This document discusses the role of calcium channel blockers in treating hypertension. It begins by describing the effects of calcium channel blockers on calcium channels and their cardiovascular effects. It then discusses the efficacy of various calcium channel blocker classes and specific drugs used in Vietnam for hypertension treatment. Finally, it summarizes that calcium channel blockers are effective in treating hypertension and reducing blood pressure, with few side effects and benefits like reduced vascular stiffness.
Basics of hypertension and available treatment.
Overview of mechanism of action, risks/benefits of various classes of drugs.
Prevalent prescription trends and future market review.
hypertension, simplified, jnc 8, treatment and newer modalities to treat. surgical procedures involved for hypertension and jnc 8 versus jnc 7 is compared in this ppt, and also, prevelance and epidemeiology of hypertension is explained. antihypertensives for preffered class and age are explained
Basics of hypertension and available treatment.
Overview of mechanism of action, risks/benefits of various classes of drugs.
Prevalent prescription trends and future market review.
hypertension, simplified, jnc 8, treatment and newer modalities to treat. surgical procedures involved for hypertension and jnc 8 versus jnc 7 is compared in this ppt, and also, prevelance and epidemeiology of hypertension is explained. antihypertensives for preffered class and age are explained
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
please comment
thank u
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of Hypertension. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to primary care and ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
Un nuevo horizonte en el tratamiento de las dislipemias
14/09/15 18:00h-19:30h Casa del Corazón (Madrid)
http://objetivoLDL.secardiologia.es
#objetivoLDL
Objetivos en el tratamiento de la dislipemia en pacientes con cardiopatía isquémica: “New kids on the block”
Dr. José Ramón Gonzalez-Juanatey, Jefe Servicio Cardiología C.H.U.S. (Santiago de Compostela). Presidente SEC
@JoseJuanatey
A case study on anemia with congestive heart failuremartinshaji
a case dealing with a patient having anemia with congestive heart failure, this gives a clear idea about management, diagnosis, treatment , patient counselling, pharmacist interventions etc
please comment
thank u
This student "cheat sheet" is designed to provide medical students with basic information regarding the diagnosis and treatment of Hypertension. It includes Questions to Ask, what to look for on a Physical Exam, Labs to Order, and basic Treatment Plans.
These guides are particularly designed for first and second-year medical students as an introduction to primary care and ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
ARBs (Angiotensin receptor blockers) are the most widely used anti hypertensive throughout the world. A solid knowledge related to ARB will make our practice more patients friendly & benefit will be maximum.
Un nuevo horizonte en el tratamiento de las dislipemias
14/09/15 18:00h-19:30h Casa del Corazón (Madrid)
http://objetivoLDL.secardiologia.es
#objetivoLDL
Objetivos en el tratamiento de la dislipemia en pacientes con cardiopatía isquémica: “New kids on the block”
Dr. José Ramón Gonzalez-Juanatey, Jefe Servicio Cardiología C.H.U.S. (Santiago de Compostela). Presidente SEC
@JoseJuanatey
Combination Therapy In Hypertension - Dr Vivek Baliga PresentationDr Vivek Baliga
Dr Vivek Baliga of Baliga Diagnostics, Bangalore, discusses the common combination therapies used in the management of hypertension in clinical practice.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Vai tro-thuoc-uc-che-calci-trong-dieu-tri-benh-tang-huyet-ap-pham-nguyen-vinh
1. Vai trò thuốc ức chế calci trong
điều trị bệnh Tăng huyết áp:
Cập nhật các khuyến cáo mới
PGS. TS. Phạm Nguyễn Vinh
Đại học Y khoa Phạm Ngọc Thạch
Đại học Y khoa Tân Tạo
Bệnh viện Tim Tâm Đức
Viện Tim TP. HCM
1
2. Vai trò thuốc UC Calci trong đt bệnh THA
Mô hình
kênh
Calci
• N: Nifedipine
• D: Diltiazem
• V: Verapamil
• P: Phosphorylation
• Tất cả các DHPs gắn kết cùng
vị trí Nifedipime
2TL: Opie HL. Durgs for the Heart, 7th ed, 2009, p. 59-82
3. Vai trò thuốc UC Calci trong đt bệnh THA
3
Hiệu quả tim mạch của các ức chế calci nhóm dihydropyridine
(DHP) và nhóm không dihydropyridine (non-DHP)
TL: Opie HL. Durgs for the Heart, 7th ed, 2009, p. 59-82
4. Vai trò thuốc UC Calci trong đt bệnh THA
4
Hiệu quả của thuốc ức chế calci đối với
chức năng thất trái, tần số xoang,
điện tâm đồ bề mặt và điện tâm đồ trong tim
Hiệu quả lâm sàng
ECG ECG trong tim
Ức chế calci Co Dãn mạch Tần số PR QRS QT AH HV
tâm thất xoang
Verapamil <-> <-> <->
Diltiazem <-> <-> <->
Dihydropyridine <-> <-> <-> <-> <-> <->
Bepridil <->
TL : Murphy JG. Mayo Clinic Cardiology Review. Lippincott Williams &
Wilkins 2nd ed 2000, p. 2000
5. Vai trò thuốc UC Calci trong đt bệnh THA
5
Các thuốc ức chế Calci sử dụng ở Việt Nam
• Diltiazem
• Verapamil
• Dihydropyridines :
* Nifedipine (Adalat )
* Nicardipine (Loxen )
* Amlodipine (Amlor )
* Felodipine (Plendil )
* Nimodipine
* Lacidipine (Lacipil ®)
* Lercanidipine (Zanedip )
6. Vai trò thuốc UC Calci trong đt bệnh THA
6
Hiệu quả của ức chế calci trong
điều trị bệnh THA
• Hữu hiệu trong điều trị bệnh THA và cơn cao HA
• Giảm áp lực tâm thu và tâm trương
• Rất ít tác dụng phụ ; không tác động lên biến dưỡng
• Hiệu quả kháng giao cảm và lợi niệu
• Hữu hiệu cả người già và người trẻ
• Không làm giảm áp lực ở người có HA bình thường
• Giảm xơ vữa động mạch (lacidipine…)
TL : Frishman WH, Sonnenblick EH : The Heart 8th ed. 1994, p. 1291-1304
7. Vai trò thuốc UC Calci trong đt bệnh THA
Systematic Review Questions on High BP in Adults
Question
Number
Question
1 Is there evidence that self-directed monitoring of BP and/or
ambulatory BP monitoring are superior to office-based measurement
of BP by a healthcare worker for 1) preventing adverse outcomes for
which high BP is a risk factor and 2) achieving better BP control?
2 What is the optimal target for BP lowering during antihypertensive
therapy in adults?
3 In adults with hypertension, do various antihypertensive drug classes
differ in their comparative benefits and harms?
4 In adults with hypertension, does initiating treatment with
antihypertensive pharmacological monotherapy versus initiating
treatment with 2 drugs (including fixed-dose combination therapy),
either of which may be followed by the addition of sequential drugs,
differ in comparative benefits and/or harms on specific health
outcomes?
BP indicates blood pressure.
7
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
8. Vai trò thuốc UC Calci trong đt bệnh THA
Categories of BP in Adults*
*Individuals with SBP and DBP in 2 categories should be
designated to the higher BP category.
BP indicates blood pressure (based on an average of ≥2
careful readings obtained on ≥2 occasions, as detailed in DBP,
diastolic blood pressure; and SBP systolic blood pressure.
BP Category SBP DBP
Normal <120 mm Hg and <80 mm Hg
Elevated 120–129 mm Hg and <80 mm Hg
Hypertension
Stage 1 130–139 mm Hg or 80–89 mm Hg
Stage 2 ≥140 mm Hg or ≥90 mm Hg
8
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
9. Vai trò thuốc UC Calci trong đt bệnh THA
Prevalence of Hypertension Based on 2 SBP/DBP Thresholds*†
SBP/DBP ≥130/80 mm Hg or
Self-Reported
Antihypertensive Medication†
SBP/DBP ≥140/90 mm Hg or Self-
Reported Antihypertensive
Medication‡
Overall, crude 46% 32%
Men
(n=4717)
Women
(n=4906)
Men
(n=4717)
Women
(n=4906)
Overall, age-sex
adjusted
48% 43% 31% 32%
Age group, y
20–44 30% 19% 11% 10%
45–54 50% 44% 33% 27%
55–64 70% 63% 53% 52%
65–74 77% 75% 64% 63%
75+ 79% 85% 71% 78%
Race-ethnicity§
Non-Hispanic White 47% 41% 31% 30%
Non-Hispanic Black 59% 56% 42% 46%
Non-Hispanic Asian 45% 36% 29% 27%
Hispanic 44% 42% 27% 32%
The prevalence estimates have been rounded to the nearest full percentage.
*130/80 and 140/90 mm Hg in 9623 participants (≥20 years of age) in NHANES 2011–2014.
†BP cutpoints for definition of hypertension in the present guideline.
‡BP cutpoints for definition of hypertension in JNC 7.
§Adjusted to the 2010 age-sex distribution of the U.S. adult population.
BP indicates blood pressure; DBP, diastolic blood pressure; NHANES, National Health
and Nutrition Examination Survey; and SBP, systolic blood pressure.
9
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
10. Vai trò thuốc UC Calci trong đt bệnh THA
Choice of Initial Medication
COR LOE
Recommendation for Choice of Initial
Medication
I ASR
For initiation of antihypertensive drug
therapy, first-line agents include thiazide
diuretics, CCBs, and ACE inhibitors or ARBs.
SR indicates systematic review.
10
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
11. Vai trò thuốc UC Calci trong đt bệnh THA
Choice of Initial Monotherapy Versus
Initial Combination Drug Therapy
COR LOE
Recommendations for Choice of Initial Monotherapy Versus Initial
Combination Drug Therapy*
I C-EO
Initiation of antihypertensive drug therapy with 2 first-line agents of
different classes, either as separate agents or in a fixed-dose
combination, is recommended in adults with stage 2 hypertension and
an average BP more than 20/10 mm Hg above their BP target.
IIa C-EO
Initiation of antihypertensive drug therapy with a single
antihypertensive drug is reasonable in adults with stage 1 hypertension
and BP goal <130/80 mm Hg with dosage titration and sequential
addition of other agents to achieve the BP target.
11
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
12. Vai trò thuốc UC Calci trong đt bệnh THA
Stable Ischemic Heart Disease
COR LOE
Recommendations for Treatment of Hypertension in
Patients With Stable Ischemic Heart Disease (SIHD)
I
SBP:
B-R
In adults with SIHD and hypertension, a BP target of less than
130/80 mm Hg is recommended.
DBP:
C-EO
I
SBP:
B-R
Adults with SIHD and hypertension (BP ≥130/80 mm Hg) should
be treated with medications (e.g., GDMT beta blockers, ACE
inhibitors, or ARBs) for compelling indications (e.g., previous MI,
stable angina) as first-line therapy, with the addition of other
drugs (e.g., dihydropyridine CCBs, thiazide diuretics, and/or
mineralocorticoid receptor antagonists) as needed to further
control hypertension.
DBP:
C-EO
12
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
13. Vai trò thuốc UC Calci trong đt bệnh THA
Stable Ischemic Heart Disease (cont.)
COR LOE
Recommendations for Treatment of Hypertension in Patients With
Stable Ischemic Heart Disease (SIHD)
I B-NR
In adults with SIHD with angina and persistent uncontrolled
hypertension, the addition of dihydropyridine CCBs to GDMT beta
blockers is recommended.
IIa B-NR
In adults who have had a MI or acute coronary syndrome, it is
reasonable to continue GDMT beta blockers beyond 3 years as long-
term therapy for hypertension.
IIb C-EO
Beta blockers and/or CCBs might be considered to control
hypertension in patients with CAD (without HFrEF) who had an MI
more than 3 years ago and have angina.
13
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
14. Vai trò thuốc UC Calci trong đt bệnh THA
Management of Hypertension in Patients With SIHD
•ACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker;
BP, blood pressure; CCB, calcium channel blocker; GDMT, guideline-directed
management and therapy; and SIHD, stable ischemic heart disease.
Hypertension With SIHD
Reduce BP to <130/80 mm Hg with
GDMT beta blockers*, ACE inhibitor, or ARBs†
(Class I)
Add
dihydropyridine CCBs
if needed
(Class I)
Add
dihydropyridine CCBs,
thiazide-type diuretics,
and/or MRAs as needed
(Class I)
Angina
pectoris
No
BP goal not met
Yes
Colors correspond to Class of Recommendation in Table 1.
*GDMT beta blockers for BP control or relief of angina include carvedilol, metoprolol tartrate, metoprolol succinate,
nadolol, bisoprolol, propranolol, and timolol. Avoid beta blockers with intrinsic sympathomimetic activity. The beta
blocker atenolol should not be used because it is less effective than placebo in reducing cardiovascular events.
†If needed for BP control.
14
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
15. Vai trò thuốc UC Calci trong đt bệnh THA
Chronic Kidney Disease
COR LOE
Recommendations for Treatment of Hypertension
in Patients With CKD
I
SBP:
B-RSR
Adults with hypertension and CKD should be treated to a BP
goal of less than 130/80 mm Hg.
DBP:
C-EO
IIa B-R
In adults with hypertension and CKD (stage 3 or higher or
stage 1 or 2 with albuminuria [≥300 mg/d, or ≥300 mg/g
albumin-to-creatinine ratio or the equivalent in the first
morning void]), treatment with an ACE inhibitor is
reasonable to slow kidney disease progression.
IIb C-EO
In adults with hypertension and CKD (stage 3 or higher or
stage 1 or 2 with albuminuria [≥300 mg/d, or ≥300 mg/g
albumin-to-creatinine ratio in the first morning void]),
treatment with an ARB may be reasonable if an ACE
inhibitor is not tolerated.
SR indicates systematic review.
15
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
16. Vai trò thuốc UC Calci trong đt bệnh THA
Management of Hypertension in Patients With CKD
•Colors correspond to Class of Recommendation in Table 1.
•*CKD stage 3 or higher or stage 1 or 2 with albuminuria ≥300 mg/d or ≥300 mg/g
creatinine.
•ACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BP
blood pressure; and CKD, chronic kidney disease.
Treatment of hypertension in patients with CKD
Albuminuria
(≥300 mg/d or ≥300 mg/g
creatinine)
ACE inhibitor*
(Class IIa)
Yes
Usual “first-line”
medication choices
ACE inhibitor
(Class IIa)
ARB*
(Class IIb)
No
Yes
ACE inhibitor
intolerant
No
BP goal <130/80 mm Hg
(Class I)
16
17. Vai trò thuốc UC Calci trong đt bệnh THA
Hypertension After Renal Transplantation
COR LOE
Recommendations for Treatment of Hypertension After Renal
Transplantation
IIa
SBP:
B-NR
After kidney transplantation, it is reasonable to treat patients
with hypertension to a BP goal of less than 130/80 mm Hg.
DBP:
C-EO
IIa B-R
After kidney transplantation, it is reasonable to treat
patients with hypertension with a calcium antagonist on the
basis of improved GFR and kidney survival.
17
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
18. Vai trò thuốc UC Calci trong đt bệnh THA
Management of Hypertension in Patients With Acute Ischemic Stroke
Colors correspond to Class of Recommendation in Table 1.
BP indicates blood pressure; DBP, diastolic blood pressure; IV, intravenous; and SBP,
systolic blood pressure.
Acute (<72 h from symptom onset) ischemic
stroke and elevated BP
Yes
Initiating or reinitiating treatment of
hypertension within the first 48-72
hours after an acute ischemic stroke is
ineffective to prevent death or
dependency
(Class III: No Benefit)
Lower SBP to <185 mm Hg and
DBP <110 mm Hg before
initiation of IV thrombolysis
(Class I)
Lower BP 15%
during first 24 h
(Class IIb)
Patient
qualifies for IV
thrombolysis
therapy
BP ≤220/110 mm Hg BP >220/110 mm Hg
For preexisting hypertension,
reinitiate antihypertensive drugs
after neurological stability
(Class IIa)
Maintain BP <180/105 mm Hg for
first 24 h after IV thrombosis
(Class I)
No
And
18
19. Vai trò thuốc UC Calci trong đt bệnh THA
Management of Hypertension in Patients With a Previous
History of Stroke (Secondary Stroke Prevention)
Colors correspond to Class of Recommendation in Table 1.
DBP indicates diastolic blood pressure; SBP, systolic blood pressure; and TIA, transient
ischemic attack.
Stroke ≥72 h from symptom onset and stable
neurological status or TIA
Initiate
antihypertensive
treatment
(Class I)
Restart
antihypertensive
treatment
(Class I)
Usefulness of starting
antihypertensive
treatment is not
well established
(Class IIb)
Previous
diagnosed or treated
hypertension
Established
SBP ≥140 mm Hg or
DBP ≥90 mm Hg
No
Aim for
BP <140/90 mm Hg
(Class IIb)
Established
SBP <140 mm Hg and
DBP <90 mm Hg
Aim for
BP <130/80 mm Hg
(Class IIb)
Yes
19
20. Vai trò thuốc UC Calci trong đt bệnh THA
Diabetes Mellitus
COR LOE
Recommendations for Treatment of Hypertension in
Patients With DM
I
SBP:
B-RSR
In adults with DM and hypertension, antihypertensive drug
treatment should be initiated at a BP of 130/80 mm Hg or
higher with a treatment goal of less than 130/80 mm Hg.
DBP:
C-EO
I ASR
In adults with DM and hypertension, all first-line classes
of antihypertensive agents (i.e., diuretics, ACE
inhibitors, ARBs, and CCBs) are useful and effective.
IIb B-NR
In adults with DM and hypertension, ACE inhibitors or
ARBs may be considered in the presence of
albuminuria.
SR indicates systematic review.
20
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
21. Vai trò thuốc UC Calci trong đt bệnh THA
Pregnancy
COR LOE
Recommendations for Treatment of Hypertension
in Pregnancy
I C-LD
Women with hypertension who become pregnant,
or are planning to become pregnant, should be
transitioned to methyldopa, nifedipine, and/or
labetalol during pregnancy.
III:
Harm
C-LD
Women with hypertension who become pregnant
should not be treated with ACE inhibitors, ARBs, or
direct renin inhibitors.
21
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
22. Vai trò thuốc UC Calci trong đt bệnh THA
BP Thresholds for and Goals of Pharmacological Therapy in
Patients With Hypertension According to Clinical Conditions
Clinical Condition(s)
BP Threshold,
mm Hg
BP Goal,
mm Hg
General
Clinical CVD or 10-year ASCVD risk ≥10% ≥130/80 <130/80
No clinical CVD and 10-year ASCVD risk <10% ≥140/90 <130/80
Older persons (≥65 years of age; noninstitutionalized, ambulatory,
community-living adults)
≥130 (SBP) <130 (SBP)
Specific comorbidities
Diabetes mellitus ≥130/80 <130/80
Chronic kidney disease ≥130/80 <130/80
Chronic kidney disease after renal transplantation ≥130/80 <130/80
Heart failure ≥130/80 <130/80
Stable ischemic heart disease ≥130/80 <130/80
Secondary stroke prevention ≥140/90 <130/80
Secondary stroke prevention (lacunar) ≥130/80 <130/80
Peripheral arterial disease ≥130/80 <130/80
ASCVD indicates atherosclerotic cardiovascular disease; BP, blood pressure; CVD,
cardiovascular disease; and SBP, systolic blood pressure.
TL: Whelton PK et al. JACC 13 Nov 2017. www.acc.org
34. Vai trò thuốc UC Calci trong đt bệnh THA
Kết luận
‐ Chẩn đoán THA: nên dựa vào huyết áp đo tại nhà và
ABPM
‐ Huyết áp kế điện tử; băng quấn cánh tay
‐ Nên ngưng thuốc lá
‐ THA do hẹp ĐM thận: điều trị nội là chính
‐ Thuốc đầu tiên không chỉ định bắt buộc: UCMC, chẹn
thụ thể AG II, ức chế calci, lợi tiểu, chẹn beta
‐ Phối hợp thuốc là cần thiết
‐ Ức chế calci DHP: vai trò quan trọng trong điều trị THA
34