Ukwelashwa 'okujwayelekile' kwe-hypertension kungase kushintshe
Ngaphandle kokuba yingozi enkulu yesifo senhliziyo, izibilini, njll, ukucindezeleka kwegazi kungaholela nasifo sezinso . Akukhona nje lokho, iziguli ezinesifo sezinso ezikhona ezikhona (CKD), zisengozini enkulu yokuqhubekela phambili ekupheleni kwesifo sezinso (lapho zizodinga i-dialysis noma ukufakelwa kwezinso), uma ukucindezeleka kwegazi kuhlala phezulu / kungalawulwa.
Ngemuva kokushukela kwesifo sikashukela, ukucindezelwa kwegazi eliphezulu yisisusa esivamile kakhulu sokuthi abantu bakhule ukwehluleka kwezinso .
Umehluko Phakathi Kokwehluleka Kokuphela Kwezinso Nezifo Ezibucayi
Ngokuhamba kwesikhathi, ukufeza nokulondoloza "ukubhebhethekiswa kwengcindezi yegazi" kungenye yezindlela eziyisisekelo zokuvimbela ukuqhubeka kwe-CKD. Kungakuvimbela ekungeneni ekufinyeleleni lapho uzoba khona ngokuthembela kwe-dialysis. Kodwa yikuphi lokhu okuthiwa yi-target blood pressure?
Indlela Esiphatha Ngayo Ukucindezeleka Kwegazi Akuyona Imbono Yombono Omunye Wezokwelapha
Hhayi njalo! Empeleni kunqunywe yizinceku zezidakamizwa ezihlakaniphile ezihlala etafuleni, bheka ubufakazi obukhona, futhi utshele sonke ukuthi kufanele sikwenze kanjani! Leli qembu elibizwa nge-Joint National Committee (JNC) futhi lisungulwe yiNational Institutes of Health (NIH). Isiphakamiso sabo samuva sezincomo sakhishwa ngoFebruwari 2014, futhi ngokuvamile sibhekwa ngokuthi "i-JNC 8." NguJNC ozohlala ephethe igama lokugcina hhayi kuphela ukuthi izidakamizwa okufanele sizisebenzeleni ukuphatha umfutho wegazi ophezulu, kodwa nokuthi yini umgomo wethu wokugonywa kwengcindezi yegazi okufanele ibe.
Okwenza Ukuguqulwa Kwegazi Kuhloswe
Ngokuvamile, ngaphambi kwe-JNC 8, sasivame ukuhlukumezeka kakhulu ngezinhloso zokwelashwa kwegazi, ngokuvamile ukuphatha iziguli zibe yizinhloso ngaphansi kuka 130/80. Kodwa-ke, ukuze nje ngenze izinto zidideke, ake ngikhulume ukuthi i-JNC akuyona yedwa izincomo zomzimba ezisemthethweni mayelana nokuphathwa kwegazi.
Bheka iThebula 6 lapha.
Ungase uqaphele ukuthi imihlahlandlela yangaphambilini evela ngo-2010-2011 futhi ngaphambi kokubonakala ibusa ukulawulwa okunamandla kokucindezela kwegazi ukuze kube nemigomo ephansi. Lokho, eqinisweni, kwakuyiqiniso levangeli elimukelweyo odokotela abaningi abakhulu, izazi ze-cardiologists, ne-nephrologists, kuze kube sekwephuzile kakhulu. Kodwa-ke, ngo-2010 sasihlolisise kakhulu umfutho wegazi ophezulu owabikwa emakhasini angcwele eNew England Journal of Medicine (NEJM). Lolu cwaningo olubizwa ngokuthi i-ACCORD trial lubonise ukuthi kwakungekho nzuzo yokwelapha umfutho wegazi ophezulu kumoya ophansi we-systolic 120 mm ngokubhekiswe kwelitshe elikhululekile lika-140 mm. Lokhu kwavela ebusweni bokuhlakanipha "okwamukelwe" emphakathini wezokwelapha, okuvame ukukholelwa ukuthi ukucindezeleka kwegazi okuphansi kuhle njalo futhi kubi kakhulu! Kodwa-ke, lesi sivivinyo sasingekho i-flash epanini, kusukela ekuqaleni, sibonile esinye isifundo esibizwa ngokuthi yi-INVEST trial esabika akukho nzuzo yokuphatha ukucindezeleka kwegazi kakhulu.
(Ngingathanda ukugcizelela ukuthi noma kunjalo kunoma yimuphi omunye umkhakha wezokwelapha, ukwelashwa komfutho wegazi ophezulu kuyindawo yokuphikisana okukhulu futhi izinto ziyaqhubeka zishintsha. Akukho mikhombandlela emibili ibonakala ivumelana futhi ngisho ne-JNC ithole ukwabelana kwayo okuhle kwama-barb ).
Amakhredithi okwelapha okwamanje
I-JNC ihlose ngokuyinhloko amathegethi ngokususelwa eminyakeni yobubanzi bendawo:
- Ubudala <60 yrs: okuhloswe ukuwugcina ngaphansi kuka 140/90
- Ubudala> 60 amahora: okuhloswe ukuwagcina ngaphansi kuka 150/90
Amathegethi Ahlukile Kubantu abanezinso Zengane
Izinhloso zokucindezelwa kwegazi ezisebenza kumuntu ophezulu wegazi ophezulu angeke zisebenze kwisiguli esiphezulu esinesifo sezinso . Eqinisweni, sinezinhlangano ezingaphezulu kakhulu ezibhekana ngqo nezifo zezinso ezifana neZifo Zesifo Sezinso Zokuthuthukisa Imiphumela Yomhlaba Wonke (i-KDIGO) ekhuthaze imigomo ephansi yokwelapha. Kodwa ngokuya ku-JNC 8, ihlose ukugcina wonke umuntu enezinso zezinso, kungakhathaliseki ukuthi uphathwe kangakanani ekucindezelweni kwegazi <140/90.
Futhi akufanele udinga ukwelashwa uma uvame ukuhlala ngaphansi kwaleveli ngokwesilinganiso. Uma usondelene nale nombolo, ungase ubalekele ukuguqulwa kokudla / yokuphila kuphela.
Kubuye Futhi Ngendlela Ongayiphatha ngayo
Lokho engikushilo ngenhla yilokho okuhloswe ukuthi uyiphatha BP. Kodwa udokotela osesikhathini esizayo uzophinde agcine engqondweni ukuthi yiziphi izidakamizwa okumele zizisebenzise ukukuyisa emgomweni. Ukuphela akusho ngaso sonke isikhathi izindlela zokuphathwa ngophuthumayo . Ngeke ngiye kulokho okushiwo lapha kodwa ungadlula imininingwane ye-JNC 8 uma ufuna ngempela ukwazi.
Sivame futhi sibe nento okuthiwa "izinkomba eziphoqelela" uma kuziwa ekwelapheni kwegazi. Ngokwesibonelo, umuntu ophethe amaprotheni amaningi ngokweqile emgqeni angase abekwe ku-lisinopril (iphilisi ye-blood pressure), ngisho noma ingcindezi yegazi ingaphansi kwalomgomo. Kulesi simo, iphilisi ye-blood isetshenziswa ezinye izinkomba.
Ukufingqa, iziguli eziningi ezinesifo sezinso, umgomo ohlosiwe wokucindezela ukwenza umsebenzi wezinso nokunciphisa amathuba abo okuqhubekayo ekupheleni kwesifo sezinso kungaba '140/90. Okungenani lapho sihlala khona kuze kufike ku-JNC 9!