I-Hypertension yisifo lapho umfutho wegazi uphezulu kakhulu kangangokuba ukwelashwa kumuntu kubaluleke kakhulu. Izinzuzo zokwelashwa zikhulu kakhulu kunokulimala kwemiphumela emibi kulesi simo.
Ngomfutho wegazi we-140/90 nangaphezulu, kuyadingeka ukubonana nodokotela ngokushesha. Umfutho wegazi ophindwe kaningi ukhulisa amathuba okushaywa unhlangothi, ukushaya kwenhliziyo, ukungaboni ngokushesha, ukwehluleka kwezinso nezinye izifo ezingathí sina ezingaphenduki.
Umkhawulo wegazi ophakeme kakhulu wohlobo 1 noma uhlobo 2 sikashukela wehlela ku-130/85 mm Hg. Ubuciko. Uma ingcindezi yesiguli ingaphezulu, khona-ke zonke izinyathelo kufanele zithathwe ukwehlisa.
Umfutho wegazi ophezulu ngohlobo 1 noma isifo sikashukela esiyingozi 2 uyingozi kakhulu. Uma i-hypertension nayo ibonwa kwisifo sikashukela, khona-ke amathuba okubonakala kwezifo anjalo ayanda:
- ingozi yokuhlaselwa yisifo senhliziyo inyuka ngesizathu se-3-5;
- Izikhathi ezi-3-4 zanda ingozi yokushaywa unhlangothi;
- Izikhathi eziyi-10- 20 ezingabakhona kakhulu kokungaboni;
- Izikhathi ezingama-20-25 - ukwehluleka kwezinso;
- Izikhathi ezingama-20 kaningi kuvela i-gangrene ngokunqunywa kwezitho zomzimba okwalandela.
Ngasikhathi sinye, ingcindezi ephezulu ingenziwa ibe yodwa, inqobo nje uma isifo sezinso singenanga esigabeni esinzima.
Kungani ushukela eba nomfutho wegazi ophakeme
Ukuvela kwe-arterial hypertension kuhlobo lwe-mellitus yesifo sikashukela 1 noma 2 kungaba ngenxa yezizathu ezahlukahlukene. Ezimweni ezingama-80% ezinesifo sikashukela sohlobo 1, umfutho wegazi ophakeme wenzeka ngemuva kwe-nephropathy yesifo sikashukela, okungukuthi, ukulimala kwezinso.
Umfutho wegazi ophezulu ngohlobo 2 sikashukela, njengomthetho, uvela kumuntu ngaphambili kakhulu kunokuphazamiseka kwe-carbohydrate metabolism kanye nesifo sikashukela uqobo.
I-Hypertension ingesinye sezingxenye zama-metabolic syndromes, siyisandulelo esicacile sohlobo 2 sikashukela.
Ngezansi izimbangela eziphambili zokubonakala kokuqina komfutho wegazi kanye nokuvama kwabo ngokwemibandela yamaphesenti:
- Umfutho wegazi ophambili noma obalulekile - 10%
- I-hyperension ye-Isstated Hypertension - ukusuka ku-5 kuye ku-10%
- I-Diabetes nephropathy (umsebenzi wezinso ophazamisekile) - 80%
- Ezinye izindlela ze-endocrine - 1-3%
- I-nephropathy yesifo sikashukela - 15-20%
- Umfutho wegazi ophezulu ngenxa yokulimala kwemithambo ye-renal yemithambo - kusuka ku-5 kuye ku-10%
Isostated hypstension ye-Isstated iyinkinga ejwayelekile yeziguli esezikhulile.
Indlela yesibili evame kakhulu yi-pheochromocytoma. Ngaphezu kwalokho, i-Itsenko-Cushing's syndrome, i-hyperaldosteronism eyinhloko, njll ingavela.
I-hypertension ebalulekile ukugula okuthize okukhulunywa ngakho lapho udokotela engakwazi ukubona imbangela yokwanda kwengcindezi yegazi. Uma kunokukhuluphala okubonakalayo nge-hypertension, imbangela ingaba khona okungabekezeleleki kakhulu kuma-carbohydrate okudla ngokuhlangana nezinga le-insulin egazini.
Ngamanye amagama, yi-metabolic syndrome engalashwa ngokuphelele. Amathuba okwenzeka nawo aphakeme:
- ukuntuleka kwe-magnesium emzimbeni;
- ukucindezeleka okungapheli nokucindezelwa;
- ubuthi nge-cadmium, i-mercury noma i-lead;
- unciphise i-artery enkulu ngenxa ye-atherosclerosis.
Izici Key of Pressure High for Type 1 Diabetes
Ukwanda kwengcindezi yohlobo lwe-1 yesifo sikashukela kuvame ukwenzeka ngenxa yokulimala kwezinso, isb., Isifo sikashukela. Le nkinga yenzeka cishe kuma-35-40% abantu abanesifo sikashukela sohlobo 1. Ukwephulwa kweziphathimandla kubalwa ngezigaba eziningana:
- isigaba se-microalbuminuria. Kuvela imolekyuli yamaprotheni e-Albumin emchameni;
- isigaba se-proteinuria. Izinso zisebenza ukuhlunga kubi kakhulu, futhi kuvela amaprotheni amaningi kumchamo;
- isigaba sokwehluleka kwezinso okungamahlalakhona.
Ososayensi ngemuva kocwaningo olude baphetha ngokuthi ama-10% kuphela eziguli ezinesifo sikashukela sohlobo 1 ezingenaso isifo sezinso.
I-20% yeziguli esiteji se-microalbuminuria isivele inokulimala kwezinso. Cishe i-50-70% yabantu abahluleka ukuqina kwezinso babe nezinkinga zezinso. Ukubusa okujwayelekile: lapho amaprotheni eningi e-umchamo, umfutho wegazi uphezulu kumuntu.
Ngokuphikisana nesizinda sokulimala kwezinso, umfutho wegazi ophakeme uyanda ngoba izinso azisusi kahle umchamo. Ngokuhamba kwesikhathi, inani le-sodium esegazini liyakhuphuka futhi ukulinciphisa, uketshezi luqongelela. Inani eleqile legazi elijikelezayo lenyusa umfutho wegazi.
Uma, ngenxa yesifo sikashukela i-mellitus, izinga likashukela wegazi likhuphuka, bese lidonsa isilinganiso esikhulu soketshezi ukuze igazi lingabi mnene kakhulu.
Isifo sezinso nomfutho wegazi ophakeme senza umjikelezo omubi. Umzimba womuntu uzama ngandlela thize ukuthi unxephezele umsebenzi wezinso obuthaka, ngakho-ke umfutho wegazi uyenyuka.
Futhi, umfutho wegazi ukhulisa umfutho ngaphakathi kwe-glomeruli, okungukuthi, izinto zokuhlunga ngaphakathi kwalezi zitho. Ngenxa yalokho, i-glomeruli yehle ngokuhamba kwesikhathi, futhi izinso zisebenza zimbi kakhulu.
Umfutho wegazi ophezulu nohlobo 2 sikashukela
Esikhathini eside ngaphambi kokuvela kwesifo esinegciwane eligcwele, inqubo yokumelana ne-insulin iqala. Okusho into eyodwa - ukuzwela kwezicubu kwe-insulin kuyancipha. Ukunxenxa ukumelana ne-insulin, kune-insulin eningi egazini, yona ngokwayo ekhulisa umfutho wegazi.
Ngokuhamba kwesikhathi, i-lumen yemithambo yegazi iyancipha ngenxa ye-atherosulinosis, okuba esinye isigaba ekwakhiweni kwe-hypertension.
Kulesi simo, umuntu uba nokukhuluphala esiswini, okungukuthi, ukubekwa kwamafutha okhalweni. Izicubu ze-Adipose zikhipha izinto ezithile ziye egazini, zandisa umfutho wegazi ngisho nangokwengeziwe.
Le nqubo ivame ukuphela ngokuhluleka kwezinso. Emazingeni okuqala we-nephropathy yesifo sikashukela, konke lokhu kungamiswa uma kuphathwa ngendlela enenhlonipho.
Into ebaluleke kakhulu ukunciphisa inani loshukela egazini liye kwelejwayelekile. Ama-diuretics, ama-angiotensin receptor blockers, ama-inhibitors we-ACE azosiza.
Le nkinga yokuphazamiseka ibizwa ngokuthi yi-metabolic syndrome. Ngakho-ke, umfutho wegazi ophakeme ukhula ngaphambili kunoshukela wesifo sohlobo 2. Umfutho wegazi ophakeme uvame ukutholakala esigulini khona lapho. Ukudla okune-carb ephansi kwabanesifo sikashukela kusiza ukulawula zombili izinhlobo zesifo sikashukela kanye nomfutho wegazi ophakeme.
I-Hyperinsulinism isho ukuqoqwa okwandayo kwe-insulin egazini, okuyindlela yokuphendula ngokumelana ne-insulin. Lapho indlala kufanele ikhiqize inani le-insulin ngokweqile, khona-ke iqala ukuwohloka kakhulu.
Ngemuva kokuthi i-gland iyeke ukubhekana nemisebenzi yayo, ngokwemvelo, ushukela wegazi ukhuphuka kakhulu bese kuvela uhlobo 2 lwesifo sikashukela.
Ngabe i-hyperinsulinism yandisa kanjani umfutho wegazi:
- kusebenze kohlelo lwezinzwa olunozwela;
- izinso azikhuphi uketshezi nensimbi ngomchamo;
- calcium ne-sodium ziqala ukuqongelela ngaphakathi kwamangqamuzana;
- ukweqisa kwe-insulin kukwenza ungqimba kwezindonga zemithambo yegazi, okuholela ekuncipheni kokuqina kwabo.
Izici ezibalulekile ze-hypertension kushukela
Ngokuphikisana nesizinda sikashukela, isigqi semvelo sokuguquguquka kwengcindezi yegazi siyaphazamiseka. Ekuseni, okujwayelekile futhi ebusuku ngesikhathi sokulala, umuntu unengcindezi ye-10-20% engaphansi kakhulu ngesikhathi sokuvuka.
Isifo sikashukela siholela ekutheni ezigulini eziningi ebusuku ingcindezi ihlala ilingana. Ngokuhlanganiswa kwesifo sikashukela kanye nomfutho wegazi ophakeme, ingcindezi yasebusuku iphakeme kakhulu kunokucindezela kwasemini.
Odokotela basikisela ukuthi ukuphazamiseka okunjalo kuvela ngenxa yesifo sikashukela se-neuropathy. Ukugcotshwa kakhulu koshukela egazini kuholela ekuphazamisweni kwesistimu yezinzwa elawula umzimba. Ngakho-ke, amandla emikhumbi ukulawula ithoni liwohloka - ukuphumula futhi kunciphise inani elivela emthwalweni.
Kubalulekile ukwazi ukuthi ngokuhlanganiswa kwesifo sikashukela kanye nomfutho wegazi ophakeme, kudingeka ngaphezu kwesilinganiso esisodwa sokucindezela nge-tonometer. Kepha ukuqapha njalo nsuku zonke. Ngokwemiphumela yocwaningo, imithamo yemithi kanye nesikhathi sokuphatha kwabo iyaguqulwa.
Njengoba umkhuba ukhombisa, abantu abanesifo sikashukela sohlobo 1 nohlobo 2 ngokuvamile mancane amathuba okubekezelela izinhlungu kuneziguli ezinomfutho wegazi ngaphandle kwesifo sikashukela. Lokhu kusho ukuthi imikhawulo kasawoti ingaba nomphumela omkhulu wokupholisa.
Ku-mellitus yesifo sikashukela, kufanelekile ukusebenzisa usawoti omncane ukuze ususe umfutho wegazi ophakeme. Ngenyanga eyodwa, umphumela womzamo uzobonakala.
I-Symbiosis yomfutho wegazi ophakeme nesifo sikashukela sivame ukuhlanganiswa yinkimbinkimbi ye-orthostatic hypotension. Ngakho-ke, umfutho wegazi lesiguli wehla kakhulu lapho usuka endaweni yokuqamba amanga uye endaweni yokuma noma yokuhlala.
I-Orthostatic hypotension ukugula okuvela emva kokuba umuntu eshintshe ngokushesha isikhundla sakhe somzimba. Isibonelo, ngokunyuka okubukhali, isiyezi, izibalo zejometri phambi kwamehlo, futhi kwezinye izimo zokwehluleka, kungavela.
Le nkinga ivela ngenxa yokuqalwa kwesibindi sikashukela. Iqiniso ngukuthi uhlelo lwezinzwa lomuntu luphulukana namandla alo okulawula ithoni ye-vascular ngokuhamba kwesikhathi.
Lapho umuntu eshintsha ngokushesha isikhundla, umthwalo uphakama kakhulu. Kepha umzimba awukhuphi masinyane ukuphuma kwegazi, ngakho-ke isiyezi nezinye izibonakaliso ezingathandeki kungenzeka.
I-Orthostatic hypotension izokwengeza kakhulu ukwelashwa kanye nokuxilongwa komfutho wegazi ophezulu. Esikhathini sikashukela, ingcindezi ingalinganiswa kuphela ezikhundleni ezimbili: ukuqamba amanga nokuma. Uma isiguli sinenkinga, kufanele sisukume kancane.
Ukuncishiswa Kwesifo Sikashukela
Abantu abaphethwe yi-hypertension nesifo sikashukela basengozini enkulu kakhulu yezinkinga zenhliziyo.
Bayalwa ukuthi behlise ingcindezi ibe ngu-140/90 mm Hg. Ubuciko. ngenyanga yokuqala, ngokubekezelela okuhle izidakamizwa. Ngemuva kwalokho, udinga ukuzama ukunciphisa ingcindezi uye ku-130/80.
Into esemqoka ukuthi isiguli sikubekezelela kanjani ukwelashwa, nokuthi ngabe inemiphumela yini. Uma ukubekezelela kuncane, khona-ke umuntu udinga ukwehlisa ukucindezela kancane, ngezigaba eziningana. Esigabeni ngasinye, cishe i-10-15% yezinga lokucindezela lokuqala liyancipha.
Le nqubo ithatha amasonto amabili kuya amane. Ngemuva kokuzivumelanisa nesiguli, umthamo uyanda noma inani lezidakamizwa liyanda.
Izidakamizwa Zokucindezela Ushukela
Imvamisa kunzima ukukhetha amaphilisi okucindezela umuntu onesifo sikashukela. I-carbohydrate metabolised eyonakele ibeka imingcele ethile ekusetshenzisweni kwezidakamizwa ezithile, kufaka phakathi ne-hypertension.
Lapho ekhetha umuthi oyinhloko, udokotela ubheka isilinganiso sokuphathwa kweziguli ngesifo sakhe sikashukela, kanye nokuba khona kwezifo ezikhona, ngaphezu komfutho wegazi ophakeme, okuwukuphela kwendlela yokunikeza amaphilisi.
Kunamaqembu ayinhloko emithi yezingcindezi, njengoba imali eyengeziwe njengengxenye yokwelashwa okujwayelekile yile:
- Amacwecwe e-diuretic nemithi - ama-diuretics;
- Abaphikisi beCalcium, i.e. calcium blockers blockers;
- Izidakamizwa zesenzo esimaphakathi;
- Beta blockers;
- Ama-blocker ama-Angiotensin-II receptor blockers;
- Ama-inhibitors e-ACE;
- Ama-block adrenergic blockers;
- I-Rasilez iyi-renin inhibitor.
Amaphilisi okwehlisa ushukela okusebenzayo kufanele abe nalezi zindawo ezilandelayo:
- ukunciphisa kakhulu ingcindezi, kepha ungadali imiphumela emibi kakhulu;
- musa ukwandisa ukugcwala koshukela egazini futhi ungangezi inani le-triglycerides ne-cholesterol "embi";
- Vikela izinso nenhliziyo ekulimaleni okubangelwa ushukela nomfutho wegazi ophakeme.
Manje kunamaqembu ayisishiyagalombili wezidakamizwa ezenzelwe ukufaka umfutho wegazi ophakeme, ezinhlanu zazo zingokokuqala, kanti ezintathu ziyengeziwe. Ithebhulethi ezingamaqembu angeziwe zivame ukubekwa njengengxenye yokwelapha okuhlanganayo.
