







 
 



 !
"#$%&'($%
")
"*$+,#$%&'(
 /0
Adapted from Dzau, Braunwald. Am Heart J 1991;121:1244–1263
Mở đầu: Chuỗi diễn tiến bệnh
tim mạch
CAD Death Rate per 10,000 Person-years
100+ 90-99 80-89
75-79 70-74 <70
<120
120-139
140-159
160+
Diastolic BP (mmHg)
Systolic BP
(mmHg)

!"#$%&
!"#$%&
%'()*) +,-
%'()*) +,-
+./0
+./0
Mở đầu:
Mở đầu:
+12'3$4$%
+12'3$4$%
 
 
:+*1+3;;2)4*&1$&13<*1*1131*+24/&=:>//+2?@131*+)+$3*++3A/B*
13<*1*1213*6CCD7E6DFEE52
Mở đầu:
Mở đầu:
$56728+
$56728+
9)6%
9)6%
:+*1+3;;2)4*&1$&13<*1*1131*+24/&=:>//+2?@131*+)+$3*++3A/B*
13<*1*1213*6CCD7E6DFEE52
Mở đầu:
Mở đầu:
:$85;2"2"<
:$85;2"2"<
*842"2"<=>?,
*842"2"<=>?,
:+*1+3;;2)4*&1$&13<*1*1131*+24/&=:>//+2?@131*+)+$3*++3A/B*
13<*1*1213*6CCD7E6DFEE52

  " $   Đ ề ị ở ạ ổ ị
  " $   Đ ề ị ở ạ ổ ị

"" $   ! Đ ở ộ ứ ạ ấ
"" $   ! Đ ở ộ ứ ạ ấ

"" $#)  Đ ở ệ Đ
"" $#)  Đ ở ệ Đ

 %       *+, /-ấ ỳ ố ạ ệ ả ể ấ
 %       *+, /-ấ ỳ ố ạ ệ ả ể ấ
    ề ụ ă ừ
    ề ụ ă ừ
@$'7 +,
@$'7 +,
:+*1+3;;2)1/31$1+;131*+1G31'1+1$1+;4*&1$&13
<*1*121;&1$1H3+$1)+&/*+)/&/)3+/+>1$+/+
G31'1+2)3&/+6CCD76D8F6DIE2
@$'7 +,
@$'7 +,

J3KL$,#
J3KL$,#
&M&+$N&,#J
&M&+$N&,#J

012
012
or
or

G31'1+2)3&/+6CCD76D8F6DIE2
% K 
% K 
+,LMNOPIHHQ
+,LMNOPIHHQ
• Caution should be exercised when combining a non DHP-CCB and a beta-blocker
• If abnormal systolic left ventricular function: avoid non DHP-CCB (Verapamil or
Diltiazem)
•
Dual therapy with an ACEI and an ARB are not recommended in the absence of
refractory heart failure
•
The combination of an ACEi and CCB is preferred
1. Beta-blocker
2. Long-acting CCB
Stable angina
ACEI are recommended for most
patients with established CAD*
ARBs are not inferior to ACEI in IHD
Short-acting
nifedipine
*Those at low risk with well controlled risk factors may not benefit from ACEI therapy
Kết cục lâm sàng chính: NC
Kết cục lâm sàng chính: NC
EUROPA
EUROPA
% Tử vong do TM, NMCT hay ng
% Tử vong do TM, NMCT hay ng
ư
ư

0
0
2
2
4
4
6
6
8
8
10
10
12
12
14
14
0
0
1
1
2
2
3
3
4
4
5
5
-TUVWX4Y)ZV[G>
Tử vong do tim

Placebo
Ramipril
Years
Primary
outcome
(% HOPE-TOO
patients)
25
20
15
10
5
4652
4645
4432
4456
4204
4256
3981
4079
3647
3789
2719
2819
1923
2075
1550
1731
Placebo
Ramipril

;3+$,3;,'13***3+^1/]$$G3+1&+;3+$4*&1$&131'1*+*&1&[3+3*^3+$1*
O^G[^Q3+$\1&/&/3/*2$13@6CC7C68CF68D2
_&M`
'+
)0$a
!bc$!
_&M
de
f/#
f/#'()
66
66
Có THA kèm:
BCTPĐ tắc nghẽn

^
MT: ↓ HA tới
<130/80mmHg/1h.Kh
ông ↓ HATTr
<60mmHg.
Thuốc: -Lợi tiểu
-Nitroglycerine
-UC hệ RAA
-Chẹn β
- Chẹn β
- UC calcium non
dihydropyrindin
MT: ↓ HA tới
<130/80mmHg/3h.Không ↓
HATTr < 60mmHg.

131*+;+3
+*/\1
G1*2)3
GA*
)3+/6CCD78
CF8C2
7STU
7STU
6E
6E
>)X1/1*;+31+**31$1+;
&1&3+&13;/316CCI2
%%R
%%R
69
69
):?H[:<2):<4[g[X^2
6CC7G895
%&%RT
%&%RT

 ẹ
 ẹ

$44
$44

;  ợ ể
;  ợ ể
