Ukuthola Imithi Yokucindezela Igazi Eliphezulu "Elihle kakhulu"
Uhlu lwezidakamizwa nezidakamizwa ezivame ukusetshenziselwa ukwelapha umfutho wegazi ophezulu ( umfutho wegazi ophezulu) kude kakhulu.
Iqiniso lokuthi kunezidakamizwa eziningi kakhulu ongakhetha kuzo okungenani izinto ezimbili. Okokuqala, kusho ukuthi akukho "isidakamizwa" esingcono kakhulu somfutho wegazi ophezulu, okungukuthi, akukho muthi osebenza kahle cishe wonke umuntu ngaphandle kokudala imiphumela engavumelekile engavumelekile.
Uma bekunjalo, izinkampani ezidakamizwa zizoyeka imizamo yabo yokuthuthukisa izidakamizwa ezintsha zokulwa nemithi esikhathini eside esidlule-futhi uhlu lwezidakamizwa ezivunyiwe luyoba mfushane kakhulu.
Okwesibili, ngezidakamizwa eziningi ongakhetha kuzo, uma nje wena nodokotela wakho unesineke futhi uphikelela, kungenzeka kakhulu ukuthi umuthi wokwelashwa osebenza kahle futhi okhuthazwe kahle uzothola umfutho wegazi ophezulu. Ngamanye amazwi, ngenkathi kungekho "ukwelapha" okuphelele emhlabeni jikelele we-hypertension, kungenzeka ukuthi ube "ukwelashwa" okungcono kakhulu kuwe.
Kulesi sihloko, sizochaza izinhlobo zezidakamizwa ezisetshenziselwa ukushisa komfutho wegazi, futhi yiziphi izinyathelo okufanele udokotela wakho azithathe ekukhetheni (kusukela ezinhlobonhlobo ezikhethiwe zokukhetha) ukuphathwa kwakho okuhle. Okokugcina, sizohlinzeka uhlu oluphelele lwezo zonke izidakamizwa ezisetshenziswa manje e-US (nakwamanye amazwe asethuthukile) ukwelashwa kwesifo somfutho wegazi ophezulu.
Ukukhetha Ukwelashwa Okufanele Kokuphefumula Kwegazi
Odokotela ngokuvamile basebenzisa indlela ehlelekile yokukhetha ukwelashwa okuphelele kwe-hypertension.
Isinyathelo sokuqala: Kubantu abaye bathola ukuthi banesifo sofuba esincane noma esincane , kubalulekile ukuqala ngokuncoma izinguquko zokuphila eziye zaboniswa ukusiza ukunciphisa ukucindezelwa kwegazi. Lokhu kufaka phakathi izinguquko zokudla , ukuvinjelwa kasawoti , ukuzivivinya umzimba njalo nokuyeka ukubhema.
Isinyathelo sesibili: Uma lezi zindlela zokuphila zingabangeli ukulawulwa kwegazi okwanele emva kwamasonto ambalwa, ngokuvamile kuvame ukufaka ukwelashwa kwezidakamizwa.
Indlela Eyisisekelo Yokukhetha Ukwelashwa Kwemithi Ye-Hypertension
Kunezigaba ezinhlanu ezinkulu zezidakamizwa eziye zafakazelwa ukuthi ziyasebenza ekuphatheni umfutho wegazi ophezulu. Lezi izi:
- Thiazide diuretics
- I-Angiotensin iguqula i-enzyme (ACE) inhibitors
- Abavimba be-calcium
- Abavimba be-Beta
- I-Angiotensin receptor blockers (ama-ARB)
Ukwelapha Okudakayo Kwemithi
Uma une-level 1 yomshuwalense (lapho isisindo sakho se-systolic singaphansi kuka-160 mm Hg, futhi ukucindezela kwakho kwe-diastolic kungaphansi kuka-100 mm Hg), isincomo esijwayelekile siqala ngomuthi owodwa kusuka kwenye yalezi zigaba ezinhlanu.
Ngokuvamile, izidakamizwa ezivela kulawo makilasi (ngaphandle kwe-beta-blockers, ejwayelekile kakhulu njengezidakamizwa ezilodwa) zivame ukusebenza ngokulinganayo ekulawuleni umfutho wegazi ophezulu. Ngokuqondile, kunamathuba angama-50-50 ukuthi noma imuphi umuthi ozosebenza ngokufanele kunoma yimuphi umuntu onikezwe isigaba somfutho wegazi ophezulu.
Kodwa-ke, abantu bazophendula ngokungafani kule mithi. UJim angase aphendule kahle i-thiazide, kodwa ahluleke nge-calcium blocker, kanti icala noJane kungenzeka libe yilokho okuqondile. Ngokuvamile akukho ndlela ngaphambi kwesikhathi ukubikezela ukuthi yimuphi umuntu ozokwenza kahle ukuthi imuphi uhlobo lwemithi. Ngakho-ke, yiziphi odokotela neziguli ezishiywe yiyo ndlela yokufunda-nephutha efundisiwe.
"Ukuqagela" esilungwini esihle sokuqala esisodwa sokuzama ukuzama, izazi eziningi manje zincoma ukuthi ziqale noma nge-thiazide diuretic (ngokuvamile i-chlorthalidone noma i-hydrochlorothiazide), i-calcium blocker ende ende, noma i-ACE inhibitor. Ama-ARB ngokuvamile acatshangwa njengama-substitute ACE inhibitors, futhi ngokuvamile asetshenziselwa kuphela uma ama-inhibitors e-ACE engavumi ukubekezelela.
Ayikho imithetho enzima futhi esheshayo mayelana nokuthi yimiphi imithi okufanele isetshenziswe kuyo abantu, kodwa kukhona ukuthambekela okuthile okuwusizo ekukhetheni ukwelashwa okukodwa-izidakamizwa:
- Iziguli ezincane ngokuvamile ziphendula kahle kuma-ACE inhibitors.
- Iziguli ezimnyama neziguli asebekhulile zivame ukwenza kangcono nge-thiazide diuretics noma i-calcium channel blockers.
- Iziguli ezimnyama zivame ukwenza kabi nge-ACE inhibitors.
- Abavimbela i-Beta ngokuvamile bahlukumezeka kakhulu ukwelashwa okukodwa, futhi ngokuvamile kusetshenziselwa kuphela uma kukhona esinye isizathu sezokwelapha sokusebenzisa i-beta blockers (njengesidingo sokwelapha i- angina noma ukuhluleka kwenhliziyo , noma ukulawula izinga lenhliziyo kumuntu nge -fibrillation ye-atrial ).
Ngokuvamile, ukulinganiselwa okuphansi kwemithi yegazi kusebenza njengamazinga aphezulu, futhi kubangele imiphumela embalwa emibi. Ngakho-ke, lapho bezama ukuthola ukwelapha okukodwa okukodwa, odokotela ngokuvamile baqala ngesilinganiso esincane. Bangase banqume ukwandisa umthamo kancane uma umthamo wokuqala ungasebenzi - kodwa akuvamile ukuthi usebenzise "ukuphoqa" umthamo wokwelashwa okukodwa kwamakhambi ezindaweni eziphezulu zezilingo. Kunalokho, uma izidakamizwa zihluleka ukusebenza ngomthamo ophansi, sekuyisikhathi sokushintshela kumthamo ophansi wesidakamizwa esihlukile.
Ukusebenzisa lolu hlobo lwezinyathelo zokulinga nokuphutha, abantu abangaba ngu-80% abanesifo somfutho wegazi ophezulu esiteji ekugcineni bangaphathwa ngokunempilo ngesidakamizwa esisodwa segazi.
Ukwelashwa Kwezidakamizwa Zokuhlanganiswa
Ukusebenzisa imithi engaphezu kweyodwa yokwelapha umfutho wegazi ophezulu kuyadingeka ngaphansi kwezimo ezimbili. Okokuqala, ukwelashwa okuhlanganiswa kusetshenziswa kubantu abanesisindo somfutho wegazi ophezulu futhi okungenani imizamo emibili noma emithathu ayiphumelelanga ekwenzeni ukucindezelwa kwegazi nge-one-drug treatment.
Okwesibili, ukuxilongwa kwezidakamizwa kuhlanganiswa kubantu abanesisindo somfutho wegazi ophezulu (okungukuthi, ukucindezela kwabo kwe-sympression kuyinto yi-160 mm Hg noma ngaphezulu, noma ukucindezelwa kwabo kwe-diastolic 100 mm Hg noma ngaphezulu.) Ukwelapha okukodwa kokudakamizwa akunakwenzeka kakhulu ukusebenza kulaba bantu , ukwelapha okuhlanganiswa ngokuvamile kuvame ukuqala kusukela ekuqaleni.
Njengoba kunezidakamizwa eziningi ongakhetha kuzo, odokotela banganquma kanjani ukuthi yiziphi izidakamizwa ezizohlangana? Ngokujabulisayo, kwenziwa izinyathelo eziningi zokwelashwa ezihlinzeka isiqondiso esikhulu ekukhetheni ukwelashwa okuhambisanayo okuhambisana nomfutho wegazi ophezulu.
Ubufakazi obuhle kakhulu (kusukela ku-trial ACCOMPLISH) bubonisa ukuthi imiphumela yomtholampilo (kuhlanganise nobungozi bokushaya isifo , ukuhlasela kwenhliziyo nokufa kwenhliziyo) kuthuthukiswa kakhulu nge-combination combination uma i-calcium blocker esebenza isikhathi eside isetshenziselwa kanye ne-ACE inhibitor noma i-ARB. Ngakho-ke, namuhla odokotela abaningi bazozama le nhlanganisela kuqala.
Uma ingcindezi yegazi ihlala iphakanyiswe ukwelashwa okuhlanganisiwe usebenzisa i-calcium blocker kanye ne-ACE noma i-ARB, isidakamizwa se-thiazide ngokuvamile sizengezwa njengesidakamizwa sesithathu. Futhi uma le nhlanganisela isalokhu ihluleka ukulawula ukucindezelwa kwegazi, isisindo sesine (ngokuvamile i-spironolactone, i-diuretic engeyona thiazide) ingezwa.
Iningi leziguli ezinomfutho wegazi ophezulu uzothola ukwelashwa okuphumelelayo ngaphambi kokuthi isidakamizwa sesithathu noma sesine sidinga ukucatshangelwa. Umuntu ongavamile ohluleka ukusabela ngokwanele kuloluhlobo lwe-combination combination kufanele adluliselwe kuchwepheshe we-hypertension.
Ukugwema Imiphumela Embi Evela Ezidakamizweni Zezidakamizwa
Noma yikuphi kwezidakamizwa ezisetshenziselwa ukwelapha umfutho wegazi ophezulu kungabangela izinkinga. Futhi uma ukhetha imithi "engcono kakhulu" yokwelapha umuntu onomfutho wegazi ophezulu, kubalulekile ukuthola isidakamizwa (noma izidakamizwa) ezingagcini nje ngokunciphisa ngempumelelo umfutho wegazi, kodwa nazo zibekezelela kahle.
Ngenxa yalesi sizathu, kuye kwaba usizo kakhulu ukuthi ukusebenzisa izidakamizwa eziphansi zezidakamizwa ze-hypertension kuyasebenza njengoba usebenzisa amanani aphezulu. Ikhono lokuthola ngezinga eliphansi liyanciphisa kakhulu ingozi yemiphumela emibi.
Noma kunjalo, lezi zidakamizwa zingabangela izinkinga, futhi kubalulekile ukuthi uqaphele imiphumela engase ibe nemiphumela emibi. Ngenkathi zonke izidakamizwa eziningi ze-hypertension zinezici "zephrofayili yecala," ingxenye enkulu engaba nemiphumela emibi yalezi zidakamizwa zihlobene nesigaba sabo. Imiphumela emibi ehlobene nesigaba esilandelayo yilezi:
- I-Thiazide diuretics: hypokalemia (amazinga aphansi e-potassium), ukuvuthwa njalo, ukuqhuma kwe- gout
- I-ACE inhibitors: ukukhwehlela, ukulahleka komqondo wokunambitheka, ama- hyperkalemia (amazinga aphezulu e-potassium)
- Abavimbela i-calcium: ukuqotshwa, ukuvuvukala kwemilenze, ikhanda
- Abavimbela i-Beta: ukuwohloka kwe- dyspnea kubantu abane- chronic obstructive pulmary disease noma i- asthma , ukungasebenzi ngokocansi, ukukhathala, ukucindezeleka, ukuwohloka kwezimpawu kubantu abane- arterial disease
- Ama-ARB: ukusabela kokugula, isizungu , i-hyperkalemia
Njengoba kunezidakamizwa eziningi ongakhetha kuzo, akuvamile ukuthi udokotela azokucela umuntu onomfutho wegazi ophezulu ukubekezelela imiphumela embi kakhulu. uma uphathwa nge-hypertension futhi ubhekene nanoma imiphi imiphumela emibi, kufanele nakanjani ukhulume nodokotela wakho mayelana nokuthola imithi yokwelapha ongayibekezelela kangcono.
Uhlu lwezidakamizwa ezivame ukusetshenziswa kakhulu
Njengoba kuphawuliwe ekuqaleni kwalesi sihloko, uhlu lwezidakamizwa ezivunyelwe ukwelashwa kokweqile komfutho wesikhathi eside. Nasi uhlu oluphelele oluphelele lwale mithi. Igama elijwayelekile lomuthi ngamunye libalwe kuqala, lilandelwa ngamagama ezohwebo.
I-Diuretics
I-Diuretics ("amaphilisi amanzi") ukwandisa inani le-sodium namanzi adonsa emcinini ngezinso. Kucatshangwa ukuthi ukuncipha kwengcindezi yegazi ikakhulu ngokunciphisa ivolumu yamanzi emithanjeni yegazi.
I-Diuretics evame ukusetshenziswa ku-hypertension:
- I-Acetazolamide - i-Diamox
- I-Chlorthalidone - iThalidone, futhi idayiswa njenge-Tenoretic neClorpres
- I-Hydrochlorothiazide - i-HydroDiuril, futhi ithengiswa njenge-Microzide ne-Esidrix
- Indapamide - Lozol
- I-Metolazone - i-Zaroxolyn, futhi ithengiswa njenge-Mykrox
I-Diuretics encane engasetshenziselwa isifo somfutho wegazi ophezulu:
- Amiloride hydrochloride - Midamor
- I-Bumetanide - i-Bumex
- I-ethacrynic acid - i-Edecrin
- I-Furosemide - Lasix
- I-spironolactone - i-Aldactone
- I-Torsemide - Demadex
- I-Triamterene - Dyrenium
Beta-blockers
Abavimbela i-Beta bavimbela umphumela we-adrenaline ohlelweni lwe-cardiovascular, ukunciphisa izinga lokushaya kwenhliziyo, nokunciphisa ukucindezeleka enhliziyweni kanye nemithambo.
- Acebutolol - Isigaba
- Atenolol - Tenormin
- I-Betaxolol - Kerlone
- I-Bisoprolol - uZebeta, futhi wathengiswa njengoSiac
- Mapolol - Cartrol
- I-Carvedilol - I-Coreg
- I-Labetalol - Normodyne, futhi idayiswa njenge-Trandate
- I-Metoprolol - Lopressor, futhi idayiswa njengeThorol
- Nadolol - Corgard
- Penbutolol - Levatol
- Ipropranolol - Inderal, Inderal LA
- I-Timolol - i-Blocadren
Ama-blockers wesiteshi se-Calcium
Ama-blockers esiteshini se-calcium anganciphisa ukucindezelwa kwegazi ngokunciphisa imishanguzo futhi, kwezinye izimo, ukunciphisa amandla okuphikisa kwenhliziyo.
- Amlodipine - Norvasc, futhi ithengiswe njengeCaduet noLotrel
- I-Diltiazem - I-Cardizem, nayo idayiswa njengeDilacor noTiazac
- I-felodipine - i-Plendil
- I-Isradipine - iDynaCirc
- I-Nicardipine - iKardene
- I-Nifedipine - i-Procardia XL, futhi ithengiswa njenge-Adalat
- I-Nisoldipine - I-Sular
- I-Verapamil hydrochloride - i-Isoptin, futhi idayiswa njengeCalan, i-Verelan, neCovera
Angiotensin Ukuguqula Inhibitors Enzyme
I-angiotensin eguqulela i-enzyme inhibitors ("i-ACE inhibitors") inganciphisa ukucindezelwa kwegazi ngokunciphisa imishanguzo.
- Benazepril - Lotensin
- I-Captopril - Capoten
- I-Enalapril - iVasotec, nayo idayiswa njengeVaseretic
- I-Fosinopril - i-Monopril
- I-Lisinopril - i-Prinivil, nayo idayiswa njenge-Zestril
- I-Moexipril - Univasc
- I-Quinapril - I-Accupril
- I-Ramipril - i-Altace
- I-Trandolapril - Mavik
I-Angiotensin II Receptor Blockers
I-angiotensin II receptor blockers ("i-ARBs") iphinde inciphise ukucindezelwa kwegazi ngokunciphisa imishanguzo.
- Candesartan - Atacand
- Irbesartan - Avapro
- I-Losartan - Cozaar
- I-Telmisartan - Micardis
- Valsartan - Diovan
Okunye, Izidakamizwa ezingasetshenziswa ngokujwayelekile
- I-Clonidine - i-Catapres
- Doxazosin - Cardura
- I-Guanabenz - Wytensin
- I-Guanfacine - i-Tenex
- I-Hydralazine hydrochloride - i-Apresoline
- I-Methyldopa - Aldomet
- I-Prazosin - I-Minipress
- I-Reserpine -Ã, Serpasil
- I-Terazosin - Hytrin
Izidakamizwa zoMfutho we-Hypertension
Izidakamizwa eziningi ezihlanganisiwe ziye zathengiswa nge-hypertension, futhi cishe akunakwenzeka ukugcina ithrekhi yamasha ezayo, noma asebekhulile abaphela. Okulandelayo yiluhlu oluphelele oluphelele lwezidakamizwa ezivame kakhulu ezihlanganisiwe ezisetshenziselwa umfutho wegazi ophezulu.
- Amiloride ne-hydrochlorothiazide - i-Moduretic
- I-Amlodipine ne-benazepril-i-Lotrel
- I-Atenolol ne-chlorthalidone - i-Tenoretic
- I-Benazepril ne-hydrochlorothiazide - i-Lotensin HCT
- I-bisoprolol ne-hydrochlorothiazide - Ziac
- I-Captopril ne-hydrochlorothiazide - i-Capozide
- I-Enalapril ne-hydrochlorothiazide - i-Vaseretic
- I-Felodipine ne-enalapril - Lexxel
- I-Hydralazine ne-hydrochlorothiazide - I-Apresazide
- I-Lisinopril ne-hydrochlorothiazide - i-Prinzide, futhi idayiswa njenge-Zestoretic
- I-Losartan ne-hydrochlorothiazide - Hyzaar
- I-Methyldopa ne-hydrochlorothiazide - Aldoril
- I-Metoprolol ne-hydrochlorothiazide - i-Lopressor HCT
- I-Nadolol ne-bendroflumethiazide - Corzide
- Ipropranolol ne-hydrochlorothiazide - Inderide
- I-spironolactone ne-hydrochlorothiazide - i-Aldactazide
- I-Triamterene ne-hydrochlorothiazide - i-Dyazide, futhi idayiswa njengo-Maxide
- I-Verapamil ikhululwe ukukhululwa) ne-trandolapril - Tarka
Izwi elivela
Ukucindezeleka ngokweqile kuyinkinga ejwayelekile kakhulu yezokwelapha okungaba nemiphumela emibi uma ingelashwa ngokufanele. Kodwa-ke, ngezinketho eziningi zokwelashwa, kufanele ulindele udokotela wakho ukuthi athole umgomo wokwelapha oyokwehlisa kakhulu ingozi yakho yomphumela omubi wegazi, ngaphandle kokuphazamisa impilo yakho yansuku zonke.
> Imithombo:
> Ukwelashwa Kwegazi Lokunciphisa Ukwelashwa Kwezingxabano, U-Turnbull F, Neal B, et al. Imiphumela Yezinhlobo Ezihlukene Zokunciphisa Ukucindezeleka Kwegazi Ngezimbangela Ezinzima Zezinhliziyo Ezikhulile Kubantu Abadala nabancane: Ukuhlaziywa kwe-Meta-Analysis of Trials Randomised. BMJ 2008; 336: 1121.
> Jamerson KA, Bakris GL, Wun CC, et al. Ukulinganisa kanye nokuklama kokugwema izenzakalo zenhliziyo ngokusebenzisa ukwelashwa kokuhlanganiswa kweziguli eziphila nge-Hypertension ye-Systolic (ACCOMPLISH) Isivivinyo: Isivivinyo sokulawulwa kokuqala esibuyiselwayo sokuqhathanisa imiphumela yomtholampilo Imiphumela ye-Anti-line Combination Treatment in Hypertension. Am J Hypertens 2004; 17: 793.
> Mancia G, Fagard R, Narkiewicz K, et al. Imihlahlandlela ye-ESH / ESC ka-2013 yokuphathwa kwe-Hypertension Eyingozi: i-Task Force yokuphatha ukucindezeleka komzimba we-European Society of Hypertension (ESH) ne-European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281.
> Weber MA, Schiffrin EL, i-White WB, et al. Izinkombandlela Zokuzivocavoca Zomtholampilo Ukulawulwa Kokweqile Kwengqondo Emphakathini Isitatimende se-American Society of Hypertension kanye ne-International Society of Hypertension. J Hypertens 2014; 32: 3.