Umfutho wegazi ophezulu uvame kakhulu kubantu abadala asebekhulile uma kuqhathaniswa namaqembu amancane abantu, kodwa akufanele baphathwe njengengxenye evamile yokuguga. Imishanguzo iba yinkimbinkimbi futhi ayihambisani ncamashi njengoba sikhula. Lokhu kubangela izingcindezi eziphakeme zegazi ze-systolic, nakuba i-diastolic ingcindezi yegazi ivame ukuqiniswa kubantu abaphakathi kweminyaka engama-50 no-60. "Umfutho we-pulse" umehluko phakathi kwe-systolic ne-diastolic yegazi.
Ingozi yesifo senhliziyo isanda njengoba ukwanda kwengcindezi kukhula.
I-systolic hypertension asebekhulile yayisetshenziselwa ukubizwa ngokuthi "isifo somfutho we-systolic esingekho," esichazwa yi-systolic blood pressure ngaphezu kuka 160 mm Hg nge-diastolic yegazi engaphansi kuka-90 mm Hg. I-Systolic hypertension iyimbangela evame kakhulu yomshuwalense ezigulini ezingaphezu kweminyaka engu-50, okuphawulekayo ngoba kuyingozi enkulu yesifo senhliziyo kanye nesifo sokushaya isifo uma kuqhathaniswa nezinye izinhlobo zomshuwalense ophezulu. Kubuye kuhlotshaniswe nengozi eyengeziwe yokufa kusuka ezenzakalweni zenhliziyo. babe nemishanguzo encane engavumelani, ochwepheshe bonke bayavuma ukuthi kubalulekile ukuqhubeka ukuhlose ukucindezela kwegazi evamile kwasebekhulile.
Ukubaluleka Kwokwelashwa Kwegazi Ebandleni
Kunezici eziningana ezihlukile kubantu asebegugile noma asebekhulile abalawula ukucindezeleka kwegazi ikakhulukazi:
- Ingozi eyengeziwe yemicimbi yezinhliziyo uma kuqhathaniswa neziguli ezincane ezinezici ezifanayo zengozi.
- Umfutho wegazi we-Systolic kungenzeka ube ophakeme, ne-hypertension eyimvelo ehlukile ejwayelekile kule ndawo.
- Iziguli ezindala zinesimo esiphezulu sezinye izimo zezokwelapha okufanele zicatshangelwe uma ukhetha imithi yokwelapha yegazi.
- Ukushisa komfutho kuthinta ukuqonda kahle ngisho nabantu abadala asebekhulile. Kukhona futhi kubonakala sengathi ubuhlobo phakathi kwesifo somfutho wegazi ophezulu nomqondo owohloka komqondo. Ucwaningo oluningi luye lwabonisa ukuthi iziguli eziphathwe ngemishanguzo yokulwa nama-antihypertensive zinomngciphezi ophansi wokuthuthukiswa kokukhubazeka kwengqondo, ukucindezeleka kwengqondo, kanye ne-atrophy yobuchopho. Ukwelashwa kwesikhashana eside kwengcindezi ephakeme yegazi kunciphise kakhulu ingozi kokubili ukushada komqondo kwe-Alzheimer kanye nokuwohloka komqondo kwegazi.
Umfutho wegazi ophakeme yiyona ingozi ebaluleke kunazo zonke izifo ze-vascular zazo zonke izinhlobo nokufa. Ucwaningo oluningi luye lwabonisa ukuthi iziguli eziphathwa ngezinga eliphezulu zegazi zinezinombolo ezincane kakhulu, izifo ezibulalayo ngenxa yokushaywa yisifo, ukuhlaselwa yinhliziyo, ezinye izenzakalo zenhliziyo, ukufa okuvela ezenzakalweni zenhliziyo, nakho konke okubangelwa ukufa. Ukuhlaziywa "kwezinombolo ezidingekayo zokwelapha," okubonisa ukuthi bangaki abantu okufanele baphathwe ukuze umuntu oyedwa azuze ekwelashweni, kubonisa ukuthi abadala abangaphansi kwamakhulu ayisishiyagalolunye badinga ukuphathwa ngegazi eliphezulu lokuvimbela umuntu oyedwa ubhekene nesiphumo esinzima njengesihlungu noma isifo senhliziyo. I-NNT ingumlinganiso wezindleko / inzuzo yezokwelapha. I-NNT ehlotshaniswa nokuphathwa kwengcindezi yegazi kubantu abadala asebekhulile iphakamisa ukuthi ukwelashwa kwegazi kusebenza ngendlela ebiza kakhulu ngokuhamba kwesikhathi, ngoba ukwelashwa kungavimbela imicimbi eminingi eyingozi ebiza ukwelashwa futhi ingabangela ukulahlekelwa okukhulu kokuzimela.
Yini Okufanele Abantu Abadala Abene-Hypertension Ukuthuthukisa Amanani Abo?
Ukuguqulwa kwempilo yokunciphisa ukucindezela kwegazi, kodwa akucaci uma behlisa lezi zenzakalo. I-DASH (Ukudla Kwemithi Yokumisa Ukucindezeleka) ukudla kuyasebenza ekunciphiseni umfutho wegazi we-systolic kubantu asebekhulile, ngoba kubonakala sengathi bangabe besabela kakhulu emiphumeleni ye-sodium (usawoti) ezidlweni zabo. Abantu asebekhulile asebenzayo bazuza ngokuzivocavoca komzimba kanye nezinye izincomo zokuphila, kuhlanganise nokuyeka ugwayi nokulinganisela kokusetshenziswa kotshwala, kusebenza kuwo wonke amaqembu.
Ukwelashwa kwengcindezi yegazi kubantu asebekhulile kufanele kucatshangelwe ezinye izimo:
- Ukunciphisa ukucindezeleka kwegazi kubonakala kubaluleke kakhulu kunokusebenzisa iklasi elithile lezidakamizwa.
- Ukwelapha ngemishanguzo elwa nama-antihypertensive kunciphisa ingozi yokwehla komfutho wegazi ophakeme ngamaphesenti angu-94.
- Ukuhluleka kwenhliziyo, okuyinto evame ukuwumphumela wokucindezela kwegazi okungapheli, kuboniswe ukuthi kuncishiswe ngamaphesenti angu-42 ezigodini ezindala ezinegazi eliphezulu eziphathwa ngemithi uma kuqhathaniswa nalabo ababenomfutho wegazi ophezulu ongazange baphathwe.
- Umfutho wegazi ophezulu ungabangela isifo sezinso, kodwa ucwaningo olunzulu lubonise ukuthi ukuncipha kwengcindezi yegazi kuphumelela kakhulu kunokuguqulwa kokudla kokunciphisa ingozi.
Ukucindezelwa Kwegazi Okucabangelayo Okubhekiswe Kwabadala
Nakuba izinhlahlandlela zamanje zomphakathi jikelele zikhomba umgomo wegazi we-less than 140 mm Hg systolic kanye ne-diastolic yomshoshaphansi wegazi engaphansi kwe-90 mm Hg, isisulu seziguli asebekhulile kufanele sibe nesisindo segazi samaphesenti angaphansi kuka-150 mm Hg ne-diastolic yegazi ngaphansi kuka-90 mm Hg. Kulaba asebekhulile abanesifo sikashukela noma isifo esingenasifo sezinso, umgomo wokunciphisa ukucindezelwa kwegazi kumele ube yi-systolic blood pressure ngaphansi kuka-140 mm Hg. Iziguli ezindala ezingafani futhi ziphilile zingabheka isisindo somfutho wegazi ngaphansi kuka-140 mm Hg.
Umgomo wokwelapha umfutho wegazi ufinyelelwa ngamaphesenti angaba ngu-70 kuphela asebekhulile abathola imithi yokwelapha ngokweqile, kodwa izifundo zibonise izinzuzo ezibalulekile ukwelashwa, ngisho nalapho umgomo wegazi wegazi ungaphumeleli. Lezi zinzuzo zihlanganisa ukunciphisa inengozi yokushaywa kwesifo se-hemorrhagic ne-ischemic futhi ukuncipha kwe-4.4% ekupheleleni kwenhliziyo.
Ingabe Bonke Abantu asebekhulile kufanele babe nokucindezelwa kwegazi eliphezulu?
Nakuba izinguquko endleleni yokuphila, njengokunciphisa isisindo, ukunciphisa usawoti, nokuzivocavoca, zizuzisa, empilweni yangempela kubonakala sengathi ukuguqula indlela yokuphila akuyona njalo eyenziwa njalo ngendlela yokuvumela iziguli ezindala ukuba zibone izinzuzo. Ukuguqula indlela yokuphila akuyona njalo eyenziwa ngabantu abadala asebekhulile futhi kungabi kubiza, lapho abacebisi abaqedayo bezondlo, abaqeqeshi bezokwelapha, nezindleko zokuhamba, phakathi kwezinye izici, bacatshangelwa.
Kubalulekile kubo bonke abagulayo abane-high blood pressure ukuba baphile impilo enempilo, kodwa abukho ubufakazi bokuthi lezi zinyathelo zinethonya elikhulu ekunciphiseni ingozi ye-sequelae yezokwelapha ezibi kakhulu ekucindezelekeni kwegazi kubantu asebekhulile. Ucwaningo lubonisa ukuthi ukusetshenziswa kwemithi ephakeme yegazi kusebenza kakhulu ekunciphiseni imicimbi ye-cardiovascular.
Ngokuvamile, abantu abanezici eziyinhloko zempilo yengculazi, kungakhathaliseki ubudala babo, kufanele baphathwe nesidakamizwa ukuze bahlangabezane nomgomo wabo wegazi. Ngesinye isikhathi, kwaba nokwamukelwa okuthile komqondo wokuyeka ukwelashwa kweziguli ezingaphezu kweminyaka engu-79, kodwa ubufakazi bubonisa ngokucacile ukuthi imiphumela, kuhlanganise nokushaya, isifo senhliziyo, nokuhluleka kwenhliziyo, kubi kakhulu kwiziguli ezingaphathwa , ngisho nangeminyaka eyisishiyagalolunye yokuphila.
Isidakamizwa esiphezulu se-antihypertensive for an elderly person with high blood pressure
Ngokuvamile, imishanguzo efanayo ephakanyisiwe kubantu abaningi ngokuvamile iyakulungele umuntu osekhulile. Isivivinyo se-ALLHAT (Ukwelashwa Kwe-Antihypertensive and Lowering Treatment for Prevent Heart Attack) kubonise ukuthi ama-alpha-blockers ahlobene nengozi enkulu yemicimbi ye-cardiovascular like heart failure uma kuqhathaniswa namanye amakilasi ezidakamizwa. Kodwa-ke, kubantu abaningi asebekhulile abanesinye isimo sezokwelapha, ochwepheshe babonakala bevuma ukuthi ukwelashwa kufanele kube ngabanye ngokusekelwe ezidingo zesiguli.
Izinkinga zezokwelapha ezifana nesifo sezinso, igciwane, isifo sikashukela, isifo sofuba, nokuhluleka kwenhliziyo kuyoba nomthelela ngqo ekukhethweni kwezidakamizwa ezisetshenziselwa ukulawula ukucindezeleka kwegazi, ikakhulukazi uma esinye isimo singelashwa ngesidakamizwa esifanayo esetshenziselwa ukucindezeleka. Izimo eziningi zezokwelapha ezigulini asebekhulile zidinga iseluleko sobuchwepheshe kumtholampilo ukuthola ukuthi imishanguzo yegazi ingabhekana kanjani nezidingo zomuntu.
Umfutho wegazi ophezulu ungase ube nzima kakhulu ukulawula kumuntu omdala kanye nomuthi ongaphezu kwesisodwa uvame ukushiwo. Lokhu kungabangela "i-hypotension ye-orthostatic," noma ukwehla kwegazi lapho uhamba ukusuka endaweni ehlezi noma ehlezi endaweni yokuma. Kubaluleke kakhulu ukukala umfutho wegazi lomdala uma bemi ukuze kuqiniseke ukuthi akuphansi kakhulu futhi kubangele ukuphelelwa amandla noma isizungu. I-Orthostatic hypotension yingozi enkulu yokuwa kubantu asebekhulile futhi ngoba iziguli ezindala zivame ukuthatha izinhlobo eziningi zemithi, zingase zihlanganyele futhi zandise lolu hlobo lomphumela.
I-American Geriatrics Society incoma ukuhlola ukukhubazeka kwabantu abadala ukuze babone noma yiziphi izingozi ezihambisana nokuphathwa kogonyamelo lwegazi, kuhlanganise nezingozi zokuwa nokukhathala. Iningi labachwepheshe bayavuma ukuthi ukunciphisa ukucindezelwa kwegazi ngemithi kwiziguli asebekhulile kufanele kwenzeke kancane kancane, ngokulinganisa kancane kancane. Nakuba imihlahlandlela yempinga yegazi okwamanje isikisela ukuqala izidakamizwa ezimbili ezihlukene uma ukucindezeleka kwegazi kuqala kungaphezu kuka-20 mm Hg phezu kwehlongo, imithi eyodwa kufanele iqaliswe kancane ngaphambi kokungeza imithi ehlukile.
Okunye okucatshangwayo
Njengoba sikhula, silahlekelwa ukuzwela ukunambitha, ngakho-ke abantu asebekhulile bangase badle ukudla kwabo ngaphandle kokuqaphela ukuthi banda ingozi yabo. I-apnea yokulala ihlotshaniswa nentuthuko ye-hypertension, ngakho-ke kunengqondo ukukhuluma ukulala okungajwayelekile emini noma ukuzwa ukukhathala ekuvukeni lapho ubona udokotela wakho.
Njengaminyaka esiyonke yabantu, sizoqhubeka sibona inani elikhulayo labantu abahlala eminyakeni yabo eyishumi nambili noma eyishumi leminyaka yokuphila. Kubantu abangaphezu kweminyaka engama-60, amaphesenti angaba ngu-80 azothinteka yi-hypertension. Abantu abadala abakwazi ukukhulisa nokuthuthukisa ikhwalithi yabo yokuphila ngokunciphisa ingozi yokushaywa yisifo, ukuhlasela kwenhliziyo, ukwehluleka kwenhliziyo, nokufa ngokulawulwa kwegazi. Izincomo ze-Joint National Commission (JNC8) zinikeze ubufakazi obuningi obukhona ezincomo zabo zokulawulwa komfutho wegazi ophezulu.
Izwi elivela
Ukwelashwa kwengcindezi ephezulu yegazi kungakwandisa isikhathi sakho sokuphila futhi kunciphise izingozi ezinkulu eziyingozi njenge-stroke noma isifo senhliziyo. Iziguli ezindala zizuza ngaphezu kweziguli ezincane ngokuphathwa kokwelashwa komfutho wegazi ophezulu. Kungenzeka futhi ukuthi banezinye izimo zezokwelapha futhi bangase babe nengozi eyengeziwe yemiphumela emibi yemithi. Uma ungumuntu omdala onomfutho wegazi ophakeme, kufanele uthintane nochwepheshe wezempilo owaziyo ngemithi yokwelapha. Uchwepheshe wezempilo wezempilo uzoba nokuqonda okuphelele kwezinselele zokusebenza eziza nokuguga kanye nezinkinga eziningi zokwelashwa ezibambisene nabantu abaningi asebekhulile.
> Imithombo:
> I-American Academy of Family Physicians. (2014). Imihlahlandlela ye-JNC 8 yokuphathwa kwe-Hypertension kubantu abadala. Am Fam Physician , 90 (7), 503-504.
> Franklin SS, Gustin W 4th, Wong ND, et al. Amaphethini we-Hemodynamic wezinguquko ezihlobene nobudala e-blood pressure. I-Framingham Heart Study. Ukujikeleza ngo-1997; 96: 308.
> James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS , I- Ortiz E. 2014 Isiqondiso Esisekelwe EmiBhalweni Yokuphathwa Kokucindezelwa Kwegazi Eliphezulu Kwabantu AbadalaBika Kuvela Kumalungu Amalungu Esikhundla Aqokwe Ikomidi Lezizwe Eziyisishiyagalombili (JNC 8). I-JAMA. 2014; 311 (5): 507-520. i-doi: 10.1001 / jama.2013.284427
> I-Mahajan R. Joint National Committee 8 Umbiko: Ihluke kanjani kuJNC 7. International Journal of Applied and Basic Medical Research . 2014; 4 (2): 61-62. i-doi: 10.4103 / 2229-516X.136773.
> Patel MD, A. (2015, February 20). On Hypertension in the Elderly: An Epidemiologic Shift - American College of Cardiology. Ibuyiswa kusuka ku-http: //www.acc.org/latest-in-cardiology/articles/2015/02/19/14/55/on-hypertension-in-the-elderly