Isifo sikashukela kanye nomfutho wegazi ophakeme kuyiziphazamiso ezimbili ezihlobene kakhulu. Kokubili ukwephulwa kunomthelela onamandla wokugcizelela ohambisanayo, othinta:
- imithambo yokuhlanza
- inhliziyo
- imithambo yamehlo
- izinso.
Izimbangela eziphambili zokukhubazeka nokufa kwabantu ezigulini ezinesifo sikashukela esine-hypertension kuyatholakala:
- I-Myocardial infarction
- Isifo senhliziyo
- Ukuphazamiseka kokujikeleza ebuchosheni,
- Ukwehluleka kwangempela (ukuphela).
Kuyaziwa ukuthi ukwanda komfutho wegazi kuwo wonke ama-6 mmHg kwenza amathuba okuba nesifo senhliziyo siphezulu nge-25%; ubungozi bokushaywa unhlangothi bukhuphuka ngamaphesenti angama-40.
Izinga lokwakheka kwe-esibulalayo se-renal ukwehluleka ngomfutho wegazi onamandla lenyuka amahlandla ama-3 noma amane. Kungakho kuqakathekile ukwamukela ngesikhathi ukutholakala kwesifo sikashukela nge-hypertension ye-arterial. Lokhu kuyadingeka ukunquma ukwelashwa okwenele futhi kuvimbele ukwanda kwezinkinga ezinkulu ze-vascular.
I-arterial hypertension ikhulisa inkambo yesifo sikashukela sazo zonke izinhlobo. Kuhlobo 1 sikashukela, i-arterial hypertension form diabetesic nephropathy. Le nephropathy ibalelwa ku-80% yezimbangela zomfutho wegazi ophakeme.
Endabeni yohlobo 2 lwesifo sikashukela, i-70-80% yamacala atholakala nge-hypertension ebalulekile, okuyi-harbinger yentuthuko yesifo sikashukela mellitus. Cishe i-30% yabantu, umfutho wegazi ophakeme ubangelwa ukulimala kwezinso.
Ukwelashwa kwe-hypertension kusifo sikashukela kubandakanya hhayi ukwehlisa umfutho wegazi kuphela, kepha futhi kulungisa izinto ezingezinhle njenge:
- ukubhema
- hypercholesterolemia ,,
- gxuma ushukela wegazi;
Ukuhlanganiswa kwe-hypertension ye-arterial ne-sikashukela engakaze ibonwe yinto engathandeki kakhulu ekwakhekeni:
- Imivimbo
- Isifo senhliziyo,
- Ukwehluleka izinso nokulimala kwenhliziyo.
Cishe ingxenye yesifo sikashukela ine-hypertension ye-arterial.
Isifo sikashukela: kuyini?
Njengoba wazi, ushukela ungumphakeli wamandla oyisihluthulelo, uhlobo “kaphethiloli” womzimba womuntu. Egazini, ushukela uvezwa njengeglucose. Igazi lidlulisa ushukela kuzo zonke izitho nezinhlelo, ikakhulukazi, ziye ebuchosheni nasemisiphani. Ngakho-ke, izitho zinikezwa amandla.
I-insulin yinto esiza glucose ukungena kumaseli ukuqinisekisa umsebenzi obalulekile. Lesi sifo sibizwa ngokuthi "isifo sikashukela", ngoba ngesifo sikashukela, umzimba awukwazi ukuligcina kahle ushukela oludingekayo egazini.
Ukuntuleka kokuzwela kwamaseli ku-insulin, kanye nokukhiqizwa kwawo okunganele, kuyizimbangela zokwakhiwa kwesifo sikashukela sohlobo 2.
Ukubonakaliswa okuyinhloko
Ukwakheka kwesifo sikashukela kuyabonakala:
- umlomo owomile
- ukoma okungapheli
- ukuchama njalo
- ubuthakathaka
- isikhumba esikhanyayo.
Uma kuvela izimpawu ezingenhla, kubalulekile ukuthi ihlolwe ukuze ihlolwe ushukela wegazi.
Umuthi wesimanjemanje ukhombe izimbangela eziyingozi ezimbalwa ngokuvela kwesifo sikashukela sohlobo 2:
- Umfutho wegazi ophezulu we-Arterial. Izikhathi eziningana nenkimbinkimbi yesifo sikashukela kanye nomfutho wegazi ophakeme, ubungozi bokuvela buyanda:
- Ukweqa ngokweqile kanye nokudla ngokweqile. Amanani ama-carbohydrate amaningi ekudleni, ukugcoba ngokweqile, futhi, ngenxa yalokho, ukukhuluphala, kuyingozi yokuqala kwesifo kanye nenkambo yaso ebucayi.
- Isizungu. Engcupheni yokuqhamuka nalesi sifo, kunabantu abanezihlobo ezihlushwa isifo sikashukela sezindlela ezahlukahlukene.
- unhlangothi
- Isifo senhliziyo se-Ischemic,
- ukwehluleka kwezinso.
- Ucwaningo lukhombisa ukuthi ukwelashwa okwanele kwe-hypertension kuyisiqinisekiso sokuncipha okukhulu engcupheni yokuthola lezi zingqinamba ezingenhla.
- Iminyaka. Uhlobo 2 sikashukela lubizwa nangokuthi "ushukela osekhulile." Ngokwezibalo, wonke umuntu oneminyaka eyi-12 oneminyaka engama-60 uyagula.
Isifo sikashukela i-mellitus yisifo esithinta imikhumbi emincane nemincane. Ngokuhamba kwesikhathi, lokhu kuholela ekukhuleni noma ekucambeni kwenkambo ye-hypertension ye-arterial.
Phakathi kokunye, isifo sikashukela siholela ku-atherossteosis. Ku-diabetes, i-pathology yezinso iholela ekwandeni kwengcindezi yegazi.
Cishe ingxenye yesifo sikashukela yayivele ine-hypertension ye-arterial ngesikhathi sokuthola ushukela wegazi ophakeme. Vimbela ukwenzeka kwe-hypertension uma ulandela izeluleko zokuqinisekisa indlela yokuphila enempilo.
Kubalulekile, balawula ngokweqile umfutho wegazi, basebenzise izidakamizwa ezifanele, futhi balandele nokudla.
Target Isifo Sikashukela Segazi Sikashukela
Umfutho wegazi okuqondisiwe ubizwa ngokuthi izinga lokucindezela kwegazi, okunganciphisa kakhulu amathuba okuba nezinkinga zenhliziyo. Ngokuhlanganiswa kwengcindezi yegazi nesifo sikashukela, izinga lomfutho wegazi eliqondisiwe lingaphansi kwe-130/85 mm Hg.
Izindlela zobungozi zokuvela kwama-renal pathologies ngenhlanganisela yesifo sikashukela kanye ne-hypertension ye-arterial ziyahlukaniswa.
Uma ukutholwa kwenqwaba yamaprotheni kutholakala ku-urinalysis, khona-ke kukhona izingozi eziphakeme zokwakhiwa kwe-pathology yezinso. Manje kunezindlela eziningana zokwelashwa zokuhlaziya ukuthuthukiswa kokulimazeka kwe-renal function.
Indlela yocwaningo evame kakhulu futhi elula kunazo zonke ukuthola izinga le-creatinine egazini. Ukuhlolwa okubalulekile kokuqapha ejwayelekile ukuhlolwa kwegazi nomchamo ukuthola iprotheni noshukela. Uma lezi zivivinyo zivamile, khona-ke kukhona ukuhlolwa kokuthola inani elincanyana lamaprotheni kumchamo - i-microalbuminuria - ukulimala okuyinhloko kokusebenza kwezinso.
Izindlela ezingezona izidakamizwa zokwelapha isifo sikashukela
Ukulungiswa kwendlela yokuphila ejwayelekile kuzokwenza ukuthi kungabi nje kuphela ukulawula umfutho wegazi, kodwa futhi nokugcina izinga elifanele likashukela egazini. Lezi zinguquko zifaka:
- ukuhambisana nazo zonke izidingo zokudla,
- ukunciphisa umzimba
- ezemidlalo ejwayelekile
- ukuyeka ukubhema kanye nokwehlisa inani lotshwala obudliwayo.
Ezinye izidakamizwa ze-antihypertensive zingaba nomthelela ongemuhle kuma-carbohydrate metabolism. Ngakho-ke, ukuqokwa kokwelashwa kufanele kwenziwe kusetshenziswa indlela yomuntu ngamunye.
Kulesi simo, ukuthandwa kunikezwa eqenjini labakhethi be-agonist abakhethi bemidazoline receptor, kanye nabaphikisi be-AT receptors abavimba isenzo se-angiotensin, i-constitutionor eqinile yemithambo.
Kungani i-arterial hypertension iba nesifo sikashukela
Izindlela zokuthuthuka kwe-arterial hypertension kulesi sifo sezinhlobo 1 no-2 azifani.
I-hypertension ye-arterial ngohlobo 1 sikashukela ingumphumela we-nephropathy yesifo sikashukela - cishe amaphesenti angama-90. I-Diabetesic nephropathy (DN) ngumqondo oyinkimbinkimbi ohlanganisa ukuhlukahluka kwe-morphological of deformation yezinso ku-mellitus yesifo sikashukela, nokuthi:
- pyelonephritis,
- i-papillary necrosis,
- isifo sezinzwa
- izifo ezithinta umchamo
- atherossteotic nephroangiosulinosis.
Umuthi wanamuhla awudalanga uhlakahlangene. I-Microalbuminuria ibizwa ngokuthi isigaba sokuqala se-nephropathy yesifo sikashukela, sitholakala kuhlobo 1 lwesifo sikashukela esinesifo esingaphansi kweminyaka emihlanu (izifundo ze-EURODIAB). Ukwanda kwengcindezi yegazi kuvame ukuqashelwa eminyakeni eyi-15 ngemuva kokuqala kwesifo sikashukela.
Isici esibangela i-DN yi-hyperglycemia. Lesi simo silimaza imikhumbi ye-glomerular kanye ne-microvasculature.
Nge-hyperglycemia, i-non-enzymatic glycosylation yamaprotheni iyenziwa isebenze:
- izindlela zamaprotheni ezingqimba ezingaphansi ze-capillaries ze-mesangium ne-glomerulus azonakalisiwe,
- ukukhokhiswa nosayizi we-BMC kulahlekile,
- indlela ye-polyol ye-glucose metabolism iba nezinguquko, futhi iphenduka i-sorbitol, ngokubamba iqhaza ngokuqondile ekunciphisweni kwe-enzyme aldose.
Izinqubo, njengomthetho, zenzeka kwezicubu ezingadingi ukubandakanyeka kwe-insulin ekufakweni kweglucose kumaseli, isibonelo:
- ilensi yeso
- endothelium yemithambo,
- imicu yezinzwa
- amaseli glomerular we izinso.
Amathishu aqongelela i-sorbitol, i-intracellular myoinositol idlisiwe, konke lokhu kwephula i-osmoregulation ye-intracellular, kuholela ku-edema yezicubu kanye nokuvela kwezinkinga ze-microvascular.
Lezi zinqubo zifaka ubuthi be-glucose ngqo, obuhambisana nomsebenzi we-enzyme yamaprotheni kinase C.
- kuvusa ukwanda kokubonakala kwezindonga zemithambo,
- kusheshise inqubo yesifo sokuqina kwezicubu,
- yephula i-intraorgan hemodynamics.
I-Hyperlipidemia ngesinye isici esibangela. Kuzo zombili izinhlobo zesifo sikashukela i-mellitus, kukhona ukuphazamiseka kwesimo se-lipid metabolism: ukunqwabelana kwama-triglycerides, kanye ne-serum ye-cholesterol ye-atherogenic, kwabantu abaphansi kakhulu kanye ne-lipoproteins ephansi kakhulu.
I-Dyslipidemia inomphumela we-nephrotoxic, ne-hyperlipidemia:
- Umonakalo we-capillary endothelium,
- kulimaza ulwelwesi lwesisekelo se-glomerular kanye nokwanda kwe-mesangium, okuholela ku-glomerulosclerosis ne-proteinuria.
Ngenxa yazo zonke izinto, ukungasebenzi kahle kwe-endothelial kuqala ukuthuthuka. Ukwehluka kwe-bioavailability ye-nitric oxide kuyancishiswa, njengoba ukwakheka kwayo kunciphe futhi ukuvela kwayo kuyanda.
Ngaphezu kwalokho, ubukhulu be-receptors ye-muscarinic-yehla, ukusebenza kwabo kuholela ekwakhiweni kwe-NO, ukwanda komsebenzi we-enixens-eguqula i-enzyme ngaphezulu kwamaseli we-endothelial.
Lapho i-angiotensin II iqala ukwakheka okusheshayo, lokhu kuholela emiphongolweni yama-arterioles asebenza kahle kanye nokwanda kwesilinganiso sobubanzi bokuletha i-arterioles ephumayo neya ku-3-4: 1, ngenxa yalokho, kuvela umfutho wegazi we-intracubic.
Izici ze-angiotensin II zifaka phakathi ukukhuthaza kokuqanjwa kwamangqamuzana angama-mesangial, ngakho-ke:
- izinga lokuhlunga le-glomerular lehla
- ukutholakala kwesibalo se-glomerular basement membrane,
- i-microalbuminuria (MAU) ivela okokuqala kubantu abanesifo sikashukela, bese kuthiwa yi-proteinuria.
I-Arterial hypertension imbi kakhulu lapho isiguli sinamanani amaningi e-plasma insulin, kucatshangwa ukuthi maduze nje sizothuthukisa umfutho wegazi ophambana nobunzima.
Ama-nuances ekwelapha okuyinkimbinkimbi ye-arterial hypertension kanye nesifo sikashukela
Akunakungatshazwa ukuthi kunesidingo sokwelashwa okusebenza kakhulu kwe-antihypertensive kwabanesifo sikashukela, kuyadingeka ukuthatha amaphilisi omfutho wegazi ophezulu wesifo sikashukela. Noma kunjalo, lesi sifo, esiyinhlanganisela yokuphazamiseka kwe-metabolic kanye ne-psychology yezitho eziningi, siphakamisa imibuzo eminingi, isibonelo:
- Ngabe umuthi nokunye ukwelashwa kuqala kuliphi izinga lokucindezela kwegazi?
- Kukuba kuliphi izinga lapho umfutho wegazi we-diastolic kanye ne-systolic blood pressure kungancishiswa?
- Yimiphi imishanguzo ethathwa kangcono uma kunikezwe isimo esisehlelweni?
- Yiziphi izidakamizwa kanye nokuhlanganiswa kwazo okuvunyelwe ekwelashweni kwenkimbinkimbi yesifo sikashukela kanye nomfutho wegazi ophezulu we-arterial?
- Yiliphi izinga lokucindezela kwegazi - isici sokuqala ukwelashwa?
Ngo-1997, ikomidi elihlanganisiwe le-United National Joint Committee on the Prevention and Treatment of Arterial Hypertension laqaphela ukuthi kubantu abanesifo sikashukela bayo yonke iminyaka, izinga lomfutho wegazi ngaphezulu kwalapho ukwelashwa kufanele luqale khona:
- HELL> 130 mmHg
- HEL> 85 mmHg
Ngisho nokudlula okuthe xaxa kwalawa ma-diabetes ku-diabetes kuyandisa ingozi yesifo senhliziyo ngo-35%. Kufakazelwa ukuthi ukuzinza kwengcindezi yegazi kuleli zinga nangaphansi kuletha umphumela othile we-organoprotective.
Umfutho wegazi we-diastolic ofanele
Ngo-1997, kwaqedwa isifundo esikhulu, inhloso yawo kwakungukuthola ukuthi iliphi izinga lokucindezela kwegazi (<90, <85, noma <80 mm Hg) okufanele ligcinwe ukuze kuncishiswe ubungozi besifo senhliziyo nokufa kwabantu.
Cishe iziguli eziyizinkulungwane eziyi-19 zabamba iqhaza kulolo cwaningo. Kulaba, abantu abayi-1,501 babenesifo sikashukela kanye ne-hypertension ye-arterial. Kwaziwa ukuthi izinga lomfutho wegazi lapho inani elincane lezifo zenhliziyo lenze khona lalingu-83 mm Hg.
Ukwehlisa umfutho wegazi kuleli zinga bekuhambisana nokuncipha kwengozi yesifo senhliziyo, ngokungeqi ngaphansi kwama-30%, nakubantu abanezifo ezinoshukela ngo-50%.
Ukwehla okubonakalayo kokucindezela kwegazi kuze kufike ku-70 mm Hg kwizifo sikashukela, bekuhambisana nokuncipha kokushona kwezifo zenhliziyo ezi-coronary.
Umqondo wezinga elifanele kakhulu lomfutho wegazi kufanele ubhekwe, ukhuluma ngokuthuthukiswa kwe-renal pathology. Kudala bekukholelwa ukuthi esigabeni se-CRF, lapho iningi le-glomeruli libekwa khona, kuyadingeka ukugcina izinga eliphakeme lomfutho wegazi, ozoqinisekisa ukufafazwa okwanele kwezinso kanye nokugcinwa kokulondolozwa okusele komsebenzi wokuhlunga okusaseleyo.
Noma kunjalo, ucwaningo olusanda kwenzeka oluye lwabonisa ukuthi amanani omfutho wegazi angaphezu kuka-120 no-80 mm Hg, noma esesigabeni sokuhluleka kwezinso okungapheli, asheshise ukwakheka kwe-pathology ye-renal eqhubekayo.
Ngakho-ke, ngisho nasezigabeni zokuqala kakhulu zokulimala kwezinso, futhi esigabeni sokuhluleka kwezinso okungamahlalakhona, ukuze wehlise ukukhula kwesifo sikashukela, kubalulekile ukugcina umfutho wegazi ezingeni elingeqi umfutho wegazi ku-120 no-80 mm Hg.
Izici zokuhlanganisa zokwelapha i-antihypertensive ekwakhiweni kwesifo sikashukela
Ukuthuthukiswa kwe-hypertension ye-arterial kanye nokukhula kwesifo sikashukela i-nephropathy yesifo sikashukela kuvame ukungalawuleki. Isibonelo, kuma-50% eziguli, ukwelashwa ngemithi enamandla kakhulu ngeke kuzinze umfutho wegazi ezingeni elifunekayo le-130/85 mm Hg.
Ukwenza ukwelashwa okusebenzayo, kubalulekile ukuthatha izidakamizwa ezilwa ne-hypertensive zamaqembu ahlukahlukene. Kubalulekile ezigulini ezinokwehluleka okukhulu kwe-renal ukunquma inhlanganisela ye-4 noma ngaphezulu yama-antihypertensive agents.
Njengengxenye yokwelashwa kwe-hypertension lapho kunoshukela wanoma yiluphi uhlobo, le mithi elandelayo isetshenziswa ngempumelelo:
- inhlanganisela ye-diuretic ne-ALP inhibitor,
- inhlanganisela ye-calcium antagonist ne-ACE inhibitor.
Ngokuhambisana nemiphumela yocwaningo oluningi lwesayensi, kungaphethwa ngokuthi ukulawulwa ngempumelelo kwengcindezi yegazi ezingeni le-130/85 mm Hg kwenza ukuthi kumiswe ukuqhubekela phambili ngokushesha kwezifo zemithambo yesifo sikashukela, okuzothuthukisa impilo yomuntu okungenani okungenani 15-20. iminyaka.
