Ho fumana Meriana ea "Ho Molemo ka ho Fetisisa" ea Ts'oaetso ea Mali bakeng sa Hao
Lethathamo la lithethefatsi le lithethefatsi tse ngata tse atisang ho sebelisoa ho phekola khatello ea mali (khatello ea mali e phahameng) ke nako e telele haholo.
Taba ea hore ho na le lithethefatsi tse ngata ho khetha ho tloha bonyane lintho tse peli. Ntlha ea pele, ho bolela hore ha ho na meriana e "molemo ka ho fetisisa" bakeng sa khatello ea meriana, ke hore, ha ho na lithethefatsi tse sebetsang hantle hoo e batlang e mong le e mong ntle le ho baka liphello tse sa amoheleheng.
Haeba ho ne ho le joalo, lik'hamphani tsa lithethefatsi li ne li tla emisa boiteko ba tsona ba ho hlahisa lithethefatsi tse ncha tsa antihypertensive khale-mme lethathamo la lithethefatsi tse amohelehang le ka be le khutšoanyane haholo.
Ea bobeli, le lithethefatsi tse ngata tseo u ka li khethang, hafeela uena le ngaka ea hau le mamella mme le phehella, ho ka etsahala haholo hore molao o sebetsang hantle le o mamelloang o tla fumanoa bakeng sa khatello ea meriana ea hau. Ka mantsoe a mang, ha ho se na phekolo e ntle ka ho fetisisa ea "khatello ea kelello" ea khatello ea meriana, ho ka 'na ha e-ba le phekolo e "ntle ka ho fetisisa" bakeng sa hau.
Sehloohong sena, re tla hlalosa mefuta e meng ea lithethefatsi tse sebelisetsoang khatello ea meriana, 'me ke litekanyetso life tseo lingaka li lokelang ho li nka ha u khetha (ho tloha mefuteng e mengata ea lintho tse khethollang) kalafo ea hau e nepahetseng. Qetellong, re tla fana ka lenane le feletseng la lithethefatsi tsohle tse sebelisoang hona joale US (le linaheng tse ngata tse tsoetseng pele) bakeng sa phekolo ea meriana ea khatello ea kelello.
Ho Khetha Phekolo e nepahetseng ea Chefo ea Mafu
Hangata lingaka li sebelisa mokhoa o hlophisitsoeng oa ho khetha phekolo e phahameng ea khatello ea meriana ea mali.
Mohato oa 1: Ho batho ba fumanoeng ba e -na le khatello ea kelello e bonolo kapa e itekanetseng , ke habohlokoa ho qala ka ho buella liphetoho tsa bophelo tse bontšitsoeng ho thusa ho fokotsa khatello ea mali. Tsena li kenyelletsa liphetoho tsa lijo , ho thibela letsoai , ho ikoetlisa kamehla le ho khaotsa ho tsuba.
Mohato oa bobeli: Haeba mehato ena ea bophelo ea bophelo e sa fane ka phekolo ea mali e lekaneng ka mor'a libeke tse 'maloa, hangata ke nako ea ho eketsa phekolo ea lithethefatsi.
Tsela e ka sehloohong ea ho khetha phekolo ea meriana bakeng sa khatello ea meriana
Ho na le likarolo tse hlano tse kholo tsa lithethefatsi tse 'nileng tsa pakoa ka katleho ho phekola khatello ea meriana. Tsena ke:
- Thiazide diuretics
- Angiotensin e fetola enzyme (ACE) inhibitors
- Calcium blockers
- Li-blockers tsa Beta
- Li-Angiotensin receptor blockers (ARBs)
Phekolo ea Meriana e le Mong
Haeba u e-na le sethapo sa mokuli oa mokuli (moo khatello ea hau ea systolic e ka tlase ho 160 mm Hg, mme khatello ea hao ea diastolic e ka tlaase ho 100 mm Hg), tlhahiso ea kakaretso e qala ka lithethefatsi tse le 'ngoe ho tloha ho e' ngoe ea lihlopha tsena tse hlano.
Ka kakaretso, lithethefatsi tse tsoang ho e 'ngoe le e' ngoe ea lihlopha tsena (ntle le beta-blockers, tseo ka tloaelo li sa sebetseng joaloka lithethefatsi tse le 'ngoe) li atisa ho sebetsa hantle ka ho lekaneng ho laola khatello ea meriana. Ha e le hantle, ho na le monyetla oa 50-50 hore lithethefatsi leha e le life li tla sebetsa ka mokhoa o lekaneng ho motho ofe kapa ofe ea nang le khatello ea mokuli ea mohato oa pele.
Leha ho le joalo, batho ba tla arabela ka ho fapaneng le meriana ena. Jim a ka 'na a arabela thizide hantle, empa a sitoa ho ba le calcium blocker,' me nyeoe le Jane e ka 'na ea e-ba eona ntho e tobileng. Ka kakaretso ha ho na nako e tlang pele ho nako ea ho bolela esale pele hore na ke mang ea tla etsa hantle ka mofuta ofe oa meriana. Kahoo, ke lingaka life le bakuli ba setseng ke mokhoa o rutehileng oa liteko le phoso.
Ka "ho nahanisisa" ka mokhoa o motle ka ho fetisisa oa ho sebelisa lithethefatsi tse le 'ngoe ho qala, litsebi tse ngata hona joale li khothalletsa hore li qale ka mofuta oa thiazide diuretic (hangata chlorthalidone kapa hydrochlorothiazide), e leng nako e telele e etsang calcium blocker, kapa ACE inhibitor. Li-ARB li atisa ho nkoa e le li-substitute for ACE inhibitors, 'me ka kakaretso li sebelisoa feela ha li-inhibitor tsa ACE li sa mamellehe.
Ha ho melao e thata le e potlakileng eo lithethefatsi li ka e sebelisang ho batho, empa ho na le mekhoa e itseng e thusang ho khetha phekolo ea moriana o le mong:
- Hangata bakuli ba bacha ba arabela hantle ho ACE inhibitors.
- Bakuli ba batšo le bakuli ba hōlileng ba atisa ho sebetsa hantle le thiazide diuretics kapa calcium channel blockers.
- Bakuli ba batšo ba atisa ho etsa hampe ka ACE inhibitors.
- Li-blockers tsa Beta hangata ke khetho e bobebe ea phekolo ea meriana e le 'ngoe,' me hangata e sebelisoa feela haeba ho e-na le mabaka a mang a bongaka a ho sebelisa beta blockers (e kang tlhokahalo ea ho tšoara angina kapa ho hloleha ha pelo , kapa ho laola lebelo la pelo ka motho ka li -atrial fibrillation ).
Ka kakaretso, meriana e tlaase ea meriana ea khatello ea mali e sebetsa hantle joaloka tekanyo e phahameng, 'me e bakela litla-morao tse seng kae. Kahoo, ha o leka ho fumana phekolo e sebetsang ea meriana e le 'ngoe, hangata lingaka li qala ka tekanyo e tlase. Ba ka 'na ba etsa qeto ea ho eketsa lethal dose ha tekanyo ea pele e sa sebetse - empa ha ho bonolo ho thusa "ho sutumetsa" tekanyo ea phekolo ea meriana e le' ngoe ho ea litekong tse phahameng tsa litekanyetso. Ho e-na le hoo, haeba sethethefatsi se hlōleha ho sebetsa ka tekanyo e tlaase, ke nako ea ho fetolela tekanyo e tlaase ea lithethefatsi tse fapaneng.
Ho sebelisa mokhoa ona oa teko-le-phoso, hoo e ka bang 80% ea batho ba nang le khatello ea meriana e phahameng ea sethaleng qetellong ba ka phekoloa ka mokhoa o lekaneng le lithethefatsi tse le 'ngoe tse nang le khatello ea mali.
Phekolo ea Meriana e Kopaneng
Ho sebelisa meriana e fetang e le 'ngoe ho phekola khatello ea meriana ho hlokahala tlasa maemo a mabeli. Ntlha ea pele, phekolo e kopanetsoeng e sebelisoa ho batho ba nang le khatello ea meriana ea methapo ea mokuli 'me bonyane ho ile ha etsoa boiteko bo lekaneng ba makhetlo a mararo kapa a mararo ho phekola khatello ea mali ea bona ka phekolo ea moriana o le mong.
Ntlha ea bobeli, phekolo ea moriana e sebelisoa ho batho ba nang le khatello ea meriana ea motlakase (e leng, khatello ea bona ea systolic ke 160 mm Hg kapa e phahameng, kapa khatello ea bona ea diastolic 100 mm Hg kapa e holimo.) Kalafo ea meriana e le mong ha e kholoe ho sebetsa ho batho bana , joalo-joalo kalafo ea meriana e khethoa ho tloha qalong.
Kaha ho na le lithethefatsi tse ngata tseo u ka li khethang, lingaka li ka etsa qeto joang hore li sebelise lithethefatsi life? Ka lehlohonolo, liteko tse 'maloa tsa kliniki li' nile tsa etsoa tse fanang ka tataiso e kholo tabeng ea ho khetha phekolo e kopanetsoeng ea khatello ea mokuli.
Sepheo se setle ka ho fetisisa (ho tloha ka nyeoe ea ACCOMPLISH) se fana ka maikutlo a hore liphello tsa kliniki (ho kenyelletsa kotsi ea ho otloa ke lefu , lefu la pelo le lefu la pelo) li ntlafatsoa haholo ka phekolo ea motsoako ha khalase ea khale e sebetsang e sebelisoa hammoho le ACE inhibitor kapa ARB. Ka hona, kajeno lingaka tse ngata li tla leka kopano ena pele.
Haeba khatello ea mali e ntse e phahame ka phekolo ea motsoako e sebelisa calcium blocker hammoho le setho sa ACE kapa ARB, lithethefatsi tsa thiazide hangata li kenyelletsoa e le lithethefatsi tsa boraro. 'Me haeba motsoako ona o ntse o sitoa ho laola khatello ea mali, mofuta oa bone (hangata spironolactone, e seng thiazide diuretic) e ka ekeletsoa.
Bongata ba bakuli ba nang le ts'oaetso ea mali bo tla finyella phekolo e atlehileng nako e telele pele setlhare sa boraro kapa sa bone se hloka ho nkoa. Motho ea sa tloaelehang ea sa arabeleng ka mokhoa o lekaneng bakeng sa phekolo ea mofuta ona o lokela ho fetisetsoa ho setsebi se phahameng sa khatello ea meriana.
Ho Qoba Litlokotsi Tse Mpe Tsa Meriana ea Matšoafo ea Matšoafo
Meriana leha e le efe e sebelisoang ho phekola khatello ea meriana e na le monyetla oa ho baka mathata. 'Me ha u khetha meriana e "molemo ka ho fetisisa" bakeng sa ho phekola motho ea nang le khatello ea meriana, ke habohlokoa hore u fumane lithethefatsi (kapa lithethefatsi) tse sa fokotseng khatello ea mali ka katleho, empa le tsona li mamella hantle.
Ka lebaka lena, ho 'nile ha e-ba molemo haholo hore ho sebelisa litebelisuoa tse tlase tsa lithethefatsi tsa meriana e matla ho sebetsa joaloka ho sebelisa tekanyo e phahameng. Tsebo ea ho finyella ka tekanyo e tlaase e fokotsa kotsi ea liphello tse bohloko.
Leha ho le joalo, lithethefatsi tsena li ka bakela mathata, 'me ke habohlokoa hore u hlokomele liphello tse bohloko. Le hoja e 'ngoe le e' ngoe ea lithethefatsi tse nang le khatello ea meriana ea mali e na le "setšoantšo sa phello ea mahlakoreng," haholo-holo liphello tse mpe tsa lithethefatsi tsena li amana le sehlopha sa tsona. Liphetho tse bohloko tse amanang le sehlopha ke tse latelang:
- Thiazide diuretics: hypokalemia (maemong a tlase a potassium), ho tlosoa hangata, ho mpefala ha gout
- ACE inhibitors: khohlela, tahlehelo ea kutlo ea lijo, hyperkalemia (maemo a phahameng a potassium)
- Li-calcium blockers: ho pata, ho ruruha ha maoto, hlooho
- Batch blockers: ho mpefala ha dyspnea ho batho ba nang le boloetse bo sa foleng ba pulmonary or asthma , ho se sebetse ka thobalano, mokhathala, ho tepella maikutlong, ho senyeha ha matšoao ho batho ba nang le lefu la methapo ea pherekano
- Li-ARB: liphello tsa allergic, mokelikeli , hyperkalemia
Kaha ho na le lithethefatsi tse ngata tseo u lokelang ho li khetha, ha ho bonolo hore ngaka e botse motho ea nang le khatello ea meriana hore a mamelle liphello tse bohloko tse khōlō. haeba u ntse u tšoeroe ke lefu la mokuli 'me u na le litla-morao tse bohloko, u lokela ho bua le ngaka ea hau mabapi le ho fumana mekhoa ea phekolo eo u ka e mamellang hamolemo.
Lethathamo la Lithethefatsi Tse Ngata ka ho Fetisisa Tse Sebelisoang ke Meriana ea Matšoafo
Joalokaha ho boletsoe qalong ea sehlooho sena, lethathamo la lithethefatsi tse amoheletsoeng bakeng sa ho phekoloa ke khatello ea meriana ke nako e telele haholo. Mona ke lenane le feletseng la lithethefatsi tsena. Lebitso la tlhaho la lithethefatsi ka 'ngoe le thathamisitsoe pele, le lateloa ke mabitso a khoebo.
Diuretics
Diuretics ("lipilisi tsa metsi") eketsa lenane la sodium le metsi tse fetisetsoang ka morong ke liphio. Ho nahanoa hore ba theola khatello ea mali haholo ka ho fokotsa molumo oa metsi ka har'a methapo ea mali.
Diuretics e atisang ho sebelisoa bakeng sa khatello ea mokuli:
- Acetazolamide - Diamox
- Chlorthalidone - Thalidone, e boetse e rekisoa e le Tenoretic le Clorpres
- Hydrochlorothiazide - HydroDiuril, e boetse e rekisoa e le Microzide le Esidrix
- Molemo ka ho fetisisa - Lozol
- Metolazone - Zaroxolyn, e boetse e rekisoa e le Mykrox
Mefuta e fokolang ea diuretiki e atisang ho sebelisoa bakeng sa khatello ea meriana:
- Amiloride hydrochloride - Midamor
- Bumetanide - Bumex
- Ethacrynic acid - Edecrin
- Furosemide - Lasix
- Moea oa moea - Motho ea nang le bothata
- Torsemide - Demadex
- Triamterene - Dyrenium
Beta-blockers
B block blockers e thibela phello ea adrenaline meleng ea pelo, e liehisa pelo, mme e fokotsa khatello ea maikutlo pelong le methapong.
- Acebutolol - Sectral
- Atenolol - Tenormin
- Betaxolol - Kerlone
- Bisoprolol - Zebeta, o boetse o rekisoa e le Ziac
- Mapolol - Cartrol
- Carvedilol - Coreg
- Labetalol - Normodyne, e boetse e rekisoa e le Trandate
- Metoprolol - Lopressor, e boetse e rekisoa e le Toprol
- Nadolol - Corgard
- Penbutolol - Levatol
- Propranolol - Inderal, Inderal LA
- Timolol - Blocadren
Li-blockers tsa Calcium Channel
Li-block block tsa Calcium li ka fokotsa khatello ea mali ka ho fokotsa methapo ea meriana 'me, maemong a mang, ho fokotsa matla a ho thibela pelo.
- Amlodipine - Norvasc, e boetse e rekisoa e le Caduet le Lotrel
- Diltiazem - Cardizem, e boetse e rekisoa e le Dilacor le Tiazac
- Felodipine - Moralo
- Isradipine - DynaCirc
- Nicardipine - Cardene
- Nifedipine - Procardia XL, e boetse e rekisoa e le Adalat
- Nisoldipine - Sular
- Verapamil hydrochloride - Isoptin, e boetse e rekisoa e le Calan, Verelan le Covera
Angiotensin e fetola likokoana-hloko tsa enzyme
Li-angiotensin tse fetolelang li-inhibitor tsa enzyme ("ACE inhibitors") li ka fokotsa khatello ea mali ka ho theola methapo.
- Benazepril - Lotensin
- Captopril - Capoten
- Enalapril - Vasotec, e boetse e rekisoa e le Vaseretic
- Fosinopril - Monopril
- Lisinopril - Ea bohlokoa, hape e rekisoa e le Zestril
- Moexipril - Univasc
- Quinapril - Accupril
- Ramipril - Altace
- Trandolapril - Mavik
Angiotensin II Receptor Blockers
Li-angiotensin II tse amohelang li-receptor block ("ARBs") le tsona li fokotsa khatello ea mali ka ho theola methapo.
- Letsoalo - Atacand
- Irbesartan - Avapro
- Losartan - Cozaar
- Telmisartan - Micardis
- Valsartan - Diovan
Tse ling, Tse sa Fokolang ka ho Fetisisa Tse Amanang le Chefo ea Meriana
- Clonidine - Catapres
- Doxazosin - Cardura
- Guanabenz - Wytensin
- Guanfacine - Tenex
- Hydralazine hydrochloride - Apresoline
- Methyldopa - Aldomet
- Prazosin - Minipress
- Reserpine -Ã, Serpasil
- Terazosin - Hytrin
Lithethefatsi tse Kopaneng bakeng sa Khatello ea Kelello
Lithethefatsi tse ngata tse kopantsoeng li 'nile tsa rekisoa ka lebaka la khatello ea meriana,' me ho thata ho boloka tlaleho ea tse ncha tse tlang, kapa tsa khale tse senyehang. Mantsoe a latelang ke lenane le feletseng la lithethefatsi tse tloaelehileng haholo tse sebelisoang bakeng sa khatello ea meriana.
- Amiloride le hydrochlorothiazide - Moduretic
- Amlodipine le benazepril - Lotrel
- Atenolol le chlorthalidone - Tenoretic
- Benazepril le hydrochlorothiazide - HCT Lotensin
- Bisoprolol le hydrochlorothiazide - Ziac
- Captopril le hydrochlorothiazide - Capozide
- Enalapril le hydrochlorothiazide - Vaseretic
- Felodipine le enalapril - Lexxel
- Hydralazine le hydrochlorothiazide - Apresazide
- Lisinopril le hydrochlorothiazide - Prinzide, e boetse e rekisoa e le Zestoretic
- Losartan le hydrochlorothiazide - Hyzaar
- Methyldopa le hydrochlorothiazide - Aldoril
- Metoprolol le hydrochlorothiazide - Lopressor HCT
- Nadolol le bendroflumethiazide - Corzide
- Propranolol le hydrochlorothiazide - Inderide
- Spironolactone le hydrochlorothiazide - Aldactazide
- Triamterene le hydrochlorothiazide - E tseba, hape e rekisoa e le Maxide
- Verapamil e atolositsoe ho lokolloa) le trandolapril - Tarka
Lentsoe le Tsoang ho
Ho ba le khatello ea kelello ke bothata bo tloaelehileng ba bongaka bo ka ba le liphello tse bohloko haeba e sa phekoloa ka mokhoa o lekaneng. Leha ho le joalo, ka mekhoa e mengata ea kalafo, u lokela ho lebella hore ngaka ea hau e fumane mekhoa ea phekolo ea meriana e tla fokotsa menyetla ea hau ea liphello tse mpe ho tsoa khatellong ea meriana, ntle le ho senya bophelo ba hao ba letsatsi le leng le le leng.
> Mehloli:
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> Mancia G, Fagard R, Narkiewicz K, le al. Tlhahiso ea ESH / ESC ea Tsamaiso ea Ts'oaetso ea "Hypertension Arterial Hypertension": Sehlopha sa Basebetsi bakeng sa tsamaiso ea khatello e phahameng ea mali ea European Society of Hypertension (ESH) le European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281.
> Weber MA, Schiffrin EL, White WB, et al. Litlhahiso tsa Mokhoa oa Bophelo oa Meriana bakeng sa Tsamaiso ea Ts'oaetso ea Motlakase Motseng Sebopeho sa American Society of Hypertension le Mokhatlo oa Machaba oa Matšoafo a Mafura. J Hypertens 2014; 32: 3.