I-Hypertension "J Curve"
"Udokotela wami waqala ukungiphatha nge-high blood pressure ezinyangeni eziyisithupha ezedlule, futhi ukufunda kwami kwavela ngo 155/90 kwaze kwafika ku-120/70, engangiyicabanga ukuthi yayimangalisa. Ngakho ngesonto eledlule ngimangalisa lapho udokotela wami eveza ukuthi wayekhathazekile ngokuthi uphefumule kakhulu igazi, futhi wehlisa umthamo wegazi lomuthi wegazi. Umbuzo wami uwukuthi: Yini eyitholayo? Kuphansi kakhulu? Ingabe lokhu kuyiqiniso ngempela, noma kufanele ngithole udokotela omusha? "- USidney wase-Oregon
Njengoba kwenzeka, Sidney, udokotela wakho ubonakala sengathi usesikhathini sobufakazi obamuva ngokuphathelene nokwelapha komfutho wegazi ophezulu. Kukhona okungenani okunye okubonisa ukuthi ukucindezelwa kwegazi okuzobhekwa njengomuntu omuhle (120/70 ngesibonelo), kungase kube phansi kakhulu kumuntu ekwelapheni kwegazi.
Ukucindezeleka komfutho wegazi, noma ukucindezeleka okukhulu kwegazi, isimo esijwayelekile kakhulu sezokwelapha ukuthi, uma singaphathwa kabi, singabangela ukuhlukunyezwa kwe-myocardial (ukushaya kwenhliziyo) , ukwehluleka kwenhliziyo , ukushaya isifo , nesifo sezinso. Uma une-hypertension kubalulekile ukuthi wena nodokotela wakho uthathe izinyathelo ezidingekayo ukuze unciphise ngokwanele ukucindezeleka kwegazi, ngaphambi kokulimala okungenakuguqulwa kwentliziyo yakho, ubuchopho noma izinso.
Leyo ngxenye ye-equation icacile. Impikiswano ilele ekutheni ukwelashwa komfutho wegazi ophezulu kufanele kuqhutshwe kangakanani.
Yiziphi Izinhloso Zokwelashwa Okufanele?
Sekuyiminyaka eminingi, ochwepheshe be-hypertension babethanda ukusho ukuthi, "Uma kuziwa ekucindezelekeni kwegazi, ukwehla kungcono kakhulu." Lesi sitatimende sasisoloko sinokugxeka, ngoba ukunciphisa ukucindezelwa kwegazi emazingeni aphansi kakhulu, kusobala, kungaholela ikhanda elikhanyayo noma ngisho ne- syncope .
Kodwa uma kunikezwe lokho okulinganiselwe, "ukwehla okungcono" kubonakala kuyindlela enengqondo, ngoba kubantu bonke kubalulekile ngempela - ukwehla kwengcindezi yegazi, kunciphisa ingozi yesifo senhliziyo noma isifo sezinso.
Kuye kwacatshangwa ukuthi umthetho ofanayo kufanele usebenze ezigulini ezinegazi eziphakeme ukwelashwa.
Phela, ukuhlolwa okungenakubalwa kukhombise ukuthi uma unciphisa ukucindezelwa kwegazi ezigulini ezine-hypertension, imiphumela yabo ithuthuka kakhulu. Ngakho odokotela bazizwa bekhululekile ukunciphisa izingcindezi zabo zegazi ngangokunokwenzeka, uma nje iziguli zabo bezingenazo izimpawu zobukhulu noma i- orthostasis .
Yingakho imigomo eminingi yokwelashwa komfutho wegazi ophezulu ikhonjiswe njengenani "elingaphansi kunani" (njengokuthi, i-systolic blood pressure ngaphansi kuka 140 mm Hg), esikhundleni sokuthi uhla lwamanani amaningi (njengokuthi, ukucindezela kwe-systolic phakathi kuka-130 - 140 mm Hg) .
Kuye eminyakeni yamuva nje ukuthi le "paradigm ephansi" ingaphansi kombuzo omkhulu. Manje kubonakala ukuthi kungenzeka ukuthi kuncishiswe ukucindezelwa kwegazi ngaphansi kwesilinganiso esiphezulu, futhi kungase kube nokulimaza ekwenzeni kanjalo.
Igazi Lokucindezela "J Curve"
Ezinye izifundo zamuva ziphakamise ukuthi imiphumela yomtholampilo ezigulwini eziphathwe nge-hypertension ingase ilandele "i-J curve," lapho imiphumela ibonakala ingcono ngaphakathi kwezinga elithile lezingcindezi zegazi. Uma ukucindezelwa kwegazi ngenkathi ukwelashwa kungaphezulu noma ngaphansi kwalolu hlu oluhle, imiphumela yomtholampilo iba mbi kakhulu. Uma i-hypothesis ye-J ye-J ingokoqobo, i-paradigm "engezansi" ingamanga - kanti odokotela kuzodingeka baqaphele kangcono ukuthi banganciphisa kangakanani ukucindezela kwegazi labo abagulayo.
Olunye lwezifundo ezibalulekile okwenza leli phuzu lanyatheliswa ngo-2014 eMnyangweni we-American College of Cardiology. Abacwaningi abavela eSouth California Kaiser Group bathola cishe iziguli eziyizigidi eziyizigidi eziphathwa nge-hypertension, futhi ziqhathanisa nezingcindezi zabo zegazi ekwelapheni emiphumeleni yabo yomtholampilo. Bathole ukuthi umfutho wegazi we-systolic omuhle ngenkathi ukwelashwa wawuphakathi kuka-130 - 139 mm Hg, nomshini wegazi ophezulu we-diastolic wawuphakathi kuka-60 no-79 mm Hg. Izingcindezi zegazi zokwelapha ezingaphezu noma ezingezansi kwalezi zigaba zazihlobene nemiphumela emibi kakhulu.
Umbono we-J curve ungase ubaluleke kakhulu, futhi manje uyamukelwa kabanzi, kwiziguli ezindala ezine-hypertension e-systolic eyodwa. Ezinye iziqondiso zamuva zikhuthaza ukuqapha ukucindezelwa kwegazi kakhulu kulezi ziguli, futhi odokotela abaningi manje bayaqaphela kakhulu ngokuphatha iziguli zabo asebekhulile ngokweqile.
Noma kunjalo, kufanele kuqashelwe ukuthi izifundo eziningana zehlulekile ukubona i-curve J yeziguli ezingewona asebekhulile eziphathwa nge-hypertension, futhi umbuzo uhlala ungqubuzana phakathi kochwepheshe. Kodwa ochwepheshe abaningi baye baba nokucabangisisa kakhulu ekuvezeni umbono ophansi "olungcono", futhi ochwepheshe abaningi beza ukwamukela ukuthi i-curve J ingokoqobo.
Ngakho-ke, uSidney, isincomo sodokotela wakho ukuba abuyele emuva emithini yakho yokwelashwa ngokweqile kuhambisana nobufakazi bamuva. Sifanele silinde futhi sibone ukuthi izinhlaka zezobuchwepheshe ezikhiqiza iziqondiso zokwelashwa zizogcina zimbambe naye.
Imithombo:
Sim JJ, Shi J, Kovesdy CP, et al. Umthelela wezingcindezi zegazi ezibhekene nobungozi bokufa kanye nesifo sokuqeda isiteleka phakathi kwabantu abaningi, abahlukahlukene begazi. Am Coll Cardiol. 2014; 64 (6): 588-97 (ISSN: 1558-3597)
U-Mancia G, uFagard R, uNarkiewicz K, et al. Imihlahlandlela ye-ESH / ESC ka-2013 yokuphathwa kokucindezeleka komzimba: i-Task Force yokuphatha ukucindezeleka komfutho we-European Society of Hypertension (ESH) ne-European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281.
James PA, Oparil S, uCarter BL, et al. Isiqondiso esisekelwe ku-2014 sokufakazela ukuphathwa kwegazi eliphezulu kubantu abadala: kubika amalungu ephaneli akhethwe kwiKomiti Yezizwe Eziyisishiyagalombili (JNC 8). I-JAMA 2014; 311: 507.