KHUYẾN cáo điều TRỊ BỆNH TĂNG HUYẾT áp 2015, hội TĂNG HUYẾT áp CANADA (chep 2015) (sản PHỤ KHOA)

KHUYẾN CÁO ĐIỀU TRỊ BỆNH
TĂNG HUYẾT ÁP 2015/
HỘI THA CANADA
(CHEP 2015)


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

CHEP 2015 Recommendations
What’s new?
• Assess clinic blood pressures using electronic (oscillometric) monitors
• The diagnosis of hypertension should be based on out-of-office measurements
• The management of hypertension is all about global cardiovascular risk
management and vascular protection including advice and treatment for
smoking cessation
• Treatment of atherosclerotic renal artery stenosis is primarily medical

2
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

CHEP 2015 Recommendations
What’s still important?
• Know the BP threshold and treat to target
• Adopting healthy behaviours is integral to the
management of hypertension
• The most important step in prescription of
antihypertensive therapy is achieving patient “buy-in”

3
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Các ngưỡng huyết áp thông thường giúp
khởi đầu điều trị bằng thuốc
Population

SBP >

DBP >

Diabetes

130

80

High risk (TOD or CV risk factors)

140

90

Low risk (no TOD or CV risk
factors)

160

100

Very elderly* (≥80 yrs.)

160

NA

TOD = target organ damage
*This higher treatment target for the very elderly reflects current evidence and
heightened concerns of precipitating adverse effects, particularly in frail patients.
Decisions regarding initiating and intensifying pharmacotherapy in the very elderly
should be based upon an individualized risk-benefit analysis.
4
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Mục tiêu điều trị
Treatment consists of health behaviour ±pharmacological management
Population

SBP <

DBP <

Diabetes

130

80

All others < 80 yrs. (including CKD)

140

90

Very elderly (≥ 80 yrs.)

150

NA

In patients with coronary artery disease
be cautious when lowering blood pressure
if diastolic blood pressures are < 60mmHg

5
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

CHEP 2015 Recommendations
What’s still important?
• Know the BP threshold and treat to the target
• Adopting healthy behaviours is integral to the

management of hypertension
• The most important step in prescription of
antihypertensive therapy is achieving patient “buy-in”

6
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Tác dụng của thay đổi lối sống/ huyết áp
Intervention

Systolic BP
(mmHg)

Diastolic BP
(mmHg)

Diet and weight control

-6.0

-4.8

Reduced salt/sodium intake

- 5.4

- 2.8

Reduced alcohol intake (heavy
drinkers)

-3.4

-3.4

DASH diet

-11.4

-5.5

Physical activity

-3.1
-5.5

-1.8
-3.5

Relaxation therapies

Clinical Guideline: Methods, evidence and recommendations
National Institute for Health and Clinical Excellence (NICE) May 2011

7
2015

Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Tóm tắt các biện pháp thay đổi lối sống
Intervention
Reduce foods with added
sodium

Target

→ 2000 mg /day

Weight loss

BMI <25 kg/m2

Alcohol restriction

< 2 drinks/day

Physical activity

30-60 minutes 4-7 days/week

Dietary patterns

DASH diet

Smoking cessation

Smoke free environment

Waist circumference

Men <102 cm

Women <88 cm

8
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

CHEP 2015 Recommendations
What’s still important?
• Know the BP threshold and treat to the target
• Adopting healthy behaviours is integral to the
management of hypertension
• The most important step in prescription of
antihypertensive therapy is achieving patient “buy-in”

9
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Cải thiện tuân thủ điều trị bằng tiếp cận
đa phương tiện

• Encourage greater patient responsibility/autonomy in regular
monitoring of their blood pressure
• Educate patients and patients' families about their
disease/treatment regimens verbally and in writing
• Use an interdisciplinary care approach coordinating with
work-site health care givers and pharmacists if available
• Encouraging adherence to therapy by healthcare practitionerbased telephone contact, particularly, over the first three
months of therapy

10
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Cải thiện tuân thủ điều trị bằng tiếp cận tối
đa phương diện b- II
• Assess adherence to pharmacological and health behaviour
therapies at every visit
• Teach patients to take their pills on a regular schedule
associated with a routine daily activity e.g. brushing teeth.
• Simplify medication regimens using long-acting once-daily
dosing
• Utilize single pill combinations
• Utilize unit-of-use packaging e.g. blister packaging

11
2015

Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

CHEP 2015 Recommendations
What’s new?
• Monitor blood pressures in clinic using an electronic
(oscillometric) device
• The diagnosis of hypertension should be based on out-ofoffice measurements
• The management of hypertension is all about global
cardiovascular risk management and vascular protection
including advice and treatment for smoking cessation
• Treatment of atherosclerotic renal artery stenosis is primarily
medical

12
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Tổng quan về tiêu chuẩn chẩn đoán THA
và hướng dẫn theo dõi

Measurement using electronic (oscillometric) upper arm devices is preferred over
auscultation
ABPM: Ambulatory Blood Pressure Measurement
AOBP: Automated Office Blood Pressure
HBPM: Home Blood Pressure measurement
OBPM: Office Blood Pressure measurement

13

2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Các phương pháp đo huyết áp
• Office (attended, OBPM)
– Auscultatory (mercury, aneroid)
– Oscillometric (electronic)

• Office Automated (unattended, AOBP)
– Oscillometric (electronic)

• Ambulatory (ABPM)
• Home (HBPM)
For information on blood pressure measurement devices:
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14
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

BP measurement methods
Office (attended, OBPM)
Auscultatory (mercury, aneroid)
Oscillometric (electronic)

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15

2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

BP measurement methods
Office Automated (unattended, AOBP)
Oscillometric (electronic)

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16
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Khuyến cáo mới 2015 về đo huyết áp
Office BP measurement (OBPM):
•Measurement using electronic (oscillometric) upper arm devices
is preferred to auscultatory devices (Grade C).

17
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Đo huyết áp bằng nghe tại PK khơng
chính xác
• In the real world, the accuracy of auscultatory OBPM

can be adversely affected by provider, patient and
device factors such as:
– too rapid deflation of the cuff
– digit preference with rounding off of readings to 0 or 5
– also, mercury sphygmomanometers are being phased out
and aneroid devices are less likely to remain calibrated

• Consequence: Routine auscultatory OBPMs are 9/6 mm
Hg higher than standardized research BPs (primarily
using oscillometric devices)
18
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Các điểm chính về đo huyết áp tại PK
(OBPM)
• Use standardized measurement techniques and
validated equipment
• Measurement using electronic (oscillometric) upper
arm devices is preferred over auscultation
• The first reading should be discarded and the latter two
averaged.

19
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Khảo sát huyết áp ngồi PK: phương
tiện ưu tiên chẩn đốn THA

Clinic BP as alternate method

20
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Out of office BP measurement methods:
Ambulatory (ABPM)

/> />21
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Out of office BP measurement methods:
Home (HBPM)

/> />22
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Các biện pháp đo huyết áp ngồi PK
• ABPM has better predictive ability than OBPM and is
the recommended out-of-office measurement method.
• HBPM has better predictive ability than OBPM and is
recommended if ABPM is not tolerated, not readily
available or due to patient preference.
• Identifies white coat hypertension (as well as
diagnosing masked hypertension)
ABPM: Đo huyết áp di động 24 giờ
HBPM: Đo huyết áp tại nhà
23
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Các trị số huyết áp đo ngồi PK có tương
quan cao với nguy cơ do THA
SBP

DBP

Mule et al. J Cardiovasc Risk 2002;9:123-9.

24
2015


Kc đt bệnh THA 2015/ Hội THA Canada- CHEP 2015

Chỉ dựa vào huyết áp PK sẽ sai lệch trong
THA áo choàng trắng và THA che giấu

Ambulatory BP mmHg

200
180
160

True
Hypertension

Masked
Hypertension

140
120
100
100

135
White Coat
Hypertension

Normotension

120

140

160

180

200

Manual Office BP mmHg
From Pickering et al. Hypertension 2002;40:795-796

25
2015