Thiếu sót hay gặp khi dùng thuốc chữa cao huyết áp

Thieu sot hay gap khi dung

Khi dung thuoc dieu tri

cao huye't ap ngfldi bfnh

thd&ng ed cdc thifi'u sdt:

- Bieu tri mudn do phdt hien

mupn: Cao huylt dp khfing cd trifu

chiing dac hifu, khfing ed dd'u hieu

tiln bdo nfin dflde phdt hifn mufin,

ed khi rdt mufin, thdm chi dfi'n lue

xay ra tai biln mdi xdc dinh bfnh.

Ngfldi trfldng thdnh mfii ndm nen

khdm sfle khde dinh ky mfit lan

dl tim sodt bfinh trong dd ed cao

huyfi't dp. Nhflng ngfldi ed nguy

cd cao (tren 40 tuli, cd thfla can

hay bdo phi, rfi'i logn md mdu,

dai thdo dfldng) it nhlt 6 thang

mfit lln phdi do huyfi't dp dl phat

hifn bfnh. Khi thay huylt dp eao,

nen do lai 3 dot, each nhau mfii

thdng. Chi sau 3 dot do ma tri so

trung binh cua huyfi't dp deu >

140/90mmHg mdi xde dinh la bi

cao huyfi't dp.

- Bieu tri mudn do theo quan

niim dung thudc cu: Trfldc day

eho rin g ne'u huye't dp tren

140/90mmHg md sau mft ndm

thay dli lli song khfing cd hifu

qua hoac ed kem nguy cO (nhfl ddi

thdo dfldng) thi mdi dung thulc.

Nay, hfldng dan eua Hpi huyfit

dp chdu Au (ESH - 2007, ESH -

2009) vd eiia My (UN-7) qui dinh:

Ngfldi dfldi 80 tuli cao huyfi't dp

nfi'u khfing kem theo nguy cd thi

khdi diu dilu tri khi huyfi't dp

> 140/90mmHg; eon nfi'u cd ye'u

t l nguy CO thi khdi dau dilu tri

khi huyet dp > 130/85mmHg (md

khfing chd kit qua vific thay dli

Id'i sfi'ng). Nhfl vdy, vifc khdi ddu

ddng thud'c sdm han trUdc khd

nhiiu. Dung thud'c sdm lam chdm

sfl tifi'n trien dfi'n ngng, dfla huyfi't

dp vl dieh dilu tri sdm, trdnh ede

nguy ed do tdng huyfi't dp.

- Khdng dung dd thudc phdi

hgp theo chi dinh: Lifu phdp phfi'i

hop d n flu tifin dp dung eho ngfldi

nguy ca cao nham ha thd'p huyfi't

dp nhanh, tranh tham hpa. Phli

hdp thufi'e se hi sung vd ldm tdng

hifiu life cua nhau, eho hifiu qud

sdm hon, cao hdn dimg ddn; lieu

dung moi thanh phan thip hcfn khi

dung ddn, ngn ft gap tdc dung phii.

Tuy nhien mfit so phfi'i hpp c6 ihi

gay ra tde dimg phu. Khfing tu f

phli hop hay dflng cdc bifit difgc

Itep. Chi dflde phfi'i hdp theo chl

dinh cua thay thule, khi dflpc chi

dinh d n dung du thufi'c du lieu cac

thdnh phan phli hdp.

- Tli tdng liiu theo cdm giac

chd quan: Khi nhfle diu, khfi chiu.,.

ngfldi bfnh eho la do huyet ap

tdng, rli tfl tang lilu. Thfle ra, cac

trifu chflng trfin chfla hdn do huylt

dp tang. Tfl tang lilu cd thi gdy tut

huylt dp qud mfle, thdm ehi c6 thi

gdy truy maeh. Mpt nghien cdu tai

cde phdng khdm Phdp eho bilt co

80% ngfldi hi cdc trieu ehflng trSn,

thdm ehf huye't dp ed tdng cao chut

dinh so vdi huyfi't dp muc tieu, khi

dfi'n vifn chi cho ndm nghi d phong

chd yen tinh la huyfi't dp trd vl mile

mue tifiu md khfing can diJng thuoc

hay nhgp vien. Ngfldi bfinh khfing

nfin tang lilu ddng theo edm giac

chu quan.

^ Trong nghien cflu thfl hai, mang ten COSMOS, mdt

nhdm cde nhd nghifin cflu My vd chau Au do GS. Erie

Lawitz tfl Vifn Gan Texas, Hoa Ky, phdn nglu nhifin

167 bfnh nhdn cd HCV, kiiu gen la ud lb de cho ufi'ng

hai logi thule mdi trong nhdm DAA Id sofosbuuir va

simeprevir, mft lln mfii ngdy, trong 12 tuan hodc 24

tudn. Chi sau 12 tuan dilu tri, 93% ngfldi tham gia

dflpc chfla khdi (bao gim ca nhiing ngfldi hi xd gan vk

trfldc dd khdng ddp flng vdi dilu tri bing interferon).

Mot thudc tri viem gan C sd dijng trong nghidn cdu COSMOS

Bfnh nhan khdng cdn virus trong mdu 3 thdng sau

khi ngflng dilu tri. Vifc keo dai thdi gian dilu tri din

24 tudn hodc cd them ribavirin khdng eho bit ky Id

fch rd rang ndo.

Chl dp 12 tuan sofosbuvir cdng simeprevir dUBC

dung ngp td't. Chi cd it hon 2% ngfldi tham gia bao

cdo eae tdc dung phu nghifim trpng hodc phdi ngifng

dieu tri do phan dng cua thule.

Theo GS. Lawitz, "Chung tdi nhdn thay mft ty le

chfla khdi khoang 93% vdi cM 12 tuan dilu tri. bbg

edch sfl dung mdt ehe dd toan bing dfldng uing ma

khfing dung interferon hoae ribavirin.

Binh luan vl sfl kifn nay, GS. Ed Gane, Gidm d^c

cac ddn vi ghep gan tgi Bfinh vifin Auckland City 9

New Zealand cho bilt, trong tfldng lai gin, tit ea

cde phac dl dimg thufi'e uong nhdm DAA cd thi eai

thifn sfl ha'p thu va thdnh cdng vl dilu tri vifim gan

C, gidm bdt gdnh nang sfle khde do cac biln chitog

lifin quan din gan.

Khi kit hop vdi xfit nghiem vd dilu tri nhlm my^

tifiu dfl phdng d cdc quan the ngfl&i cd klia ndng gSy

truyen nhilm, cdc phae do DAA hy vpng cdn cd thi

tifi'n tdi loai bd lay nhilm HCV. 3$£

THu6c & SLfC KHOE so 507 (1.9.2014)