Iningi labantu abangaphezu kweminyaka engama-65 banomfutho wegazi ophezulu ( umfutho wegazi ophezulu), okuyingozi enkulu yokushaya isifo , isifo se-artery coronary (CAD), ukuhluleka kwenhliziyo , nesifo sezinso.
Kubaluleke kakhulu ukuthi kokubili abantu asebekhulile nabantu abasha banesifo somfutho wegazi ophezulu. Kodwa abantu abaningi asebekhulile babhekene nezinselelo ezimbili ezikhethekile ekufezeni ukulawulwa kwengcindezi eyanele yegazi: okokuqala, iningi lazo liba ne-hypertension ye-systolic.
Okwesibili, abantu asebekhulile kaningi banzima ukubekezelela ukwelashwa okunamandla.
I-Systolic Hypertension Kwabekhulile
Abantu abaningi asebekhulile abanesifo somfutho wegazi ophezulu basuke bephakama kakhulu e-systolic blood pressure, kanti ukucindezela kwabo kwe-diastolic kuhlala kujwayelekile noma kuvamile. Lokhu kungenxa yokuthi njengoba sisekhulile, imithwalo yegazi yethu iba "yinqaba," ngakho-ke ukucindezeleka kwegazi (sympression in the blood pressure) lapho kushaya khona imisipha yenhliziyo. Umfutho wegazi we-systolic we-140 mm Hg ubhekwa njengomkhawulo ophezulu wokujwayelekile.
Ngaphezu kwalokho, kubantu abangaphezu kweminyaka engama-65 ubudala, ukucindezeleka kwegazi okuphakeme kakhulu kwandisa ingozi yenhliziyo ngaphezu kokucindezela okukhulu kwe-diastolic. (Okuphambene nalokho kubantu abasha.) Eqinisweni, ukucindezeleka kwe-systolic kungaphezu kokuphindaphinda ubungozi bokuhlaselwa kwenhliziyo nokushaywa isifo. Ngakho ukwelapha isifo somfutho we-systolic kubalulekile.
Kodwa ukwelapha i-systolic hypertension kungabonisa inkinga ekhethekile: okungukuthi, ekunciphiseni umfutho wegazi we-systolic, kubalulekile ukuthi ngesikhathi esifanayo kunganciphisi ukucindezeleka kwegazi kwe-diastolic kakhulu.
Lokhu kungenxa yokuthi kubantu asebekhulile abane-CAD, ukunciphisa ukucindezela kwe-diastolic ngezansi kwe-60 noma 65 mm Hg kuye kwahlotshaniswa nokwanda kwenhliziyo nokuhlaselwa.
Ngakho ukukhohlisa ukwelashwa kwe-systolic ukunciphisa ukucindezela kwe-systolic kuya ngaphansi kuka-140 mm Hg - noma eduze no-140 mm Hg ngangokunokwenzeka - ngenkathi ugcina ingcindezi ye-diastolic engaphezu kuka-60 noma 65 mm Hg.
Ukwelashwa kwe-Hypertension kubantu abadala
Njengomunye umuntu onesifo somfutho wegazi ophezulu, isinyathelo sokuqala ekwelapheni umfutho wegazi ophezulu kubantu asebekhulile ukufaka izinguquko zokuphila ezinganciphisa ukucindezelwa kwegazi, okufaka ukulahlekelwa kwesisindo, ukuvinjelwa kosawoti, ukuvivinya umzimba, nokuyeka ukubhema.
Uma ingcindezi yegazi ihlala iphakanyisiwe ngemuva kwenyanga noma ezimbili zokuguqula indlela yokuphila, udokotela wakho cishe uzotusa ukwelashwa kwezidakamizwa.
Kubantu asebekhulile, ukusebenzisa izidakamizwa eziphikisanayo ngokuphepha kungaba yinto ekhohlisayo. Akufanele nje ukukhathalela kuthathwe ukugwema ukwehlisa ukucindezeleka kwe-diastolic, kodwa abanye abantu asebekhulile, ikakhulu labo labo abane-hypertension ye-systolic, bangase bahlakulele i- hypotension ye-orthostatic (ukuwa egazini legazi lapho bema) neminye imithi yegazi. I-postpandial hypotension (ukuwa kwegazi egameni ngemuva kokudla) kungabonakala nakubantu asebekhulile ngemithi yokwelapha ngokweqile. I-hypotension - noma yini engase ibangele - ingaholela ekumeni nokuwa, futhi kufanele igwenywe.
Ngakho igama lomdlalo ukuhamba kancane ukuze ugweme imiphumela emibi. Lapho uqala imithi yomshuwalense wegazi kubantu asebekhulile, kufanele kusetshenziswe umuthi owodwa, futhi kufanele uqalwe ngomthamo ophansi - ngokuvamile, ngomthamo okungenani isigamu somthamo ongasetshenziselwa isiguli esincane.
Ukwelashwa kuvame ukuqala nge- thiazide diuretic , i-calcium blocker ende ende, noma i-ACE inhibitor. Uma ngabe izidakamizwa zibekezelelwe ngaphandle kwemiphumela emibi, umthamo unganyuswa emva kwamasonto ambalwa uma kunesidingo. Uma ngabe i-dose ephakeme ingakapheli ukulawula okuhle kwegazi, odokotela abaningi bazobe sebebuyela emithini ehlukile , kunokungeza umuthi wesibili. Ukwelapha izidakamizwa ezihlanganiswa ngokuvamile kusetshenziselwa kuphela lapho imizamo eminingana yokwelashwa okulodwa kwezidakamizwa inganelanga.
Ngemuva kokuguquka kokwelapha - ukwandisa umthamo wesidakamizwa, ukushintsha imithi ehlukile, noma ukwengeza imithi yesibili - udokotela wakho kufanele ahlole ngokucophelela i-hypotension ye-orthostatic.
Lokhu kwenziwa ngokulinganisa ukucindezelwa kwegazi ngenkathi ulele phansi, bese kuthi lapho usukuma, ngenkathi ufuna ukwehla okukhulu ekucindezelekeni. Kubuye kubalulekile njalo ukutshela udokotela wakho nganoma yisiphi isizungu esingahle usizwe uma usukuma, noma ngemuva kokudla.
Umgomo ukuletha kancane kancane ukucindezela kwegazi ukubhekela emazingeni, ngaphezu kwamasonto noma izinyanga (kunokuba ezinsukwini) ngenkathi unakekelwa ngalesi sikhathi ukugwema ukwehlisa ukucindezeleka kwegazi kakhulu. Ukufeza le njongo ngokuvamile kuthatha uvivinyo oluningi ngomuthi owodwa noma ngaphezulu kanye nokulungiswa kwezilinganiso eziningana.
Isifingqo
Uma ungumuntu omdala, amathuba ukuthi unomfutho wegazi ophezulu. Ngenkathi i-hypertension yinkinga ebalulekile, kanti ngenkathi ukwelapha kungase kube nezinselelo, kusekhona ukuthi ngokunakekelwa nokubekezela (ngakwakho kanye nodokotela wakho), kunethuba elihle kakhulu ukuthi umfutho wegazi ophezulu uzolawulwa ngaphandle kwanoma yikuphi imiphumela emibi, futhi ingozi yakho yezinkinga ezinkulu zenhliziyo izonciphisa kakhulu.
Imithombo:
Aronow WS, Fleg JL, uPepine CJ, et al. I-ACCF / AHA 2011 idokhumenti yokuvumelanisa ngolwazi oluphathelene nokucindezeleka okukhulu kubantu asebekhulile: umbiko we-American College of Cardiology Foundation Task Force ku-Clinical Expert Consensus Documents. Ukujikeleza ngo-2011; 123: 2434.
I-AV ye-Chobanian. Umkhuba wokwelapha. I-hypertension ye-systolic ehlukanisiwe kwasebekhulile. N Engl J Med 2007; 357: 789.