Ukusebenzisa i-angiotensin-converting-inhibitor drug is a yingxenye ebalulekile yokuphatha ukuhluleka kwenhliziyo . Kubantu abanesifo senhliziyo, ama-inhibitors e-ACE aboniswe ukunciphisa isidingo sokubhedlela, ngcono izimpawu, ngisho nokuhlala isikhathi eside. Uma utholakale ukuthi unesifo senhliziyo esinqunyiwe , kufanele uphathwe nge-ACE inhibitor ngaphandle kokuba udokotela wakho enesizathu esihle kakhulu sokungenzi kanjalo.
Yini eyenziwa yi-ACE Inhibitors?
I-ACE inhibitors ivimbela i-enzyme eyinhloko ohlelweni lwe-renin-angiotensin-aldostrone (RAAS) . I-RAAS i-cascade ye-enzyme esebenza ndawonye ukulawula ukucindezelwa kwegazi, nokuhlushwa kwe-sodium egazini.
Uma igazi ligeleza ezintsheni liyancipha, i-enzyme ebizwa ngokuthi i-renin ikhishwe egazini. URenin ubangela enye i-enzyme, i-angiotensin I, ukwandisa. I-Angiotensin Ngiguqulelwa i-ACE ibe yi-angiotensin II. I-Angiotensin II ikhulisa ukucindezelwa kwegazi, futhi (ngokukhuthaza ukukhululwa kwe-hormone aldosterone kusuka ezigulini eziyingozi) kubangela ukuthi umzimba ugcine i-sodium.
I-RAAS ijwayele ukusebenza isikhathi esengeziwe kubantu abanesifo senhliziyo, okwandisa ukugcinwa kwe-sodium nokucindezelwa kwegazi, futhi kubangela inhliziyo ukuba isebenze kanzima kunalokho okufanele.
I-ACE inhibitors isebenza ngokuvimba ukubunjwa kwe-angiotensin II. Kubantu abanesifo senhliziyo lokhu kunciphise ukucindezeleka kwegazi futhi kunciphisa ukugcinwa kwe-sodium.
Ngalokhu, ama-inhibitors e-ACE anciphisa ukucindezeleka enhliziyweni futhi avumela ukuba imisipha yenhliziyo ebuthakathaka ifake kahle ngokwengeziwe.
I-ACE inhibitors nayo iyasiza kakhulu ekwelashweni kokweqile , futhi iboniswe ukuthuthukisa imiphumela kubantu abaye bahlaselwa yinhliziyo . Ngaphezu kwalokho, zingasiza ukuvimbela ukulimala kwezinso kubantu abanesifo sikashukela .
I-ACE Inhibitors ekuhlulekeni Kwezinhliziyo
Izilingo eziningana zokwelashwa ezibucayi ziye zabuka ukusetshenziswa kwe-ACE inhibitors kubantu abanokuhluleka kwenhliziyo. Bonke babonisa inzuzo ebalulekile. Ukuhlaziywa kwezibalo ezinhlobonhlobo ezinhlanu ezibandakanya abantu abangaphezu kuka-12 000 abanesifo senhliziyo kubonisa ukuthi i-ACE inhibitors yanciphisa kakhulu isidingo sokufakela esibhedlela, ngcono nokusinda, futhi yanciphisa ingozi yokuhlaselwa yinhliziyo. Izimpawu zokuhluleka kwenhliziyo ezifana ne- dyspnea (ukuphefumula) nokukhathala nakho kuthuthukisiwe.
Iziqondiso zamanje ezivela e-American College of Cardiology kanye ne-American Heart Association zincoma kakhulu ukuthi i-ACE inhibitors inganikezwa kunoma ubani onenhliziyo ehlulekayo, futhi ngaphezu kwalokho, kunoma ubani onencishisiwe ye-ventricular ejection fraction (ngaphansi kuka-0.4) noma abanayo wayenenkinga yangempela yenhliziyo.
Izinambuzane eziningana ze-ACE zisemakethe, futhi ngokuvamile zicatshangelwa ukuthi zizuzisa ngokufanayo ekwelapheni ukuhluleka kwenhliziyo. Ama-inhibitors ase-ACE avame ukusetshenziswa ahlanganisa i-captopril (i-Capoten), i-enalapril (iVasotec), i-lisinopril (i-Zestril), i-ramipril (i-Altace), ne-trandolarpril (i-Mavik).
Uma kuqala, i-ACE inhibitors ivame ukuqala ngomthamo ophansi, futhi umthamo ukhula kancane kancane kumanani aphezulu asetshenziselwa ukuvivinywa kwemitholampilo.
Ukwandisa umthamo kancane kancane kusiza ukuvimbela imiphumela emibi. Uma izilinganiso eziphakeme ezihlosiwe azibekezelelwanga kahle, ukwelashwa kuvame ukuqhubeka ngesilinganiso esincane, esingcono ukubekezelela. Iningi lezazi zikholelwa ukuthi ukulinganisa okuphansi kwe-ACE inhibitors kusebenza ngendlela ephumelelayo njengamazinga aphezulu, kodwa amanani aphezulu aphakanyiswa ngoba ahlolwe ngokusemthethweni kwizifundo zokwelashwa.
ACE inhibitors nomjaho. Ezinye izifundo zisho ukuthi ama-inhibitors e-ACE angase asebenze kangcono kubantu abamnyama kunabamhlophe, kodwa ubufakazi buphikisana. Iziqondiso zamanje zincoma ukusebenzisa i-ACE inhibitors wonke umuntu onokwehluleka kwenhliziyo, kungakhathaliseki ukuthi uhlanga luphi.
Ama-inhibitors we-ACE nobulili. Ucwaningo lwezokwelapha aluzange lubonise ubukhulu obufanayo bokuhlomula nge-ACE inhibitors kubesifazane njengoba kuboniswe emadodeni. Kodwa-ke, ukuphazamiseka kobufakazi obusaqhubeka nokusebenzisa i-ACE inhibitors kuzo zonke abesifazane abanesifo senhliziyo.
Imiphumela emibi ye-ACE Inhibitors
Nakuba i-ACE inhibitors ivame ukubekezelela kahle, imiphumela eminye ingase ivele.
I-ACE inhibitors inganciphisa ukucindezeleka kwegazi kakhulu, iveza izimpawu zobuthakathaka, isizungu , noma i- syncope . Le nkinga ingagwenywa ngokuqala ngomthamo ophansi futhi kancane kancane ukwakhiwa kwamanani aphezulu.
Ikakhulukazi kubantu abanesifo sezinso ezincane, ukusebenzisa i-ACE inhibitors kunganciphisa ukusebenza kwezinso. Ngenxa yalesi sizathu, umsebenzi wezinso (ukuhlolwa kwegazi) kufanele uqashwe kubantu abanesifo sezinso futhi baqala i-ACE inhibitors.
Ama-inhibitors e-ACE angandisa amazinga e-potassium egazi. Ngenkathi le mphumela ivame kakhulu kakhulu futhi ayiyona imithi ebalulekile. Nokho, kwabanye abantu (cishe ama-3%) amazinga we-potassium angaba phezulu kakhulu.
Umphumela ovelele kakhulu we-ACE inhibitors ukukhwehlela owomile, ukukhwehlela , okungabonakala kubantu abangaba ngu-20% abanikezwa le mithi. Nakuba engeyona inkinga eyingozi, lo mphumela ohlangothini ungaphazamisa kakhulu futhi ngokuvamile udinga ukuyeka ukuphuma kwezidakamizwa.
Ngokuvamile kakhulu, abantu abathatha i-ACE inhibitors bangathola i- angioedema -a-reaction efana ne-allergen-like engaba yingozi kakhulu.
Ama-ARB njenge-Substitute ye-ACE Inhibitors
I-Angiotensin II receptor blockers (izidakamizwa ze-ARB) zifana ne-ACE inhibitors ngoba ziphazamisa ukuhlasela kwe-RAAS nokunciphisa umphumela we-enzyme ye-angiotensin II. Ngenxa yokuthi ama-ARB kuphela abangela ukukhwehlela kanye ne-angioedema, ngezinye izikhathi asetshenziselwa ukufaka endaweni yabantu abaye baba nemiphumela emibi nge-ACE inhibitors.
Ama-ARB akhonjiswe ukuthi ayasebenza ekwelapheni ukuhluleka kwenhliziyo, nakuba kungaphansi kwe-ACE inhibitors. Ngaphezu kwalokho, ama-ARB asebenza ngendlela ephumelelayo njenge-ACE inhibitors ekwelapheni kwe-hypertension. Imithi ejwayelekile esetshenziswa i-ARB ihlanganisa candesartan (Atacand), i-lasartan (Cozaar), ne- valsartan (i-Diovan). Ezinye izidakamizwa ze-ARB ziyatholakala futhi.
Okubalulekile
Uma unesifo senhliziyo, ukunciphisa izimpawu zakho futhi ukwandise umphumela wakho, kufanele umiswe i-ACE inhibitor ngaphandle uma kunesizathu esihle kakhulu ukungabi khona.
> Imithombo:
> Flather MD, Yusuf S, uKøber L, et al. Ukwelashwa kwe-ACE-Inhibitor Yesikhathi Eside Ezinganeni Eziphelelwe Inhliziyo Ngokwehluleka Kwemvelo Noma Ukungasebenzi Okungenayo Kwesobunxele: Ukubuka Okuhlelekile Kwemininingwane Evela Ezigulini Ezizimele. I-ACE-Inhibitor Myocardial Infarction Iqoqo Lokubambisana. Lancet 2000; 355: 1575.
> McMurray JJ, Adamopoulos S, Anker SD, et al. Izinkombandlela ze-ESC zokuHlola kanye nokwelashwa kokuhluleka kwenhliziyo ephuthumayo neyiguli 2012: I-Task Force for the Discover and Treatment of Insect Heart and Chronic Heart Failure 2012 ye-European Society of Cardiology. Kuthuthukiswe ngokubambisana ne-Heart Failure Association (HFA) ye-ESC. I-Eur Heart J 2012; 33: 1787.
> Yancy CW, Jessup M, Bozkurt B, et al. I-ACCF / i-AHA Fuideline ye-2013 ye-Management of Heart Failure: Umbiko we-American College of Cardiology Foundation / i-American Heart Association Task Force on Guidelines Practice. J Am Coll Cardiol 2013; 62: e147.