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Uluhlu lwezilwanyana kunye neziyobisi eziqhelekileyo ezisetyenziswa kakhulu ukunyanga ingozi yexinzelelo ( uxinzelelo oluphezulu lwegazi) lude kakhulu.
Inyaniso yokuba kukho izidakamizwa ezininzi zokukhetha ezi zinto ubuncinane izinto ezimbini. Okokuqala, ithetha ukuba akukho "mhle" yeziyobisi ezibangelwa yingozi, oko kukuthi, akukho nkunkuma esebenza kakuhle phantse wonke umntu ngaphandle kokwenza imiphumo engavumelekanga.
Ukuba kukho, iinkampani zonyango ziye zayeka imizamo yazo yokuphuhlisa izidakamizwa ezitsha zamachiza ezangexesha elidlulileyo-kwaye uluhlu lwezidakamizwa ezivunyiweyo luya kufutshane.
Okwesibini, kunye nezidakamizwa ezininzi ukuba ukhethe kuzo, ngokungakhathaliseki ukuba wena kunye nogqirha wakho unomonde kwaye uqhubeka, kunokwenzeka ukuba i-regimen yonyango ephumelelayo neyonyameko iya kufumaneka yakho yomshurensi. Ngamanye amagama, ngelixa kungekho "unyanga" wonyango ophezulu kwi-hypertension, kunokwenzeka ukuba ube "ngonyango" unyango kuwe.
Kule nqaku, siza kuchaza iintlobo zeziyobisi ezisetyenziselwa ingozi yecindezelo, kwaye yiyiphi inyathelo kufuneka ugqirha wakho athathe xa ekhetha (ukusuka kwizinto ezikhethiweyo ezikhethiweyo) lwakho unyango olungcono. Ekugqibeleni, siza kunika uluhlu olupheleleyo ngokuphathelele zonke iziyobisi ezisetyenziswayo e-US (nakumazwe amaninzi athuthukileyo) kunyango lwexinzelelo.
Ukukhetha unyango olufanelekileyo lwe-Hypertension
Oogqirha ngokuqhelekileyo basebenzisa indlela echanekileyo yokukhetha unyango ophezulu lwexinzelelo.
Inyathelo 1: Kubantu abaye bafumanisa ukuba banesifo sengcinezelo esinyanisekileyo okanye esiphezulu , kubalulekile ukuqala ngokucebisa iindlela zokuphila eziye zaboniswa ukunceda ukunciphisa uxinzelelo lwegazi. Ezi ziquka ukutshintsha kwezinto zokutya , ukuthintela ityuwa , ukuzivocavoca rhoqo, nokuyeka ukutshaya.
Inyathelo 2: Ukuba le miqathango yokuphila ayiphumelelanga ukulawula uxinzelelo lwegazi emva kweeveki ezimbalwa, ngokuqhelekileyo ixesha lokuongeza unyango lweziyobisi.
Isisiseko esisisiseko sokukhetha unyango lweziyobisi kwi-Hypertension
Kukho iintlobo ezintlanu zamachiza eziye zabonakaliswa ngempumelelo ekuphatheni umfutho wegazi. Zezi:
- Thiazide diuretics
- I-Angiotensin iguqula i-enzyme (ACE) inhibitors
- Iibhloko ze-calcium
- Beta blockers
- I-Angiotensin receptor blockers (ARBs)
Unyango Lonyango Lodwa
Ukuba unesiqalo 1 somfutho wegazi ophezulu (apho ingcinezelo yakho ye-systolic ingaphantsi kwe-160 mm Hg, kunye noxinzelelo lwakho lwe-diastolic lingaphantsi kwe-100 mm Hg), isincomo esiqhelekileyo siqala ngesinye isilwanyana ukusuka kwenye yalezi zigaba ezintlanu.
Ngokuqhelekileyo, iziyobisi zivela nganye yeeklasi (ngaphandle kwe-beta-blockers, eziqhelekileyo ezingekho phantsi kweziyobisi ezilodwa) zivame ukusebenza ngokulinganayo ekulawuleni umfutho wegazi ophezulu. Ngokukodwa, kukho ithuba elingama-50-50 ukuba nayiphina isilwanyana esithile siya kusebenza ngokwaneleyo kunoma yimuphi umntu onikwe isigaba somngcipheko 1.
Nangona kunjalo, abantu baya kuphendula ngokungafaniyo nala mayeza. UJim usenokumphendula ngokucacileyo kwi-thiazide, kodwa ahluleke nge-calcium blocker, kwaye imeko kunye noJane inokuba yinto echanekileyo. Ngokubanzi akukho ndlela ihamba phambi kwexesha ukuqikelela ukuba ngubani oya kwenza kakuhle uhlobo lonyango. Ngoko, yintoni oogqirha kunye nezigulane ezishiywe ngayo indlela yokufunda-nephutha efundisiweyo.
"Ukuqagela" kwisicatshulwa esisodwa sokuqala ukuzama, uninzi lweengcali zincoma ukuba ziqale kunye nokuba yi-thiazide diuretic (ngokuqhelekileyo i-chlorthalidone okanye i-hydrochlorothiazide), i-calcium blocker ende ende okanye i-ACE inhibitor. I-ARB zivame ukucingwa njengezikhundla ze-ACE inhibitors, kwaye ngokuqhelekileyo zisetyenziselwa kuphela xa i-ACE inhibitors ingavumi ukunyanzeliswa.
Akukho mithetho ekhuni kunye ekhawulezayo malunga neziyobisi ezisetyenziswayo abantu, kodwa kukho ukuthambekela okuthile okuncedo ekukhetheni unyango olulodwa lonyango:
- Izigulane ezincinci zihlala ziphendula kakuhle kwi-ACE inhibitors.
- Izigulane ezimnyama kunye nezigulane ezigugile zivame ukwenza ngcono nge-thiazide diuretics okanye i-calcium channel blockers.
- Izigulane ezimnyama zivame ukwenza kakubi nge-ACE inhibitors.
- I-Beta i-Beta iyakuthi ikhethe ukunyanga i-one-drug treatment, kwaye isetyenziswe kuphela kuphela ukuba kukho esinye isizathu sezonyango sokusebenzisa i-beta blockers (ezifana nesidingo sokunyanga i- angina okanye ukungaphumeleli kwentliziyo , okanye ukulawula izinga lentliziyo kumntu kunye nefayibrillation ye-atrial ).
Ngokuqhelekileyo, amayeza aphantsi asebenzisa unyango lwegazi asebenzayo njengamaxabiso aphezulu, kwaye abangela imiphumo embalwa yecala. Ngoko, xa uzama ukufumana unyango olusebenzayo olulodwa, oogqirha badla ngokuqala ngeqondo eliphantsi. Banganquma ukwandisa umthamo xa i-dose yokuqala ingasebenzi - kodwa akunakunceda ukuba "utyhoboze" umthamo weyeza lonyango elilodwa kumgangatho ophezulu wezilingo. Endaweni yoko, ukuba isilwanyana siphumelele ukusebenza kumthamo ophantsi, sekuyisikhathi sokutshintshela kwiqondo elincinane leziyobisi ezahlukeneyo.
Ukusebenzisa olu hlobo lwenkqubo yokulinga-kunye nephutha, malunga ne-80% yabantu abaneganga lokuxinzeleleka kwegazi eligqityiweyo ekugqibeleni bangaphathwa ngokufanelekileyo kunye nesicatshulwa esisodwa.
Ulwaphulo lweMithi
Ukusebenzisa amayeza angaphezu kweyodwa ukuphatha umfutho wexinzelelo luyimfuneko phantsi kweemeko ezimbini. Okokuqala, unyango oluhlanganisiweyo lisetyenziswe kubantu abane-stage 1 yempembelelo kwaye ubuncinane ubunzima bobabili okanye abathathu abaye baphumelela ukuba baphathe uxinzelelo lwegazi ngeyeza elilodwa.
Okwesibini, unyango lweziyobisi lusetyenziswe kubantu abanesigaba esiphambili se-hypertension (oko kukuthi, ukunyanzeliswa kwabo kwe-systolic ngu-160 mm Hg okanye ngaphezulu, okanye uxinzelelo lwabo lwe-diastolic 100 mm Hg okanye ngaphezulu.) Unyango olulodwa lonyango aluvumelekanga ukuba lusebenze kula bantu , ngokunjalo unyango oludibeneyo lukhethwa ngokusuka ekuqaleni.
Ngamachiza amaninzi okukhethayo, njani oogqirha banokugqiba ukuba iziphi iziyobisi zidibanise? Ngombulelo, kuye kwaqhutyelwa izilingo ezininzi zekliniki ezinika isikhokelo esikhulu ekukhetheni unyango olufanelekileyo oluxhomekeke kwixinzelelo.
Ubungqina obugqwesileyo (ukusuka kwi-ACCOMPLISH trial) bubonisa ukuba iziphumo zekliniki (kubandakanywa umngcipheko wesifo , ukuhlaselwa kwentliziyo kunye nokufa komoya) ziphucuke kakhulu kunye neyeza lokudibanisa xa i-calcium blocker ende ende isetyenziswa kunye ne-ACE inhibitor okanye i-ARB. Ngoko, namhlanje oogqirha abaninzi baya kuzama le ntlangano kuqala.
Ukuba uxinzelelo lwegazi luhlala luphakanyiswe ngonyango oluhlanganisiweyo usebenzisa i-calcium blocker kunye ne-ACE okanye i-ARB ichiza, isisito se-thiazide siza kufakwa njengesidakamizwa sesithathu. Yaye ukuba le nhlanganisela iyahluleka ukulawula uxinzelelo lwegazi, isisisi sesine (ngokuqhelekileyo i-spironolactone, i-non-thiazide diuretic) ingafakwa.
Uninzi lwezigulane ezinegazi eliphezulu liza kuphumelela unyango oluyimpumelelo ngaphambi kokuba isicatshulwa sesithathu okanye sesine sifanele sicatshangelwe. Umntu onqabileyo ongaphumeleli ukuphendula ngokwaneleyo olu hlobo lwenyango yokudibanisa kufuneka ahanjiswe kwingcali yegazi.
Ukuphepha Iimiphumo ezimbi ezivela kwi-Hypertension Izidakamizwa
Naliphina leziyobisi ezisetyenziselwa ukunyanga ingozi yexinzelelo lwentliziyo linokubangela iingxaki. Kwaye xa ukhetha i-regimen "yezona zinto zilungileyo" zokunyanga umntu onoxinzelelo, kubalulekile ukufumana iziyobisi (okanye iziyobisi) ezingagcini nje ngokunciphisa ngempumelelo ingcinezelo yegazi, kodwa nazo ziyakunyamezela.
Ngesi sizathu, kuye kwaba luncedo kakhulu ukuba ukusebenzisa izilwanyana eziphantsi kweziyobisi zengxubevange kusebenza ngendlela esebenzisa amanani aphezulu. Ukukwazi ukufikelela kunye namaqondo aphantsi kakhulu kunciphisa umngcipheko wemiphumo emibi.
Sekunjalo, ezi zi yobisi zingabangela iingxaki, kwaye kubalulekile ukuba uqaphele iziphumo ezibi. Nangona nganye yezidakamizwa zengxakeko zengxowankulu zineziphumo "zecala lempembelelo yecala," ngenxa yeyona nto inokuba yimiphumo emibi yilezi yobisi zihambelana noluhlu lwazo. Imiphumo echaphazelekayo enxulumene neqela yile:
- I-Thiazide diuretics: i- hypokalemia (amanqanaba aphantsi e-potassium), ukuvuthwa rhoqo, ukugqithisa kwe- gout
- I-ACE inhibitors: ukukhwehlela, ukulahleka kwengqiqo, i- hyperkalemia (amazinga aphezulu e-potassium)
- Ama-blockers e-calcium: ukumbumba, ukuvuvukala kwemilenze, intloko
- Beta-blockers: ukunyuka kwesifo se- dyspnea kubantu abanesifo esingapheliyo se-pulmonary disease okanye isifo se-asthma , ukungasebenzi ngokwesini, ukukhathala, ukuxinezeleka, ukugqithisa kweempawu kubantu abane- arterial disease
- I-ARB: ukuphendula okuthintekayo, utywala , i-hyperkalemia
Ngamachiza amaninzi okukhethayo, akunqabile ukuba ugqirha uza kubuza umntu onomfutho wegazi ophezulu ukunyamezela imiphumo ebalulekileyo. ukuba uphathwa unyango lweengcinezelo kwaye uhlangabezana nayo nayiphi na imiphumo emibi, kufanele uxoxe nodokotela wakho ngokufumana unyango lwenkqubo onokunyamezela.
Uluhlu lweeNdlu ezininzi ezixhaphakileyo zonyango
Njengoko kuphawuliwe ekuqaleni kwesi nqaku, uluhlu lwezilwanyana eziye zavunywa ukuba unyango lwexinzelelo lube lude. Nantsi uluhlu olugqibeleleyo lwezobisi. Igama eliqhelekileyo lonyango ngalinye libalwe kuqala, lilandelwa ngamagama oorhwebo.
Diuretics
I-Diuretics ("iipilisi zamanzi") yandisa inani le-sodium kunye namanzi adluliselwa emcinini ngeentso. Kucingelwa ukuba banciphisa uxinzelelo lwegazi ikakhulu ngokunciphisa umthamo wetsholongwane kwimithambo yegazi.
I-Diuretics eqhelekileyo isetyenziselwa umfutho wexinzelelo:
- Acetazolamide - Diamox
- I-Chlorthalidone - iThalidone, ibuye ithengiswe njenge-Tenoretic neClorpres
- I-Hydrochlorothiazide - HydroDiuril, ibuye ithengiswe njenge-Microzide ne-Esidrix
- Indapamide - Lozol
- I-Metolazone - iZaroxolyn, ibuye ithengiswe njengeMykrox
I-Diuretics engaphantsi isetyenziswa ngokusesikweni komfutho wexinzelelo:
- Amiloride hydrochloride - Midamor
- Bumetanide - Bumex
- I-ethacrynic acid - i-Edecrin
- Furosemide - Lasix
- I-Spironolactone - Aldactone
- Torsemide - Demadex
- Triamterene - Dyrenium
Beta-blockers
I-Beta blockers ivimba umphumo we-adrenaline kwisistim senhliziyo, unciphisa intliziyo, kwaye unciphise uxinzelelo kwintliziyo kunye nemithambo.
- I-Acebutolol - iSectral
- Atenolol - Tenormin
- Betaxolol - Kerlone
- Bisoprolol - uZebeta, uthengiswa njengoZiac
- Cardolol - Cartrol
- Carvedilol - Coreg
- I-Labetalol - Normodyne, ibuye ithengiswe njengeTrandate
- I-Metoprolol - Lopressor, ibuye ithengiswe njengeTostrol
- Nadolol - Corgard
- Penbutolol - Levatol
- Propranolol - Inderal, Inderal LA
- Timolol - Blocadren
Blockers Channel
I-block blockers ye-calcium inokunciphisa uxinzelelo lwegazi ngokunciphisa imirhobho kwaye, kwezinye iimeko, ukunciphisa amandla okwehliswa kwentliziyo.
- Amlodipine - Norvasc, ibuye ithengiswe njengoCaduet noLotrel
- I-Diltiazem - iCardizem, ibuye ithengiswe njengoDilacor noTiazac
- Felodipine - Plendil
- Israel - DynaCirc
- INicardipine - iKardene
- I-Nifedipine-Procardia XL, ibuye ithengiswe njenge-Adalat
- I-Nisoldipine - iSular
- I-Verapamil hydrochloride - i-Isoptin, ibuye ithengiswe njengeCalan, i-Verelan ne-Covera
Angiotensin Ukuguqula i-Enzyme Inhibitors
I-angiotensin eguqulela i-enzyme inhibitors ("i-ACE inhibitors") inokunciphisa uxinzelelo lwegazi ngokuxubha imithwayilo.
- Benazepril - uLotensin
- Captopril - Capoten
- Enalapril - Vasotec, ibuye ithengiswe njengeVaseretic
- Fosinopril - Monopril
- Lisinopril - Prinivil, ibuye ithengiswe njengeZestril
- Moexipril - Univasc
- Quinapril - Accupril
- Ramipril - Altace
- ITrandolapril - Mavik
I-Angiotensin II Receptor Blockers
I-angiotensin II i-receptor blockers ("i-ARBs") iphinde iphinde iyanciphise uxinzelelo lwegazi ngokunciphisa imitha.
- Candesartan - Atacand
- Irbesartan - Avapro
- Losartan - Cozaar
- Telmisartan - Micardis
- Valsartan - Diovan
Okunye, okungekho ngaphantsi kokusetyenziswa kwe-Hypertension Drugs
- Clonidine - Catapres
- Doxazosin - Cardura
- Guanabenz - Wytensin
- Guanfacine - Tenex
- Hydralazine hydrochloride - Apresoline
- IMedhyldopa - Aldomet
- Prazosin - Minipress
- Reserpine -Ã, Serpasil
- Terazosin - Hytrin
Iziyobisi eziManyeneyo ze-Hypertension
Izidakamizwa ezininzi ezidibeneyo zithengiswa ngogonyamelo ophezulu, kwaye akunakwenzeka ukugcina umkhondo wezinto ezintsha eziza kunye, okanye ezakudala eziye zaphela. Olu lulandelayo luhlu olugqibeleleyo lwezonyango eziqhelekileyo ezidibeneyo ezisetyenziselwa uxinzelelo lwegazi.
- Amiloride kunye ne-hydrochlorothiazide-Moduretic
- I-Amlodipine kunye ne-benazepril -Lotrel
- I-Atenolol kunye ne-chlorthalidone - i-Tenoretic
- Benazepril kunye ne-hydrochlorothiazide - i-Lotensin HCT
- Bisoprolol kunye ne-hydrochlorothiazide - Ziac
- I-Captopril kunye ne-hydrochlorothiazide - iCapozide
- Enalapril kunye ne-hydrochlorothiazide - i-Vaseretic
- I-Felodipine kunye ne-enalapril - Lexxel
- I-Hydralazine kunye ne-hydrochlorothiazide - i-Apresazide
- I-Lisinopril kunye ne-hydrochlorothiazide - i-Prinzide, ibuye ithengiswe njengeZestoretic
- Losartan kunye ne-hydrochlorothiazide - Hyzaar
- I-Methyldopa kunye ne-hydrochlorothiazide-Aldoril
- I-Metoprolol ne-hydrochlorothiazide-Lopressor HCT
- Nadolol kunye ne-bendroflumethiazide - Corzide
- Ipropranolol kunye ne-hydrochlorothiazide - Inderide
- I-spironolactone kunye ne-hydrochlorothiazide - i-Aldactazide
- I-Triamterene ne-hydrochlorothiazide - iDyazide, ibuye ithengiswe njengo-Maxide
- I-Verapamil yandisa ukukhululwa) kunye ne-trandolapril-Tarka
ILizwi
Uxinzelelo lwengcinezelo yinkinga yezobugqirha eziqhelekileyo ezinokuba nemiphumo emibi xa ingaphathwa kakuhle. Nangona kunjalo, kunye neendlela ezininzi zokonyango, kufuneka ulindele ugqirha wakho ukuba athole irejimenti yokwelapha eya kunciphisa kakhulu umngcipheko wesiphumo esibi kwingozi yengozi, ngaphandle kokuphazamisa ubomi bakho bemihla ngemihla.
> Imithombo:
> Uxinzelelo lwe-Blood Pressure Lowering Ulwabelwano lwabalandeli, i-turnbull F, i-Neal B, et al. Iimiphumo zeMimiselo eyahlukileyo yokuNcincika kweNgcini yegazi kwiMicimbi emikhulu yee-Cardiovascular Elder and Younger Abadala: Ukuhlaziywa kweemvavanyo zoLwabiwo oluLungeleleneyo. BMJ 2008; 336: 1121.
> Jamerson KA, Bakris GL, Wun CC, et al. Isisombululo kunye noyilo lweZenzo zokuKhusela i-Cardiovascular Circle Ulwaphulo lwezonyango kwizigulana eziphila ne-Hypertension ye-Systolic (ACCOMPLISH) Uvavanyo: Uvavanyo oluQalayo oluPhezulu oluLungelelanisiweyo lokuThelekisa iMiphumo yeziphumo zeeKlinikhi Impembelelo zoNyango lweMigca yokuHlanganisa kwi-Hypertension. Am J Hypertens 2004; 17: 793.
> Mancia G, Fagard R, Narkiewicz K, et al. 2013 I-ESH / ESC Izikhokelo zoLawulo lwe-Arterial Hypertension: i-Task Force ekulawuleni umfutho wegazi ophezulu we-European Society of Hypertension (ESH) kunye ne-European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281.
> Weber MA, Schiffrin EL, White WB, et al. Izikhokelo zoLwazi lweZikliniki zoLawulo lwe-Hypertension kwi-Community iNgxelo ye-American Society of Hypertension kunye ne-International Society of Hypertension. J Hypertens 2014; 32: 3.