Khuyến cáo chẩn đoán - điều trị - dự phòng THA của Phân hội THA Việt Nam 2014

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2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
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Medical Education & Information – for all Media, all Disciplines, from all over the World
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2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
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2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
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•
!/F
•
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•
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•
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Medical Education & Information – for all Media, all Disciplines, from all over the World
Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
159:;--^=7;
Khi đo HA tại phòng khám, cần lưu ý:
•
Bệnh nhân phải ngồi nghỉ ngơi 3 – 5 phút trước khi đo HA
• Nên đo ít nhất 2 lần cách nhau 1 – 2 phút ở tư thế ngồi. Đo thêm lần nữa nếu 2 lần đo đầu khác biệt nhau nhiều. Cân nhắc lấy HA trung bình nếu cần.
• Để chính xác, nên đo HA lặp lại trong trường hợp bệnh nhân có rối loạn nhịp tim, chẳng hạn như rung nhĩ
• Sử dụng bao tay đúng tiêu chuẩn (rộng 12-13 cm và dài 35 cm) hoặc bao tay lớn hơn nếu chu vi cánh tay > 32 cm và bao tay nhỏ sao cho vừa vặn với cánh tay
bệnh nhân.
•
Đặt bao tay ngang mức tim bất kể vị trí của bệnh nhân
• Dùng ống nghe để xác định HA tâm thu và HA tâm trương theo pha I và pha V (âm thanh biến mất) của tiếng đập Korotkoff
• Đo HA cả 2 tay ở lần khám đầu tiên để phát hiện những khác biệt có thể xảy ra. Lấy số HA ở cánh tay có giá trị cao hơn như là con số tham khảo

•
Đo HA lần đầu và sau 3 phút ở tư thế đứng đối với bệnh nhân cao tuổi, bệnh nhân đái tháo đường, và những trường hợp hạ HA tư thế hoặc nghi ngờ hạ HA tư
thế
•
Thông trường khi đo HA, nên đếm nhịp tim bằng cách bắt nhịp tim trong ít nhất 30 giây sau lần đo thứ 2 ở tư thế ngồi
3;678%-99%-)
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%&6$78 %&09
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R 
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Medical Education & Information – for all Media, all Disciplines, from all over the World
Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
{4<41,U,6JC(+=p
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{4<41,1L416JC

•&>,F=/%/K,v
-FNmB=FQ
-
FNmB=,Ib+*B;%o,M,6%6\5%Kb+
*%o'%6,%,EN
•&>,FXTE
-
FNmB=b8,>%/
-
FNmB=b8,>&%o,M,6%6\5%B;,+%:/"%
&%o'%6,%%/
•u=%d+:=/%/K,v&,F
•
FNmB=,'M=Bp%=%`4,B=
•
FT/,4B,_%L ,,J D E%L,KT/,U%
•FNmB=%//"%>,@DV,NwI,
•
u=%d,F@B=,V,D_'
3;678%-99%-:3;46#7# %$78%-99%- %:3;678%-99%-:=A@6%8-$89-#9-:=.6#%8B#9#%:3;46-78%-99%- %)
{4<4L5T416JC
• =%b+,=BpIF/,NmB=KF/,K
x!==,8,F%o,yTNNi
x&>,F@</"%FB;,y/TNNi %z
&bd%:,BL b+,V/"%=,=/
>
x!==,5T/%LF
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6JC(+=pf;O=0l4;=;
CD" ^70FI!

Ma b,U.
ac b.U1/0d,U.
a b.U5/0d.U1
a# d.U5
•
2l DU F K'W< %l DU I ,d DU
F,b8b<WbK'
•
2=%,;DUB=%bJMF =
"F/"%%lDU%:%`
1%%ld,/<%:B;%l
d,>\
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
HA: 140-179 / 90-109
HA: 140-179 / 90-109
Đo Holter HA 24g nếu có sẵn: Chẩn
đoán THA: HA ngày %&2,34%#
%&254
Đo Holter HA 24g nếu có sẵn: Chẩn
đoán THA: HA ngày %&2,34%#
%&254
Đo HA phòng khám lần 3 >140/90
chẩn đoán THA
Đo HA phòng khám lần 3 >140/90
chẩn đoán THA
Tự đo HA tại nhà nếu có sẳn: HATB 5 ngày ,
chẩn đoán THA %&2,34
%#%&254
Tự đo HA tại nhà nếu có sẳn: HATB 5 ngày ,

chẩn đoán THA %&2,34
%#%&254

Khám HA lần 2
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Khám HA lần 2
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Khám HA lần 1
Đo HA, hỏi tiền sử & Khám thực
thể
Khám HA lần 1
Đo HA, hỏi tiền sử & Khám thực
thể
THA cấp cứu
THA cấp cứu
Chẩn đoán THA
Chẩn đoán THA
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Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
I0A;U,=4o
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•
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•
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•
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•
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Medical Education & Information – for all Media, all Disciplines, from all over the World
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2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
;Qxe=D-;Wmcd=dn5U,E}1-o
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• Đặc điểm của hội chứng Cushing
• Đốm da do u xơ thần kinh.
•

Khám thấy thận to
•
Nghe âm thổi ở bụng
• Nghe âm thổi ở ngực hoặc ở thượng vị
• Mạch đùi không rõ
• Khác biệt HA giữa tay phải và tay trái
(r;Bu55mcd=dn5
• Não: những khiếm khuyết về cảm giác và vận động
• Võng mạc: Soi đáy mắt có bất thường
• Tim: Nhịp tim, tiếng T3 hoặc T4, tiếng thổi, loạn nhịp tim, ran phổi, phù ngoại vi
• Động mạch ngoại biên: mất mạch, mạch yếu hoặc mạch không đều hai bên, lạnh đầu chi, những sang thương da do thiếu máu
•
Động mạch cảnh: âm thổi tâm thu
hr/F=D=TE}1-o
• Cân nặng và chiều cao
• Tính BMI
•
Vòng eo
./0.1
Medical Education & Information – for all Media, all Disciplines, from all over the World
Powered by
2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
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2013 ESH/ESC Guidelines for the management of arterial hypertension
The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) - J Hypertension 2013;31:1281-1357
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