Điều trị đầu tiên cho tăng huyết áp ở bệnh nhân tiểu đường type 2 là gì và liều

First-line treatment for hypertension in patients with type 2 diabetes is to offer a generic angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-II receptor antagonist (AIIRA, also known as ARB) regardless of age or ethnic origin.

For adults of black African or African-Caribbean origin, an ARB is preferred over an ACE inhibitor.

If an ACE inhibitor is not tolerated (e.g., due to cough), an ARB should be offered.

Do not combine ACE inhibitors with ARBs.

If hypertension is not controlled by monotherapy, add a calcium-channel blocker (CCB) or a thiazide-like diuretic (such as indapamide).

If hypertension remains uncontrolled, offer a combination of an ACE inhibitor or ARB, a CCB, and a thiazide-like diuretic.

Specific dosages: The guidelines recommend starting with low doses and titrating to the optimum or highest tolerated dose before adding further treatment, but do not specify exact starting doses in the provided context. Typically, ACE inhibitors and ARBs are started at low doses and doubled every 1–2 weeks while monitoring renal function, potassium, and blood pressure.

For example, common starting doses (not explicitly in the provided text but consistent with UK practice) include:

• Ramipril (ACE inhibitor): 1.25–2.5 mg once daily, titrated up to 10 mg once daily.
• Lisinopril (ACE inhibitor): 10 mg once daily, titrated up to 40 mg once daily.
• Losartan (ARB): 50 mg once daily, titrated up to 100 mg once daily.
• Valsartan (ARB): 80 mg once daily, titrated up to 320 mg once daily.
• Indapamide (thiazide-like diuretic): 1.5 mg sustained release once daily.
• Amlodipine (CCB): 5 mg once daily, titrated up to 10 mg once daily.

However, exact dosing should be individualized and titrated according to response and tolerance.