Tiến bộ mới trong điều trị tăng huyết áp kháng trị
Nội dung chính của bài viết
Tóm tắt
Tăng huyết áp kháng trị chiếm khoảng 10 - 20% tổng số bệnh nhân tăng huyết áp và là nhóm có nguy cơ cao gặp biến cố tim mạch, thận và đột quỵ, gây gánh nặng lớn cho hệ thống y tế toàn cầu. Dù đã áp dụng các phác đồ điều trị phối hợp tối ưu, nhiều bệnh nhân vẫn không đạt được huyết áp mục tiêu, cho thấy nhu cầu cấp thiết về các phương pháp điều trị mới. Hai hướng tiếp cận tiên tiến hiện nay gồm: triệt đốt thần kinh giao cảm động mạch thận (RDN) - một thủ thuật can thiệp giúp giảm huyết áp ổn định ở nhóm bệnh nhân chọn lọc; và nhóm thuốc ức chế aldosterone synthase (ASI) - nổi bật là Baxdrostat, chất ức chế chọn lọc enzym CYP11B2, đã chứng minh hiệu quả hạ huyết áp mạnh, bền vững, an toàn qua các nghiên cứu pha III như BaxHTN, BaxAsia, Bax24. Những tiến bộ này mở ra triển vọng mới trong kiểm soát tăng huyết áp kháng trị, hướng tới điều trị cá thể hoá và nhắm trúng cơ chế bệnh sinh.
Chi tiết bài viết
Từ khóa
Tăng huyết áp kháng trị, triệt đốt thần kinh giao cảm động mạch thận, thuốc ức chế aldosterone synthase, Baxdrostat
Tài liệu tham khảo
1. World Health Organization. Global report on hypertension 2025. WHO. 2025;
2. World HO. Global report on hypertension: the race against a silent killer. World Health Organization; 2023.
3. Brant LCC, Passaglia LG, Pinto-Filho MM, de Castilho FM, Ribeiro ALP, Nascimento BR. The burden of resistant hypertension across the world. Current Hypertension Reports. 2022; 24(3): 55-66. Doi.org/10.1007/s11906-022-01173-w.
4. Noubiap JJ, Nansseu JR, Nyaga UF, Sime PS, Francis I, Bigna JJ. Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart. 2019; 105(2): 98-105. Doi.org/10.1136/heartjnl-2018-313599.
5. Alsharari R, Shantsila E, Lip GY, Shantsila A. Revisiting the diagnosis of ‘resistant hypertension’: What should we do nowadays’. Journal of human hypertension. 2022; 36(4): 337-340. Doi.org/10.1038/s41371-021-00631-3.
6. Dogra S, Shah S, Gitzel L, et al. Baxdrostat: a novel aldosterone synthase inhibitor for treatment resistant hypertension. Current Problems in Cardiology. 2023; 48(11): 101918. Doi.org/10.1016/j.cpcardiol.2023.101918.
7. Flack JM, Azizi M, Brown JM, et al. Baxdrostat Efficacy and Safety in Uncontrolled and Resistant Hypertension. The New England journal of medicine. 2025. Doi:10.1056/NEJMoa2507109.
8. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2025; Doi.org/10.1161/CIR.0000000000001356.
9. John William Mcevoy, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). European heart journal. 2024: 3912-4018. Doi.org/10.1093/eurheartj/ehae178.
10. Huỳnh Văn Minh và cộng sự. Khuyến cáo chẩn đoán và điều trị tăng huyết áp. 2022;
11. Jafari E, Cooper-DeHoff RM, Effron MB, Hogan WR, McDonough CW. Characteristics and predictors of apparent treatment-resistant hypertension in real-world populations using electronic health record-based data. American Journal of Hypertension. 2024; 37(1): 60-68. Doi.org/10.1093/ajh/hpad084.
12. Ebinger JE, Kauko A, FinnGen, Bello NA, Cheng S, Niiranen T. Apparent treatment-resistant hypertension associated lifetime cardiovascular risk in a longitudinal national registry. European journal of preventive cardiology. 2023;30(10):960-968. Doi.org/10.1093/eurjpc/zwad066
13. Coccina F, Pierdomenico AM, Cuccurullo C, Pizzicannella J, Trubiani O, Pierdomenico SD. Ambulatory resistant hypertension and risk of heart failure in the elderly. Diagnostics. 2023; 13(9): 1631. Doi.org/10.3390/diagnostics13091631.
14. Kaczmarski KR, Sozio SM, Chen J, Sang Y, Shafi T. Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES). BMC nephrology. 2019; 20(1): 138. Doi.org/10.1186/s12882-019-1315-0.
15. Nguyễn Thị Tố Vân. Tuân thủ dùng thuốc ở người cao tuổi bị tăng huyết áp: Tổng quan hệ thống và phân tích gộp. Tạp chí Y học Việt Nam. 2025; 547(1). Doi.org/10.51298/vmj.v547i1.12926.
16. Reinhold Kreutz. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension. European journal of internal medicine. 2024; 126: 1-15. Doi.org/10.1016/j.ejim.2024.05.033.
17. Azizi M, Sharp AS, Fisher ND, et al. Patient-level pooled analysis of endovascular ultrasound renal denervation or a sham procedure 6 months after medication escalation: the RADIANCE clinical trial program. Circulation. 2024; 149(10): 747-759. Doi.org/10.1161/circulationaha.123.066941.
18. Mancia Chairperson. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). Journal of hypertension. 2023; 41(12): 1874-2071. Doi: 10.1097/HJH.0000000000003480.
19. Cicero AF, Tocci G, Avagimyan A, et al. Aldosterone Synthase Inhibitors for Resistant Hypertension: Pharmacological Insights-A Systematic Review: Arrigo. FG Cicero et al. Drugs. 2025: 1-25. Doi.org/10.1007/s40265-025-02229-2.
20. Schiffrin EL. Effects of aldosterone on the vasculature. Hypertension. 2006; 47(3): 312-318. Doi.org/10.1161/01.hyp.0000201443.63240.a7.
21. Dey S, Frishman WH, Aronow WS. Baxdrostat: an aldosterone synthase inhibitor for the treatment of systemic hypertension. Cardiology in Review. 2025; 33(3): 243-245. Doi.org/10.1097/crd.0000000000000595.
22. Flack JM, Azizi M, Brown JM, et al. Baxdrostat for uncontrolled and resistant hypertension: rationale and design of the Phase 3 clinical trials BaxHTN, BaxAsia, and Bax24. Hypertension Research. 2025: 1-13. Doi.org/10.1038/s41440-025-02297-7.
23. Ando H. Baxdrostat and the future of aldosterone-targeted therapy. Hypertension Research. 2025: 1-2. Doi.org 10.1038/s41440-025-02415-5.
24. Syed HR, Bhatia K, Dasgupta I, Ferro A. The state of renal sympathetic denervation for the management of patients with hypertension: A systematic review and meta-analysis. Eur Heart J. 2021; 42(15): 1440-1450. doi:10.1093/eurheartj/ehaa932.
25. Mahfoud F, Böhm M, Schmieder R, Narkiewicz K, Ewen S, Ruilope L, et al. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the Global SYMPLICITY Registry. Eur Heart J. 2019; 40(42): 3474-3482. doi:10.1093/eurheartj/ehz118.
2. World HO. Global report on hypertension: the race against a silent killer. World Health Organization; 2023.
3. Brant LCC, Passaglia LG, Pinto-Filho MM, de Castilho FM, Ribeiro ALP, Nascimento BR. The burden of resistant hypertension across the world. Current Hypertension Reports. 2022; 24(3): 55-66. Doi.org/10.1007/s11906-022-01173-w.
4. Noubiap JJ, Nansseu JR, Nyaga UF, Sime PS, Francis I, Bigna JJ. Global prevalence of resistant hypertension: a meta-analysis of data from 3.2 million patients. Heart. 2019; 105(2): 98-105. Doi.org/10.1136/heartjnl-2018-313599.
5. Alsharari R, Shantsila E, Lip GY, Shantsila A. Revisiting the diagnosis of ‘resistant hypertension’: What should we do nowadays’. Journal of human hypertension. 2022; 36(4): 337-340. Doi.org/10.1038/s41371-021-00631-3.
6. Dogra S, Shah S, Gitzel L, et al. Baxdrostat: a novel aldosterone synthase inhibitor for treatment resistant hypertension. Current Problems in Cardiology. 2023; 48(11): 101918. Doi.org/10.1016/j.cpcardiol.2023.101918.
7. Flack JM, Azizi M, Brown JM, et al. Baxdrostat Efficacy and Safety in Uncontrolled and Resistant Hypertension. The New England journal of medicine. 2025. Doi:10.1056/NEJMoa2507109.
8. Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2025; Doi.org/10.1161/CIR.0000000000001356.
9. John William Mcevoy, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO). European heart journal. 2024: 3912-4018. Doi.org/10.1093/eurheartj/ehae178.
10. Huỳnh Văn Minh và cộng sự. Khuyến cáo chẩn đoán và điều trị tăng huyết áp. 2022;
11. Jafari E, Cooper-DeHoff RM, Effron MB, Hogan WR, McDonough CW. Characteristics and predictors of apparent treatment-resistant hypertension in real-world populations using electronic health record-based data. American Journal of Hypertension. 2024; 37(1): 60-68. Doi.org/10.1093/ajh/hpad084.
12. Ebinger JE, Kauko A, FinnGen, Bello NA, Cheng S, Niiranen T. Apparent treatment-resistant hypertension associated lifetime cardiovascular risk in a longitudinal national registry. European journal of preventive cardiology. 2023;30(10):960-968. Doi.org/10.1093/eurjpc/zwad066
13. Coccina F, Pierdomenico AM, Cuccurullo C, Pizzicannella J, Trubiani O, Pierdomenico SD. Ambulatory resistant hypertension and risk of heart failure in the elderly. Diagnostics. 2023; 13(9): 1631. Doi.org/10.3390/diagnostics13091631.
14. Kaczmarski KR, Sozio SM, Chen J, Sang Y, Shafi T. Resistant hypertension and cardiovascular disease mortality in the US: results from the National Health and Nutrition Examination Survey (NHANES). BMC nephrology. 2019; 20(1): 138. Doi.org/10.1186/s12882-019-1315-0.
15. Nguyễn Thị Tố Vân. Tuân thủ dùng thuốc ở người cao tuổi bị tăng huyết áp: Tổng quan hệ thống và phân tích gộp. Tạp chí Y học Việt Nam. 2025; 547(1). Doi.org/10.51298/vmj.v547i1.12926.
16. Reinhold Kreutz. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension. European journal of internal medicine. 2024; 126: 1-15. Doi.org/10.1016/j.ejim.2024.05.033.
17. Azizi M, Sharp AS, Fisher ND, et al. Patient-level pooled analysis of endovascular ultrasound renal denervation or a sham procedure 6 months after medication escalation: the RADIANCE clinical trial program. Circulation. 2024; 149(10): 747-759. Doi.org/10.1161/circulationaha.123.066941.
18. Mancia Chairperson. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). Journal of hypertension. 2023; 41(12): 1874-2071. Doi: 10.1097/HJH.0000000000003480.
19. Cicero AF, Tocci G, Avagimyan A, et al. Aldosterone Synthase Inhibitors for Resistant Hypertension: Pharmacological Insights-A Systematic Review: Arrigo. FG Cicero et al. Drugs. 2025: 1-25. Doi.org/10.1007/s40265-025-02229-2.
20. Schiffrin EL. Effects of aldosterone on the vasculature. Hypertension. 2006; 47(3): 312-318. Doi.org/10.1161/01.hyp.0000201443.63240.a7.
21. Dey S, Frishman WH, Aronow WS. Baxdrostat: an aldosterone synthase inhibitor for the treatment of systemic hypertension. Cardiology in Review. 2025; 33(3): 243-245. Doi.org/10.1097/crd.0000000000000595.
22. Flack JM, Azizi M, Brown JM, et al. Baxdrostat for uncontrolled and resistant hypertension: rationale and design of the Phase 3 clinical trials BaxHTN, BaxAsia, and Bax24. Hypertension Research. 2025: 1-13. Doi.org/10.1038/s41440-025-02297-7.
23. Ando H. Baxdrostat and the future of aldosterone-targeted therapy. Hypertension Research. 2025: 1-2. Doi.org 10.1038/s41440-025-02415-5.
24. Syed HR, Bhatia K, Dasgupta I, Ferro A. The state of renal sympathetic denervation for the management of patients with hypertension: A systematic review and meta-analysis. Eur Heart J. 2021; 42(15): 1440-1450. doi:10.1093/eurheartj/ehaa932.
25. Mahfoud F, Böhm M, Schmieder R, Narkiewicz K, Ewen S, Ruilope L, et al. Effects of renal denervation on kidney function and long-term outcomes: 3-year follow-up from the Global SYMPLICITY Registry. Eur Heart J. 2019; 40(42): 3474-3482. doi:10.1093/eurheartj/ehz118.