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Thuoc dieu tri tang huyet ap

Thong ke cho thay 1/3 so nguoi tang huyet ap khong duoc phat hien. Va trong so nguoi duoc phat hien thi co toi mot nua khong duoc dieu tri thich hop hoac dieu tri khong den noi den chon.

Can hieu ro co che tac dung cua tung loai thuoc dieu tri huyet ap.

Theo To chuc Y te The gioi (WHO) thi tri so huyet ap toi uu la 120/80mmHg, trong do so tren 120 la huyet ap tam thu, con so duoi 80 la huyet ap tam truong. Nguoi bi tang huyet ap thi tri so huyet ap tam thu tren huyet ap tam truong cao hon 140/90mmHg. Viec su dung thuoc de dieu tri tang huyet ap nham muc dich dua tri so huyet ap ve duoi 130/85mmHg doi voi nguoi o tuoi trung nien hoac mac benh dai thao duong hay la duoi 140/90mmHg doi voi nguoi tu 60 tuoi tro len.

Tuy theo huyet ap do duoc, nguoi ta chia tang huyet ap lam 3 muc do khac nhau: nhe, vua va cao. O gioi han tang nhe va vua nguoi ta khuyen nen ap dung bien phap luyen tap the duc, che do an giam can, han che chat beo dong vat, giam muoi, bo thuoc la, thu gian. Neu huyet ap tam truong tren 90mmHg thi can dieu tri bang thuoc, can cu nay da mang lai hieu qua ro ret, giam cac tan suat dot quy, tai bien mach mau nao, suy tim, phi dai that trai.

Hien nay thuoc tang huyet ap co nhieu loai, chia lam nhieu nhom khac nhau, tuy theo co che tac dung cua thuoc:

Nhom thuoc loi tieu

Co 3 loai:

Thiazid: La mot trong nhung thuoc dieu tri tang huyet ap voi co che lam giam the tich tuan hoan. Phoi hop voi cac thuoc uc che men chuyen, chen beta, chen anpha... co tac dung tot hon so voi dung don doc. Khong dung thuoc nay cho nguoi suy gan, than va man cam voi thanh phan cua thuoc. Tac dung phu cua thuoc la tang dao thai natri va clorua, giam the tich huyet tuong, giam cung luong tim va dong mau than. Dao thai kali tang len nhung lai giam dao thai canxi va axit uric lam tang cholesterol toan phan. Than trong voi nguoi roi loan chuc nang tim, dai thao duong, roi loan lipid, va benh gut. Tac dung phu con co the buon non, dau dau, tieu chay, suy giam kha nang tinh duc...

Thuoc tac dung len quai Henle nhu bumetamid, furosemid,... uc che tai hap thu natri va clorua o cuoi ong than va quai Henle, duoc dung cho nguoi giam chuc nang than, suy tim, ho tro cac thuoc duy tri the tich. Khong dung cho nguoi benh nao, benh gan, mat nuoc, mat mau, suy than, tac duong nieu. Tac dung phu la doc tinh voi tai tang neu phoi hop voi aminoglycosid, voi nguoi suy than, mat canxi, kali, thuoc co the gay buon non, u tai, tieu chay, dau dau, nhin mo.

Thuoc loi tieu giu kali: Nhu amilorid, spironolactam...  ngan ngua dao thai kali do cac thiazid va loi tieu quai, do uc che canh tranh voi aldosteron dung trong dieu tri aldosteron tien phat, suy tim, xo gan co truong. Khong dung cho nguoi suy than, suy gan, nguoi mang thai, cho con bu. Thuoc co the gay buon non, buon ngu, tang kali mau, vu to o nam gioi.

Nhom thuoc doi khang canxi: Gom co nifedipin, nicardipin, amlodipin, felodipin, isradipin, verapamil, diltiazem... Co che tac dung cua thuoc la ngan chan khong cho ion canxi lot vao te bao co tron cua cac mach mau, de gay gian mach lam ha huyet ap. Thuoc duoc su dung huu hieu doi voi benh nhan tang huyet ap co them benh dau that nguc, benh nhan cao tuoi, khong anh huong den chuyen hoa duong, mo trong co the. Con dung cho benh nhan tang huyet ap nhip cham, suy than, nhung tranh dung nifedipin vi lam tang protein nieu.

                Kiem tra huyet ap tu the dung.

Nhom thuoc chen thu the anpha: Gom co prazosin, alfuzosin, terrazosin, phentolamin. Co che tac dung cua thuoc la uc che viec giai phong noradrenalin, la chat sinh hoc lam tang huyet ap tai dau day than kinh, do do lam ha huyet ap.

Thuoc duoc su dung cho benh nhan tang huyet ap dong thoi bi phi dai tuyen tien liet.

Nhuoc diem cua thuoc nhom nay la co tac dung phu gay ha huyet ap the dung, dac biet khi dung lieu dieu tri dau tien.

Nhom thuoc chen thu the beta: Gom co propanolon, pindolol, nadolol, timolol, atenolol, metoprolol, labetolol, acebutolol... Co che tac dung cua thuoc la uc che thu the beta giao cam o tim, mach ngoai vi, se lam cham nhip tim va ha huyet ap. Thuoc duoc su dung cho benh nhan tang huyet ap kem them dau that nguc hoac dau nua dau, cho benh nhan tang huyet ap sau nhoi mau co tim, it dung de khoi tri o nguoi gia, hop voi benh nhan dang trong tinh trang tang dong cuong giao cam, khong dung dai ngay neu HDL-cholesterol thap ma tang triglycerid. Thuoc duoc chong chi dinh cho benh nhan hen suyen, suy tim, nhip dap cham.

Nhom thuoc uc che men chuyen (ACE): Gom co captopril, enalapril, benazepril, lisinopril, perindopril, quinapril, trandopril... voi co che ngan su chuyen hoa angiotensin I thanh angiotensin II, lam giam san sinh aldosteron, tang thai tru natri va nuoc, tang renin va kali hoa.

Thuoc duoc lua chon dung cho nguoi suy tim, tieu duong, lipid mau, benh ly mach ngoai vi, tang tuoi mau va suc loc cau than va thay doi dung luong tim. Thuoc it lam thay doi nong do insulin huyet va duong mau. Khong dung cho phu nu co thai va cho con bu, tien su phu mach va di ung thuoc.

Thuoc co nhieu tac dung phu, gay ho toi 30% nguoi dung, rat kho chiu. Gay phu mach mat, dau chi, moi, luoi, thanh quan. Ngoai ra co the gay chong mat, co the ngat khi dung lieu dau tien. Cung co the suy than cap o nguoi hep dong mach than, giam bach cau, roi loan vi giac, protein nieu.

Nhom thuoc doi khang thu the angiotensin II: Gom co thuoc losartan, irbesartan, candesartan, valsartan... Co che tac dung cua thuoc co uu diem la khong truc tiep uc che men chuyen ACE ma thay vi uc che men nay (vi sinh tac dung phu ho khan) ma chi ngan can khong cho angiotensin II gan vao thu the cua no nam o mach mau, tim, than de khong tang duoc huyet ap ma lam ha huyet ap.

Thuoc co tac dung tuong duong ve ha huyet ap va dua ve huyet ap binh thuong, voi cac thuoc thuoc nhom doi khang canxi, nhom chen beta, nhom uc che men chuyen. Dac biet la nhom nay, tac dung ha tot huyet ap khi phoi hop voi thuoc nhom loi tieu thiazid va khong gay ho khan nhu nhom thuoc uc che men chuyen hay gay phu nhu thuoc nhom doi khang canxi. Thuoc nay cung co the gay chong mat, tieu chay, nhung rat hiem. Khong dung cho phu nu co thai hoac bi di ung voi thuoc.

Viec dung thuoc tang huyet ap rat phuc tap, vi vay muon dieu tri tot nhat la phai di kham benh de co dieu kien do huyet ap theo doi chinh xac, lam cac xet nghiem can thiet, de chon lua, chi dinh thuoc chinh xac, huong dan su dung dung benh, dung thuoc vi khong ai nam duoc benh trang cua benh nhan, tinh nang cua thuoc, cach dung cua thuoc bang bac si.

Tuyet doi khong tuy tien su dung thuoc ha huyet ap khong qua tham kham va y kien cua bac si.

DS. Phan Quoc Dong