Umfutho wegazi ophezulu wesifo sikashukela

Umfutho wegazi ophakeme yilapho umfutho wegazi uphezulu kakhulu kangangokuba izindlela zokwelapha zizoba nosizo olukhulu esigulini kunemiphumela emibi eyingozi. Uma unengcindezi yegazi engu-140/90 noma ngaphezulu - yisikhathi sokuphola ngokugcwele. Ngoba umfutho wegazi ophakeme ukhulisa ingozi yokuhlaselwa yisifo senhliziyo, unhlangothi, ukwehluleka kwezinso, noma ukungaboni izikhathi eziningana. Ngohlobo 1 noma isifo sikashukela esingu-2, umkhawulo ophakeme wegazi wehlela ku-130/85 mmHg. Ubuciko. Uma unengcindezi ephezulu, kufanele wenze yonke imizamo yokuwehlisa.

Ngohlobo 1 noma isifo sikashukela sohlobo 2, umfutho wegazi ophakeme uyingozi ikakhulukazi. Ngoba uma isifo sikashukela sihlanganiswa nomfutho wegazi ophakeme, ingozi yokuhlaselwa yisifo senhliziyo ebulalayo inyuka ngezikhathi ezingama-3-5, ukuhlaselwa yizikhathi ezi-3-4, ubumpumputhe ngezikhathi eziyi-10 - 20, ukwehluleka kwezinso ngezikhathi ezingama-20-25, ukunqotshwa umlenze kanye nokunqunywa komlenze - Izikhathi ezingama-20. Ngasikhathi sinye, umfutho wegazi ophakeme awunzima kangako ukuwenza ngokwejwayelekile, ngaphandle kokuthi isifo sezinso sakho sesihambile kakhulu.

Izimbangela Zomfutho Wegazi Esikashukela

Kuhlobo 1 nesifo sikashukela sohlobo 2, izimbangela zokukhula komfutho we-arterial hypertension zingahluka. Kuhlobo 1 sikashukela mellitus, umfutho wegazi ophezulu ngo-80% wamacala ngenxa yokulimala kwezinso (isifo sikashukela). Uhlobo 2 lwesifo sikashukela, umfutho wegazi ophakeme uvama ukukhula esigulini ngaphambi kokuphazamiseka kwengqondo kwe-carbohydrate metabolism kanye nesifo sikashukela uqobo. I-Hypertension ingenye yezingxenye zesifo se-metabolic, okuyisandulela sokuqala uhlobo 2 sikashukela.

Izimbangela zokukhula komfutho wegazi ophezulu kushukela kanye nemvamisa yazo

Amanothi etafuleni. Isolated hypstension ye-Isstated iyinkinga ethile ezigulini esezikhulile. Funda kabanzi esihlokweni esithi "Isolated systolic hypertension in the asebekhulile." Enye i-endocrine pathology - ingaba yi-pheochromocytoma, i-hyperaldosteronism eyisisekelo, isifo i-Itsenko-Cushing's, noma esinye isifo esingandile.

Umfutho wegazi obalulekile - okusho ukuthi udokotela akakwazi ukuthola imbangela yokwanda kwengcindezi yegazi. Uma umfutho wegazi ophakeme uhlanganiswa nokukhuluphala, khona-ke, okungenzeka kakhulu, imbangela ukungabekezeleli kokudla kuma-carbohydrate kanye nezinga elikhulayo le-insulin egazini. Lokhu kubizwa nge- "metabolic syndrome," futhi kusabela kahle ekwelashweni. Kungaba futhi:

• ukuntuleka kwe-magnesium emzimbeni;
• ukucindezelwa okungapheli kwengqondo;
• ukudakwa nge-zebus, lead noma i-cadmium;
• unciphise i-artery enkulu ngenxa ye-atherosclerosis.

Futhi khumbula ukuthi uma isiguli sifuna ngempela ukuphila, khona-ke umuthi awunamandla :).

Thayipha umfutho wegazi ophezulu we-1

Kuhlobo 1 sikashukela mellitus, imbangela eyinhloko futhi eyingozi kakhulu yengcindezi eyandayo ukulimala kwezinso, ikakhulukazi, isifo sikashukela. Le nkinga iba ngo-35- 40% weziguli ezinesifo sikashukela sohlobo 1 futhi zihamba ngezigaba eziningana:

• isigaba se-microalbuminuria (kuqhamuka ama-molecule amancane amaprotheni e-albhamuin emchameni);
• isigaba se-proteinuria (isihlungi sezinso sibi kakhulu, futhi kuvela amaprotheni amaningi kumchamo);
• isigaba sokwehluleka kwezinso okungamahlalakhona.

Ngokusho kwesikhungo i-Federal State Institution Endocrinology Research Center (eMoscow), phakathi kweziguli ezinesifo sikashukela sohlobo 1 ngaphandle kwe-pathology yezinso, umfutho wegazi ophakeme uthinta u-10%. Ezigulini ezisezingeni le-microalbuminuria, leli nani lenyuka lifinyelela kuma-20%, esigabeni se-proteinuria - 50-70%, esiteji sokwehluleka kwezinso okungamahlalakhona - 70-100%. Amaprotheni amaningi afakwa emchini, ayanda umfutho wegazi lesiguli - lokhu kungumthetho ojwayelekile.

Umfutho wegazi ophezulu ngomonakalo wezinso uyakhula ngenxa yokuthi izinso zisebenza kabi sodium kumchamo. Isodiyamu egazini iba nkulu futhi uketshezi luyakha ukuze luyixukuze. Amandla amaningi wegazi elijikelezayo andisa umfutho wegazi. Uma iglue glucose inyuswa ngenxa yesifo sikashukela egazini, khona-ke idonsa uketshezi olwengeziwe ngalo ukuze igazi lingabi mnene kakhulu. Ngakho-ke, inani lokujikeleza kwegazi lisakhula.

Umfutho wegazi ophakeme nesifo sezinso akha umjikelezo oyingozi oyingozi. Umzimba uzama ukunxephezela ukungasebenzi kahle kwezinso, yingakho nomfutho wegazi ukhuphuka. Futhi, yandisa ingcindezi ngaphakathi kwe-glomeruli. Izinto okuthiwa zokuhlunga ngaphakathi kwezinso. Ngenxa yalokhu, i-glomeruli iyafa kancane kancane, nezinso zisebenza zimbi kakhulu.

Le nqubo igcina ngokuhluleka kwezinso. Ngenhlanhla, ezigabeni zokuqala ze-nephropathy yesifo sikashukela, umjikelezo onesihluku ungaphulwa uma isiguli siphathwa ngokucophelela. Into esemqoka ukwehlisa ushukela wegazi kube okwejwayelekile. Ama-inhibitors e-ACE, ama-angiotensin receptor blockers, kanye nama-diuretics nawo ayasiza. Ungafunda okuningi ngabo ngezansi.

Umfutho wegazi ophezulu nohlobo 2 sikashukela

Esikhathini eside ngaphambi kokuqala kwesifo sikashukela sohlobo “lwangempela”, inqubo yesifo iqala ngokumelana ne-insulin. Lokhu kusho ukuthi ukuzwela kwezicubu ezenzweni ze-insulin kuncishisiwe. Ukunxenxa ukumelana ne-insulin, i-insulin eningi kakhulu ijikeleza egazini, futhi lokhu ngokwako kukhulisa umfutho wegazi.

Kuyo yonke le minyaka, i-lumen of imithambo yegazi iyancipha ngenxa ye-atherosulinosis, futhi lokhu kuba ngomunye "umnikelo" obalulekile ekuthuthukiseni umfutho wegazi ophezulu. Ngokufana, isiguli sinokukhuluphala esiswini (eduze okhalweni). Kukholelwa ukuthi izicubu ze-adipose zikhipha izinto egazini ezikhulisa umfutho wegazi.

Le nkimbinkimbi ibizwa ngokuthi yi-metabolic syndrome. Kuyavela ukuthi umfutho wegazi ophakeme uthuthuka kakhulu ngaphambi kwesifo sikashukela sohlobo 2. Ngokuvamile kutholakala esigulini khona lapho lapho kutholakala ukuthi banesifo sikashukela. Ngenhlanhla, ukudla okuphansi kwe-carbohydrate kusiza ukulawula uhlobo 2 sikashukela kanye nomfutho wegazi ojwayelekile ngasikhathi sinye. Ungafunda imininingwane engezansi.

I-Hyperinsulinism iyiqoqo elandisiwe le-insulin egazini. Kwenzeka lapho kuphendulwa ukumelana ne-insulin. Uma i-pancreas kufanele ikhiqize i-insulin ngokweqile, khona-ke "iyakhathala". Lapho eseyeka ukubekezelela iminyaka edlule, kuphakama ushukela wegazi bese kuthayipha isifo sikashukela esingu-2.

I-hyperinsulinism ikhulisa kanjani umfutho wegazi:

• kusebenze uhlelo lwezinzwa olunozwela;
• izinso excrete sodium kanye uketshezi kubi kakhulu kumchamo;
• i-sodium ne-calcium buthelela ngaphakathi kwamangqamuzana;
• i-insulin ethe xaxa isiza ukuqina izindonga zemithambo yegazi, okunciphisa ukuqina kwawo.

Izici zokubonakaliswa komfutho wegazi ophakeme kushukela

Njengoba unesifo sikashukela, isigqi sokuguquguquka kwemvelo ekushintshashintsheni kwengcindezi yegazi siyaphazamiseka. Imvamisa, kumuntu ekuseni nasebusuku ngesikhathi sokulala, umfutho wegazi ungaphansi kwe-10-20% kunasemini. Isifo sikashukela siholela eqinisweni lokuthi ezigulini eziningi ezinomfutho wegazi ingcindezi ebusuku ayinciphi. Ngaphezu kwalokho, ngenhlanganisela yomfutho wegazi ophakeme nesifo sikashukela, ingcindezi yasebusuku imvama iphakeme kunekucindezela kwasemini.

Lokhu kuphazamiseka kucatshangelwa ukuthi kungenxa yesifo sikashukela se-neuropathy. Ushukela wegazi ophakanyisiwe uthinta uhlelo lwezinzwa oluzimele, olawula impilo yomzimba. Njengomphumela, amandla emithambo yegazi yokulawula ithoni yawo, isb., Ukuncipha futhi aphumule ngokuya ngomthwalo, aya ngokuwohloka.

Isiphetho siwukuthi ngokuhlanganiswa kwe-hypertension kanye nesifo sikashukela, hhayi kuphela izilinganiso zokucindezela kwesikhathi esisodwa nge-tonometer, kodwa futhi nokuqapha kwamahora angama-24. Kwenziwa kusetshenziswa idivaysi ekhethekile. Ngokwemiphumela yalolu cwaningo, ungaguqula isikhathi sokuphuza kanye nesithamo semishanguzo ukuze ucindezelwe.

Ukuzijwayeza kukhombisa ukuthi iziguli ezinesifo sikashukela sohlobo 1 nohlobo 2 zivame kakhulu ukuzwela usawoti kuneziguli ezinesifo sikashukela ezingenaso isifo sikashukela. Lokhu kusho ukuthi ukunciphisa usawoti ekudleni kungaba nomphumela onamandla wokupholisa. Esikhathini sikashukela, ukwelapha umfutho wegazi ophakeme, zama ukudla usawoti omncane bese kuthi emva kwenyanga, uhlole okwenzekayo.

Umfutho wegazi ophezulu kwisifo sikashukela uvame ukuhlanganiswa yinkimbinkimbi ye-orthostatic hypotension. Lokhu kusho ukuthi umfutho wegazi lesiguli wehla kakhulu lapho usuka endaweni yokuqamba amanga uye endaweni yokuma noma ehleli. I-Orthostatic hypotension izibonakalisa ngemuva kokunyuka okubukhali kwesiyezi, iba mnyama emehlweni noma ihluleke.

Njengokwephula isigqi se-circadian somfutho wegazi, le nkinga ivela ngenxa yokuqalwa kwesifo sikashukela sesifo sikashukela. Isistimu yezinzwa kancane kancane ilahlekelwa yikhono layo lokulawula ithoni ye-vascular. Lapho umuntu esukuma ngokushesha, umthwalo uphakama ngokushesha. Kepha umzimba awunaso isikhathi sokwandisa ukuphuma kwegazi emithanjeni, futhi ngenxa yalokhu, impilo iya ngokuya ikhula.

I-Orthostatic hypotension yenza kube nzima ukuxilongwa nokwelashwa komfutho wegazi ophakeme. Ukulinganisa umfutho wegazi kushukela kuyadingeka ezikhundleni ezimbili - ukuma nokulala phansi. Uma isiguli sinale nkinga, kufanele sisukume kancane, “ngokusho kwempilo yaso”.

I-Diabetes Hypertension Diet

Isayithi lethu lenzelwe ukukhuthaza ukudla okune-carbohydrate eningi ngohlobo 1 nohlobo 2 sikashukela. Ngoba ukudla ama-carbohydrate amancane kuyindlela engcono kakhulu yokwehlisa nokugcina ushukela wegazi lakho. Isidingo sakho se-insulin sizokwehla, futhi lokhu kuzosiza ukuthuthukisa imiphumela yakho yokwelashwa kwe-hypertension. Ngoba i-insulin ethe xaxa ijikeleza egazini, ilanda umfutho wegazi. Sesivele sixoxe ngale ndlela ngenhla.

Sincoma izindatshana zakho zokunaka:

• Ama-insulin nama-carbohydrate: iqiniso okufanele ulazi.
• Indlela enhle yokwehlisa ushukela wegazi futhi ugcine ijwayelekile.

Ukudla okuphansi kwe-carbohydrate yesifo sikashukela kufaneleka kuphela uma ungakakhuli ukuhluleka kwezinso. Lesi sitayela sokudla siphephile ngokuphelele futhi sizuzisa ngesikhathi sesigaba se-microalbuminuria. Ngoba lapho ushukela wegazi wehla uye kwesejwayelekile, izinso ziqala ukusebenza ngokujwayelekile, futhi okuqukethwe kwe-albhamuin kumchamo kubuyela kokujwayelekile. Uma unesigaba se-proteinuria - qaphela, thintana nodokotela wakho. Funda futhi nesifo sikashukela sezinso.

Ngabe ushukela kufanele ancishiswe kuliphi izinga?

Iziguli ezinomfutho wegazi ophezulu onesifo sikashukela yiziguli ezinobungozi obukhulu noma obukhulu kakhulu bezinkinga zenhliziyo. Kunconywa ukuba behlise umfutho wegazi ukuya ku-140/90 mm RT. Ubuciko. emasontweni ama-4 okuqala, uma bekuvumela ukusetshenziswa kwemithi ebekiwe kahle. Emavikini alandelayo, ungazama ukwehlisa ingcindezi ibe ngu-130/80.

Into esemqoka ukuthi isiguli sikubekezelela kanjani ukwelashwa ngezidakamizwa nemiphumela yaso? Uma kukubi, khona-ke umfutho wegazi ophansi kufanele ube kancane, ngezigaba eziningana. Ngasinye salezi zigaba - ngo-10-15% wezinga lokuqala, kungakapheli amasonto angama-2-4. Lapho isiguli sivumelana, engeza imithamo noma wandise inani lemithi.

Uma unciphisa umfutho wegazi ngezigaba, khona-ke lokhu kugwema iziqephu ze-hypotension futhi ngaleyo ndlela unciphise ingozi yokuqunjelwa kwe-myocardial noma unhlangothi. Umkhawulo ophansi womkhawulo wokucindezela kwegazi okujwayelekile ngu-110-115 / 70-75 mm RT. Ubuciko.

Kunamaqembu eziguli ezinesifo sikashukela ezokwehlisa umfutho wegazi wazo “ophezulu” ku-140 mmHg. Ubuciko. futhi okuphansi kungaba nzima kakhulu. Uhlu lwabo lubandakanya:

• iziguli esevele zinezitho ezihlosiwe, ikakhulukazi izinso;
• iziguli ezinezinkinga zenhliziyo;
• abantu asebekhulile, ngenxa yokulimala kwemithambo okuhlobene nobudala ku-atherossteosis.

Amaphilisi wokucindezela kwesifo sikashukela

Kungaba nzima ukukhetha amaphilisi okucindezela kwegazi esigulini esinesifo sikashukela. Ngoba i-carbohydrate metabolism engasebenzi kahle ibeka imingcele ekusebenziseni izidakamizwa eziningi, kufaka phakathi umfutho wegazi ophakeme. Lapho ekhetha umuthi, udokotela ubheka ukuthi isiguli silawula kanjani isifo sakhe sikashukela nokuthi yiziphi izifo ezenzeka ndawonye, ​​ngaphezu komfutho wegazi ophakeme.

Amaphilisi wokucindezela ushukela omuhle kufanele abe nalezi zindawo ezilandelayo:

• ukunciphisa kakhulu umfutho wegazi, futhi ngasikhathi sinye ukunciphisa imiphumela emibi;
• musa ukwenza kabi kakhulu ukulawula ushukela wegazi, ungangezi amazinga e-cholesterol “embi” nama-triglycerides;
• Vikela inhliziyo nezinso ekulimaleni okubangelwa yisifo sikashukela nomfutho wegazi ophakeme.

Njengamanje, kunamaqembu ayi-8 wezidakamizwa ezomfutho wegazi ophakeme, okuyi-5 kuzo eziphambili futhi ezi-3 ezingeziwe. Amatafula, angawamaqembu angeziwe, anqunyelwe, njengomthetho, njengengxenye yokwelapha okuhlanganayo.

Amaqembu Wokucindezelwa Kwengcindezi

Ngezansi sinikeza izincomo zokuphathwa kwale mishanguzo ezigulini ezinomfutho wegazi ophakeme lapho kuhlanganiswa khona nesifo sikashukela sohlobo 1 noma uhlobo 2.

I-Diuretics (i-diuretics) yengcindezelo

Ukuhlukaniswa kwama-diuretics

Imininingwane enemininingwane mayelana nazo zonke lezi zidakamizwa ze-diuretic ingatholakala lapha. Manje ake sixoxe ngokuthi ama-diuretics aphatha kanjani umfutho wegazi ophezulu kushukela.

Umfutho wegazi ophezulu ezigulini ezinesifo sikashukela uvame ukukhula ngenxa yokuthi umthamo wegazi elijikelezayo uyanda. Futhi, abanesifo sikashukela bahlukaniswa ukuzwela okwengeziwe kosawoti. Kulokhu, ama-diuretics ajwayele ukunikezwa ukwelapha umfutho wegazi ophezulu kushukela. Futhi ezigulini eziningi, izidakamizwa ze-diuretic zisiza kahle.

Odokotela bayayazisa i-thiazide diuretics ngoba le mishanguzo inciphisa ubungozi bokuhlaselwa yisifo senhliziyo nokushaywa yiziguli cishe ngo-15-25%. Kubandakanya nalabo abanesifo sikashukela sohlobo 2. Kukholakala ukuthi kumthamo omncane (okulingana ne-hydrochlorothiazide <25 mg ngosuku) awaphazamisi ukulawula ushukela wegazi futhi awenyusi i-cholesterol “embi”.

I-Thiazide ne-thiazide-diuretics ifakwa ku-infraindised ezigulini ezihlala zisehluleka ukuqina kwezinso. I-Loop diuretics, ngokuhlukile, iyasebenza ekuhlulekeni kwe-renal. Banqunyelwe uma i-hypertension ihlanganiswa ne-edema. Kepha abukho ubufakazi bokuthi bavikela izinso noma inhliziyo. I-potassium-sparing ne-osmotic diuretics yesifo sikashukela ayisetshenziswa nakancane.

Ngomfutho wegazi ophezulu ngokuhambisana nesifo sikashukela, imithamo emincane ye-thiazide diuretics imvamisa ibekwe kanye ne-ACE inhibitors noma i-beta-blockers. Ngoba i-diuretics iyodwa, ngaphandle kwezinye izidakamizwa, ayisebenzi ngokwanele esimweni esinjalo.

Ama-blocker e-Beta

Imithi eqenjini le-beta-blocker yile:

• ukukhetha nokungakhethi;
• lipophilic ne-hydrophilic;
• ngomsebenzi futhi ngaphandle kokuzwela.

Zonke lezi ziyizakhiwo ezibalulekile, futhi kungakuhle ukuthi isiguli sisebenzise imizuzu eyi-10- 15 ukuzizwisisisa. Futhi ngasikhathi sinye funda mayelana ne-contraindication nemiphumela emibi ye-beta-blockers. Ngemuva kwalokho, ungaqonda ukuthi kungani udokotela enqume lokhu noma lowo muthi.

AmaBeta-blocker kumele anikezwe isiguli esinesifo sikashukela uma kutholakala ukuthi sinokuthile okuvela kulolu hlu olulandelayo:

• isifo senhliziyo;
• ukwehluleka kwenhliziyo;
• isikhathi esibi sangemva kokuqunjelwa - ukuvimbela ukuphindaphindeka kwe-myocardial infarction.

Kuzo zonke lezi zimo, ama-beta-blockers anciphisa kakhulu ingozi yokufa kwesifo senhliziyo nezinye izimbangela.

Ngasikhathi sinye, ama-beta-blockers angakwazi ukuvala uphawu lwezimpawu ezibucayi ze-hypoglycemia, futhi enze kube nzima ukuphuma esimweni se-hypoglycemic. Ngakho-ke, uma umuntu onesifo sikashukela eye wakhubazeka ukuqashelwa kwe-hypoglycemia, khona-ke le mishanguzo ingabekwa kuphela ngokuqapha okwandayo.

Abakhethi be-beta-blocker abanomphumela omncane ongemuhle kuma-metabolism kushukela. Lokhu kusho ukuthi, ngokuya izinkomba, isiguli sidinga ukuthatha ama-beta-blockers, khona-ke izidakamizwa ze-cardioselective kufanele zisetshenziswe. Ama-blocker e-beta enza umsebenzi we-vasodilator - ne-nebivolol (Nebilet) ne-carvedilol (Coriol) - angathuthukisa ngisho nomzimba we-carbohydrate namafutha. Bandisa ukuzwela kwezicubu kwe-insulin.

Qaphela I-Carvedilol akuyona i-beta-blocker ekhethiwe, kepha ingenye yezidakamizwa zesimanje ezisetshenziswa kabanzi, ezisebenza ngokuphumelelayo futhi, mhlawumbe, azimbi kakhulu i-metabolism kushukela.

Ama-beta-blockers anamuhla, esikhundleni sezidakamizwa zesizukulwane esedlule, anconyelwa ukuthi akhethe ukwelashwa kweziguli ezinesifo sikashukela, kanye neziguli ezisengozini yokuthola isifo sikashukela sohlobo 2. Ngokuphambene nalokho, ama-beta-blockers angakhethi angenawo umsebenzi we-vasodilator (propranolol) akhulisa ubungozi besifo sikashukela sohlobo 2.

Benza ngcono ukumelana kwe-insulin kwezicubu zepherishi, futhi futhi bakhulisa izinga le-cholesterol “embi” ne-triglycerides (amafutha) egazini. Ngakho-ke, azinconywa ezigulini ezinesifo sikashukela noma esengozini ekhulayo yokuba nesifo sikashukela sohlobo 2.

Ama-Calcium Channel blockers (amaCalcium Antagonists)

Ukuhlukaniswa kwe-calcium blockers

Abamelene ne-calcium kuyizidakamizwa zehypertension, ezivame ukubekwa emhlabeni jikelele. Ngasikhathi sinye, odokotela abaningi neziguli ezengeziwe “esikhunjeni sabo” bayaqiniseka ukuthi amaphilisi we-magnesium anomphumela ofanayo nama-calcium blockers. Isibonelo, lokhu kubhalwe encwadini ethi Reverse Heart Illase Now (2008) ngodokotela baseMelika uStephen T. Sinatra noJames C. Roberts.

Ukushoda kwe-Magnesium kuphazamisa i-calcium metabolism, futhi lokhu kuyimbangela evamile yomfutho wegazi ophakeme. Imithi evela eqenjini le-calcium antagonist ivame ukudala ukuqunjelwa, ukukhanda ikhanda, ukujuluka nokuvuvukala kwezinyawo. Ukulungiselela kwe-Magnesium, uma kuqhathaniswa, ayinayo imiphumela emibi engathandeki. Aziphathi nje kuphela i-hypertension, kepha futhi zidambisa izinzwa, zithuthukise ukusebenza kwamathumbu, futhi zisebenzele nabesifazane besifazane.

Ungacela ikhemisi ngamaphilisi aqukethe i-magnesium. Ungafunda kabanzi ngamalungiselelo we-magnesium ekwelashweni kwe-hypertension lapha. Izithasiselo ze-Magnesium ziphephile ngokuphelele, ngaphandle uma isiguli sinezinkinga ezinkulu zezinso. Uma unesifo sikashukela esinesifo sikashukela esigabeni sokuhluleka kwe-renal, thintana nodokotela wakho uma kufanelekile ukuthatha i-magnesium.

Amabhulokhi wesiteshi seCalcium emithamo yokwelapha esezingeni eliphansi awathinti amandla we-carbohydrate namafutha. Ngakho-ke, azikhulisi ingozi yokuba nesifo sikashukela sohlobo 2. Ngasikhathi sinye, ama-dihydropyridine amafushane emithanjeni ephakathi nephezulu akhuphula ubungozi bokufa kweziguli ezivela emithanjeni wezinhliziyo nezinye izimbangela.

Abaphikisi beCalcium kufanele babhekiselwe iziguli ezinesifo sikashukela ezinesifo senhliziyo esi-coronary, ikakhulukazi kulezi zimo ezilandelayo:

• i-angina pectoris engazinzi;
• isikhathi esibuhlungu se-myocardial infarction;
• ukuhluleka kwenhliziyo.

Ama-dihydropyridines asebenza isikhathi eside abhekwa njengaphephile ezigulini ezinesifo sikashukela esinesifo senhliziyo esijwayelekile. Kodwa ekuvinjelweni kwe-myocardial infarction kanye nokuhluleka kwenhliziyo, zingaphansi kwe-ACE inhibitors. Ngakho-ke, kunconywa ukuthi kusetshenziswe kuhlanganiswe ne-ACE inhibitors noma i-beta blockers.

Ezigulini esezikhulile ezine-systolic hypertension eyingqayizivele, abamelene ne-calcium abhekwe njengezidakamizwa zemigqa yokuqala ukuvimbela isifo sohlangothi. Ikakhulu iziguli ezinesifo sikashukela sohlobo 2. Lokhu kusebenza kuwo womabili ama-dihydropyridine nama-non-dihydropyridine.

I-Verapamil ne-diltiazem sekufakazelwe ukuthi zivikela izinso. Ngakho-ke, yilezi zivimbeli zesiteshi se-calcium ezibekelwe iziguli ezine-nephropathy yesifo sikashukela. Abamelene neCalcium abavela eqenjini le-dihydropyridine abanawo umphumela we-nephroprotective. Ngakho-ke, zingasetshenziswa kuphela ngokuhlanganiswa ne-ACE inhibitors noma i-angiotensin-II receptor blockers.

Ama-inhibitors e-ACE

Ama-inhibitors e-ACE yiqembu elibaluleke kakhulu lezidakamizwa ekwelapheni umfutho wegazi ophezulu kushukela, ikakhulukazi uma kuvela inkinga yezinso. Lapha ungathola imininingwane mayelana ne-ACE inhibitors.

Uyacelwa uqaphele ukuthi uma isiguli sakha i-artery stenosis ye-bilatal aren stenosis noma i-artery stenosis eyodwa, ama-inhibitors e-ACE adinga ukukhanselwa. Okufanayo kuhamba nge-angiotensin-II receptor blockers, esizokuxoxa ngezansi.

Okunye ukwephulwa kokusetshenziswa kwe-ACE inhibitors:

• i-hyperkalemia (amazinga aphezulu e-potassium egazini)> 6 mmol / l;
• ukukhuphuka kwe-serum creatinine ngamaphesenti angaphezu kwangama-30 kusuka ezingeni lokuqala kungakapheli isonto eli-1 ngemuva kokuqala kokwelashwa (dlulisa ukuhlaziywa - hlola!);
• ukukhulelwa nesikhathi sokuncelisa.

Ekwelapheni ukwehluleka kwenhliziyo kwanoma yiluphi ubulukhuni, ama-inhibitors e-ACE yizidakamizwa zohlu lokuqala lokukhetha, kubandakanya neziguli ezinesifo sikashukela sohlobo 1 nohlobo 2. Le mishanguzo ikhulisa ukuzwela kwezicubu kuya ku-insulin futhi ngenxa yalokho iba nomphumela prophylactic ekwakhiweni kwesifo sikashukela sohlobo 2. Azibi ngokwengeziwe ukulawula ushukela wegazi, azikhulisi i-cholesterol "embi".

Ama-inhibitors e-ACE ayisidakamizwa # 1 sokwelapha isifo sikashukela. Iziguli zohlobo 1 nohlobo 2 zikashukela ezinqunyelwe i-ACE inhibitors ngokushesha nje lapho izivivinyo zikhombisa i-microalbuminuria noma proteinuria, noma ngabe umfutho wegazi uhlala uvamile. Ngoba zivikela izinso futhi zibambezele ukukhula kwezezinhlungu ezingama-renal ezingapheli ngesikhathi esizayo.

Uma isiguli sithatha ama-inhibitors e-ACE, khona-ke siyalulekwa ngokuqinile ukuthi sinciphise ukunatha usawoti kungabi ngaphezu kwama-3 amagremu ngosuku. Lokhu kusho ukuthi udinga ukupheka ukudla ngaphandle kosawoti nhlobo. Ngoba isivele ingeziwe emikhiqizweni eseqedile nemikhiqizo esekuqediwe. Lokhu kungaphezulu kwenele ukuze ungabi nokuntuleka kwe-sodium emzimbeni.

Ngesikhathi sokulashwa nge-ACE inhibitors, umfutho wegazi kufanele ulinganiswe njalo, futhi i-serum creatinine ne-potassium kufanele ihlolwe. Iziguli esezikhulile ezine-atherossteosis ejwayelekile kufanele zihlolwe i-bilpatal renal stenosis ngaphambi kokunquma i-ACE inhibitors.

Angiotensin-II receptor blockers (angiotensin receptor antagonists)

Ungathola imininingwane enemininingwane ngalezi zidakamizwa ezintsha lapha. Ukwelapha umfutho wegazi ophakeme nezinkinga zezinso kusifo sikashukela, kubekelwa i-angiotensin-II blockers block uma isiguli sithola ukukhwehlela komile kusuka ku-ACE inhibitors. Le nkinga yenzeka ezigulini ezingama-20.

Ama-blocker ama-receptor ama-Angiotensin-II abiza kakhulu kunama-inhibitors e-ACE, kepha awadali ukukhwehlela owomile. Konke okubhalwe kulo mbhalo ngenhla esigabeni kuma-ACE inhibitors kusebenza kuma-block anginotensin receptor blockers. I-contraindication iyafana, futhi kufanele kuthathwe izivivinyo ezifanayo ngenkathi uthatha le mishanguzo.

Kubalulekile ukwazi ukuthi i-angiotensin-II receptor blockers yehlisa ama-hypertrophy asele kwesokunxele angcono kune-ACE inhibitors. Iziguli zibabekezelela kangcono kunanoma yiziphi ezinye izidakamizwa zomfutho wegazi ophakeme. Azinayo imiphumela emibi engaphezu kwe-placebo.

I-Rasilez - inhibitor eqondile ye-renin

Lesi sidakamizwa esisha. Yakhiwa ngemuva kwe-ACE inhibitors nama-angiotensin receptor blockers. URasilez ubhaliswe ngokusemthethweni eRussia
ngoJulayi 2008. Imiphumela yocwaningo lwesikhathi eside sokusebenza kwayo kusalindelwe.

I-Rasilez - inhibitor eqondile ye-renin

I-Rasilez ichazwe kanye ne-ACE inhibitors noma i-angiotensin-II receptor blockers. Inhlanganisela enjalo yezidakamizwa inomphumela obekiwe ekuvikelweni kwenhliziyo nezinso. I-Rasilez ithuthukisa i-cholesterol yegazi futhi yandisa ukuzwela kwezicubu ku-insulin.

Ama-blocker e-Alfa

Ukwelashwa kwesikhathi eside kwe-arterial hypertension, kusetshenziswa ama-alpha-1-blockers abakhethiweyo. Izidakamizwa ezikuleli qembu zihlanganisa:

• prazosin
• doxazosin
• terazosin

I-Pharmacokinetics ye-alpha-1-blockers ekhethiwe

Imiphumela emibi yama-alpha-blockers:

• i-orthostatic hypotension, kuze kufike ekuhlulekeni;
• ukuvuvukala kwemilenze;
• I-Returning syndrome (umfutho wegazi weqa “ngokuqinile”);
• i-tachycardia ephikelelayo.

Olunye ucwaningo luye lwabonisa ukuthi ama-alpha-blockers akhulisa ingozi yokuhluleka kwenhliziyo. Kusukela lapho, le mishanguzo ibingathandwa kakhulu, ngaphandle kwezimo ezithile. Zinqunyelwe kanye nezinye izidakamizwa kwehypertension, uma isiguli sine-benign Prostatic hyperplasia.

Esikhathini sikashukela, kubalulekile ukuthi babe nomphumela ozuzisayo we-metabolism. I-Alpha-adrenergic blockers ephansi ushukela wegazi, yandisa ukuzwela kwezicubu ku-insulin, futhi ithuthukise i-cholesterol ne-triglycerides.

Ngasikhathi sinye, ukwehluleka kwenhliziyo kungukuphikisana nokusetshenziswa kwabo. Uma isiguli sine-neuronomic ye-autonomic ne-orthostatic hypotension, ama-block alpha-adrenergic blockers angeke abekwe.

Yimaphi amaphilisi okufanele uwakhethe ekwelapheni umfutho wegazi ophakeme kushukela?

Eminyakeni yamuva nje, odokotela abaningi ngokwengeziwe bathambekele ekukholweni ukuthi kungcono ukunquma hhayi eyodwa, kepha ngokushesha izidakamizwa ezingama-2-3 zokwelapha umfutho wegazi ophakeme. Ngoba iziguli zivame ukuba nezindlela eziningana zokuthuthukisa umfutho wegazi ophezulu ngasikhathi sinye, futhi umuthi owodwa awukwazi ukuthinta zonke izimbangela. Ngoba amaphilisi okucindezela ahlukaniswe ngamaqembu, enza ngendlela ehlukile.

Umuthi owodwa unganciphisa ukucindezela kokujwayelekile kweziguli ezingekho ngaphezu kwe-50, futhi noma ngabe i-hypertension ekuqaleni yayilingana. Ngasikhathi sinye, ukwelashwa okuhlanganayo kukuvumela ukuthi usebenzise imithamo emincane yemithi, futhi uthole imiphumela engcono. Ngaphezu kwalokho, amanye amaphilisi enza buthaka noma aqede ngokuphelele imiphumela emibi yomunye.

I-Hypertension ayiyona ingozi ngokwayo, kepha ubunzima obudalayo. Uhlu lwabo lubandakanya: ukushaya kwenhliziyo, unhlangothi, ukwehluleka kwezinso, ukungaboni. Uma umfutho wegazi ophezulu uhlanganiswa nesifo sikashukela, khona-ke ubungozi bezinkinga banda kaningana. Udokotela uhlola le ngozi ngesiguli esithile abese enquma ukuthi angaqala yini ukwelashwa ngethebhulethi elilodwa noma asebenzise inhlanganisela yezidakamizwa khona lapho.

Izincazelo zesibalo: HELL - umfutho wegazi.

I-Russian Association of Endocrinologists incoma lelisu elilandelayo lokwelashwa kwe-hypertension ngokulinganisela kushukela. Okokuqala, kunqunyelwe i-angiotensin receptor blocker noma i-ACE inhibitor. Ngoba izidakamizwa ezivela kula maqembu zivikela izinso nenhliziyo kangcono kunezinye izidakamizwa.

Uma i-monotherapy ene-ACE inhibitor noma i-angiotensin receptor blocker ingasizi ukwehlisa umfutho wegazi ngokwanele, kunconyelwa ukufaka i-diuretic. Yikuphi i-diuretic yokukhetha kuya ngokugcinwa kokusebenza kwezinso ezigulini. Uma kunokuhluleka okungapheli kwe-renal, i-thiazide diuretics ingasetshenziswa. Umuthi i-Indapamide (i-Arifon) uthathwa njengomunye wezinto eziphephe kakhulu ekwelapheni umfutho wegazi ophakeme. Uma ukwehluleka kwezinso sekuvele, kusungulwe i-loop diuretics.

Izincazelo zesibalo:

• HELL - umfutho wegazi;
• I-GFR - isilinganiso sokuhlunga kwe-glomerular yezinso, ngemininingwane eminingi bheka "Yiziphi izivivinyo okudingeka zenziwe ukuhlola izinso zakho";
• CRF - ukuhluleka kwe-renal okungamahlalakhona;
• I-BKK-DHP - i-dihydropyridine calcium blocker;
• I-BKK-NDGP - isithinteli se-calcium non-dihydropyridine calcium blocker;
• I-BB - i-beta blocker;
• I-inhibitor ye-ACE - inhibitor ye-ACE;
• I-ARA yi-angiotensin receptor antagonist (i-angiotensin-II receptor blocker).

Kungcono ukunquma izidakamizwa eziqukethe izinto ezi-2-3 ezisebenzayo kwithebhulethi eyodwa. Ngoba mncane amaphilisi, ngokuzithandela iziguli ziyawaphuza.

Uhlu olufushane lwemithi yokuhlanganisa yehypertension:

• Korenitec = enalapril (renitec) + hydrochlorothiazide;
• foside = fosinopril (monopril) + hydrochlorothiazide;
• co-diroton = lisinopril (diroton) + hydrochlorothiazide;
• lehar = losartan (cozaar) + hydrochlorothiazide;
• noliprel = perindopril (prestarium) + thiardide-efana diuretic indapamide retard.

Ama-blocker e-ACE kanye nama-calcium blocker blocker kukholakala ukuthi athuthukisa ikhono lomunye nomunye wawo lokuvikela inhliziyo nezinso. Ngakho-ke, le mithi ehlanganisiwe elandelayo ihlala ibekiwe:

• tarka = trandolapril (hopten) + verapamil;
• prestanz = perindopril + amlodipine;
• i-equator = lisinopril + amlodipine;
• exforge = valsartan + amlodipine.

Sizixwayisa kakhulu iziguli: ungaziniki umuthi we-hypertension. Ungathinteka kakhulu yimiphumela emibi, ngisho nokufa. Thola udokotela ofanelekayo bese uthintana naye. Minyaka yonke, udokotela ubheka amakhulu eziguli ezinomfutho wegazi ophakeme, futhi ngenxa yalokho uqoqe isipiliyoni esisebenzayo, ukuthi izidakamizwa zisebenza kanjani nokuthi yiziphi ezisebenza kakhulu.

Umfutho wegazi ophakeme nesifo sikashukela: iziphetho

Siyethemba ukuthi uthola le ndatshana ilusizo nge-hypertension kushukela. Umfutho wegazi ophezulu wesifo sikashukela uyinkinga enkulu kodokotela nasezigulini ngokwazo. Okuqukethwe okukwethulwa lapha konke kufanelekile. Esihlokweni esithi “Izimbangela Zomfutho Womfutho nokuthi Ungaziqeda Kanjani. Uvivinyo lwe-hypertension ”ungathola ngokuningiliziwe ukuthi yiziphi izivivinyo okudingeka uzenze ukuze uthole ukwelashwa okusebenzayo.

Ngemuva kokufunda izinto zethu zokwelapha, iziguli zizokwazi ukuqonda kangcono i-hypertension ngohlobo 1 bese zithayipha isifo sikashukela 2 ukuze banamathele isu elisebenzayo lokwelashwa futhi bandise impilo yabo kanye namandla abo asemthethweni. Imininingwane ngamaphilisi wengcindezi ihlelwe kahle futhi izosebenza "njengephepha lokukhohlisa" elilungele odokotela.

Sifuna ukugcizelela futhi ukuthi ukudla okune-carbohydrate ephansi kuyithuluzi elisebenzayo lokwehlisa ushukela wegazi kushukela, kanye nokwenza kube nomfutho wegazi ngokwejwayelekile. Kuyasiza ukunamathela kulokhu kudla kweziguli ezinesifo sikashukela hhayi nje se-2, kodwa nohlobo lwe-1, ngaphandle kwezimo ezinzima zezinso.

Landela uhlelo lwethu lwesifo sikashukela sohlobo 2 noma uhlobo 1 sikashukela. Uma unciphisa ama-carbohydrate ekudleni kwakho, kuzokhulisa amathuba okuthi ubuyise umfutho wegazi lakho kube sekujwayelekile. Ngoba i-insulin encane ijikeleza egazini, kulula kakhulu ukuyenza.