I-hypertension iyinhloko enkulu evikelekayo ezifweni nasekufeni e-United States okubangela ukushaywa isifo, isifo sezinso nokuhlaselwa kwenhliziyo. Kubalulekile ukuyihlola ngokushesha bese uyiphatha, ukuze uvikele izinkinga ezinkulu. Ikhomishana kaZwelonke ehlangene yokuvimbela, ukutholakala, ukuhlolwa nokuphathwa kwe-High Blood Pressure ikhishwe izincomo ngokusekelwe ebufakazini besayensi.
Kuyini i-JNC 8?
Kungenzeka ukuthi uzwile ukuthi kuneziqondiso zokuphathwa kwegazi eliphezulu kubantu abadala. Le mihlahlandlela yanyatheliswa yi-8 Joint National Committee ekwenzeni ukuvimbela, ukutholakala, ukuhlolwa nokuphathwa kwe-High Blood Pressure, eyaziwa yi-JNC 8. Lezi ziqondiso zakhiwe ngemuva kokuba ikomidi labachwepheshe lenze zonke izici zesayensi ezitholakalayo futhi zivuselelwe ukunikeza isiqondiso odokotela abaphathi be-hypertension. I-JNC 8 incoma amabhodlela okwelashwa kwengcindezi ephakeme yegazi, imigomo yegazi, kanye nokwelashwa kwemithi ehlobene nobufakazi.
Ukucindezelwa Kwegazi Nezinhloso
Ucwaningo lubonisa ukuthi ukuncipha kwengcindezi yegazi kubantu abadala abane-hypertension nge-10 mm Hg kunganciphisa ingozi yokufa ngesifo senhliziyo nokushaya isifo ngo-25% kuya ku-40%. Ubufakazi bubonisa ukuthi abantu abadala abangaphansi kweminyaka engama-60 kufanele baqale imishanguzo lapho i-systolic blood pressure ifunda (inombolo ephezulu) ingama-140 mm Hg noma ngaphezulu noma uma i-diastolic yegazi ifundwa yi-90 mm Hg noma ngaphezulu.
Kubantu abadala abaneminyaka engaphezu kwengu-60 ubudala, ukwelashwa kufanele kuqale uma ingcindezi ye-systolic ingu-150 mm Hg noma ngaphezulu futhi uma ingcindezi ye-diastolic ingu-90 mm Hg noma ngaphezulu. Iziguli eziqala ukwelashwa kufanele zisebenzise lezi zinombolo njengenhloso yazo. Abantu abanesifo sikashukela noma izifo ezingapheli kumele basebenzise lezi zinhloso kusukela ku-JNC 8 abatholanga ubufakazi bokuthi ukugcina ingcindezi yegazi ephansi kuthuthukisa imiphumela yezempilo kula maqembu amabili.
Izincomo Zezokwelapha Zokuqala Ukwelapha
I-JNC 8 yashintsha izincomo zemithi yokwelapha kokuqala kokushisa komfutho wegazi, kusuka ezinkampanini ezidakamizwa ezingu-5 ezifundweni ezine eziphakanyisiwe. I-JNC 8 izincomo zokwelapha ezilungisiwe emakilasini amane omuthi:
- I-Angiotensin iguqula i-enzyme inhibitors (ACEI)
- I-Angiotensin receptor blockers (ARB)
- I-Diuretics
- Ama-blockers wesiteshi se-Calcium (CCB)
I-JNC 8 iphinde iphinde ibukeze ubufakazi ngokucophelela ukwenza izincomo eziqondile zemithi yezinhlelo ezincike emncintiswaneni kanye nokuba khona kwesifo sikashukela noma isifo esingenasifo sezinso. Kunobufakazi obuningi bokuthi kukhona ukungafani kobuhlanga ekuphenduleni amakilasi athile ejwayelekile wegazi lomuthi wegazi. Izincomo zokugcina ziyi:
- Abantu abaningi abangenabutho (abanesifo sikashukela) kumele baqale ukwelashwa nge-ACEI, ARB, CCB, noma i-diazitic yohlobo lwe-thiazide (okungukuthi, i-hydrochlorothiazide)
- Abantu abanzi abamnyama (abanesifo sikashukela) noma abasebenzisa i-CCB noma i-thiazide-type diuretic yokuthola ukwelashwa kokuqala komfutho wegazi ophezulu.
- Iziguli ezinesifo esingenangqondo ezingapheli ezingaphezu kweminyaka engu-18 kufanele zisebenzise i-ACEI noma i-ARB njengelashwa lokuqala noma ukwelashwa okungeziwe ngoba lokhu kuboniswe ukuthuthukisa imiphumela yezinso. Lokhu kusebenza kubantu abnyama nabangewona abamnyama.
Nini Ukwandisa I-Dose noma Engeza I-Drug entsha
I-JNC 8 incoma ukwanda komthamo wokuqala wezidakamizwa noma ukwengezwa kwesidakamizwa sesibili kusuka kwamanye amakilasi wezidakamizwa anconyiwe ku-subgroup yakho uma ungeke ukwazi ukufinyelela umgomo wakho wegazi wegazi phakathi nenyanga. Uma ukwanda kwenzalo noma ukungezwa kwesidakamizwa esisha akunciphisi ukucindezela kwegazi emgomweni wakho, bese udokotela wakho engeza isidakamizwa sesithathu kusuka kwamanye amakilasi anconywayo. Noma kunjalo, i-ACEIs nama-ARB akufanele zisetshenziswe ndawonye. Ezinye iziguli zingadinga ukwengezwa kwesidakamizwa esivela kwelinye iklasi.
Amanye amakilasi we-Antihypertension Drugs
Kunezikhathi lapho iziguli zinezinye izizathu zokuthatha izidakamizwa ezivela ekilasini ezingabhekwanga ngokuqondile ezincomo ze-JNC 8.
Isibonelo, ama-beta-blockers aboniswe ukuthuthukisa ukusinda ezigulini ezinokwehluleka kwenhliziyo, ngakho-ke ziyizikhethelo zokunciphisa ukucindezelwa kwegazi ezigulini ezinokuhluleka kwenhliziyo. Iziguli ezine-prostatic hypertrophy zivame ukuthatha izidakamizwa ezibizwa ngokuthi i-alpha blockers ukunciphisa izimpawu zabo. Le mithi ekuqaleni yaqhutshwa ukuphatha ukuphakama okukhulu kwegazi, kodwa iphinde iphumule i-prostate kanye nentamo yesinye, ivumela umchamo ukuba ugeleke ngokukhululekile. I-Alpha-blockers yindlela enhle yokwelashwa kwesifo somfutho wegazi ophezulu kumadoda ane-BPH.