Chẹn Bêta Chọn Lọc Trên Tim Trong
ĐiềuTrị THA, Bệnh Mạch Vành & Suy
Tim, Cập Nhật 2018
PGS. TS. BS. TRẦN VĂN HUY FACC FESC
Phó Chủ Tịch Phân Hội Tăng Huyết Áp Việt Nam
PCT Hội TMMT. Chủ Tịch Hội Tim Mạch Khánh Hòa
VNM/NONCMCGM/0518/0017
Risk Factors:
Diabetes
Hypertension
Vascular
Dysfunction
Vascular Disease
Tissue Injury
(MI, Stroke)
Pathological
Remodeling
Target Organ
Dysfunction (HF, Renal
iArrhythmia)
End-stage
Organ Failure
Death
Oxidative Stress /
Endothelial
Dysfunction
Target Organ
Damage
Adapted from Dzau et al. Circulation. 2006;114:2850-2870.
Chuổi Bệnh Lý Tim Mạch
MI: Myocardial infarction
HF: Heart failure
Sympathoadrenergic
System
VNM/NONCMCGM/0518/0017
A-II
Interactions Between RAAS and SNS
•Angiotensin II
–Central SNS activation
–Increased NE release
•Renal sympathetic
nerves
–Renin release: b1
–Vasoconstriction: a1
–Na/H20 retention: a1
–Vascular remodeling: a1
renin
SNS Activity
NE
SNS=sympathetic nervous system; NE=norepinephrine; A-II=angiotensin II.
Cody. Am J Cardiol. 1997;80:9J-14J.
VNM/NONCMCGM/0518/0017
Franz H. Messerli; Sripal Bangalore .
Eur Heart J. 2017;38(44):3321-3323.
• Sympathetic overactivity has been
documented to occur in the early phases of
hypertension[6,7] as well as in the advanced
stages with hypertensive heart disease.[8]
6. Esler M et al. Mild high-renin essential hypertension. Neurogenic human hypertension? N Engl J Med 1977;296:405–411.
7. Esler M,et al. Noradrenaline release and the pathophysiology of primary human hypertension. Am J
Hypertens 1989;2:140S–146S.
8. Smith PA et al. Relation between central sympathic activity and stages of human hypertension. Am
J.Hypertens.2004.17;217-222
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Sympathetic Nerve Activity in Patients
With HTN, Diabetes, or Both
•Sympathetic nerve activity is significantly
higher in:
–Patients with essential HTN compared with normotensive patients
(P<.01)
–Patients with diabetes compared with normotensive patients
(P<.001)
•Sympathetic nerve activity is higher in patients with both
type 2 diabetes and essential HTN compared with patients
with either essential HTN or type 2 diabetes (P<.001)
Huggett RJ. Circulation. 2003;108:3097-3101.
Data derived from 68 closely matched subjects with n=17 for all groups compared
VNM/NONCMCGM/0518/0017