7n \u0110a khoa t\u1ec9nh B\u1eafc Giang&#8221;, T\u1ea1p ch\u00ed Nghi\u00ean c\u1ee9u d\u01b0\u1ee3c v\u00e0 Th\u00f4ng tin thu\u1ed1c, 3(3):90-94.<\/p>\n<p>3. Truven Health Analytics, Micromedex 2.0, https:\/\/www.micromedexsolutions.com\/, accessed on 10 March 2016.<\/p>\n<p>4. Medicines and Healthcare products Regulatory Agency (MHRA), Drug Safety Update, &#8220;Spironolacton and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia&#8221;, 17 February 2016. Link:\u00a0<a href=\"https:\/\/www.gov.uk\/drug-safety-update\/spironolactone-and-renin-angiotensin-system-drugs-in-heart-failure-risk-of-potentially-fatal-hyperkalaemia\" rel=\"noopener\">https:\/\/www.gov.uk\/drug-safety-update\/spironolactone-and-renin-angiotensin-system-drugs-in-heart-failure-risk-of-potentially-fatal-hyperkalaemia<\/a><\/p>\n<p>5. B\u1ed9 Y t\u1ebf (2015), D\u01b0\u1ee3c th\u01b0 Qu\u1ed1c gia Vi\u1ec7t Nam, NXB Y h\u1ecdc, H\u00e0 N\u1ed9i.<\/p>\n<p>6. European Medicines Agency (EMA), Renin-angiotensin-system (RAS)-acting agents, \u201cRestriction of combined use of medicines affecting the renin-angiotensin system (RAS)\u201d, 23 May 2014. Link:\u00a0<a href=\"https:\/\/www.ema.europa.eu\/en\/news\/combined-use-medicines-affecting-renin-angiotensin-system-ras-be-restricted-chmp-endorses-prac\" rel=\"noopener\">https:\/\/www.ema.europa.eu\/en\/news\/combined-use-medicines-affecting-renin-angiotensin-system-ras-be-restricted-chmp-endorses-prac<\/a><\/p>\n<p>7. Pharmaceutical Press, Stockley\u2019s Drug Interactions [online], http:\/\/www.medicinescomplete.com, accessed on 10 March 2016.<\/p>\n<p>8. Biff F. Palmer, M.D (2004), Current Concepts, \u201cManaging hyperkalemia caused by inhibitors of the renin-angiotensin-aldosteron system\u201d, The New England Journal of Medicine, 351:585-592. Link:\u00a0<a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMra035279\" rel=\"noopener\">https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMra035279<\/a><\/p>\n<p>9. Akshay Desai, MD, MPH (2008), Editorial, \u201cHyperkalemia asociated with inhibitors of the renin-angiotensin-aldosteron system balancing risk and benefit\u201d. Circulation,118:1609-1611. Link:\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18852376\" rel=\"noopener\">https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18852376<\/a><\/p>\n<p>T\u00e1c gi\u1ea3: Tr\u1ea7n Th\u00f9y Linh &#8211; Trung T\u00e2m C\u1ea3nh Gi\u00e1c D\u01b0\u1ee3c Qu\u1ed1c Gia.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>T\u01af\u01a0NG T\u00c1C GI\u1eeeA SPIRONOLACTON V\u00c0 THU\u1ed0C \u1ee8C CH\u1ebe H\u1ec6 RENIN-ANGIOTENSIN TRONG \u0110I\u1ec0U TR\u1eca SUY TIM: NGUY C\u01a0 T\u0102NG KALI M\u00c1U \u0110E D\u1eccA T\u00cdNH M\u1ea0NG. T\u01b0\u01a1ng t\u00e1c thu\u1ed1c l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 ph\u1ed5 bi\u1ebfn trong th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng. B\u1ec7nh nh\u00e2n tim m\u1ea1ch c\u00f3 kh\u1ea3 n\u0103ng g\u1eb7p t\u01b0\u01a1ng t\u00e1c thu\u1ed1c cao v\u00e0 nh\u1ea1y c\u1ea3m v\u1edbi h\u1eadu [&#8230;]\n","protected":false},"author":1,"featured_media":7847,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-7846","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\/7846","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=7846"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/7846\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/7847"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=7846"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=7846"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=7846"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}