Isolated systolic hypertension: labile, khola

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Mukazindikira kuti mankhwalawo apangika ngati matenda a systole, izi zikutanthauza kuti kuthamanga kwa magazi mu gawo la systole - mtima kumadutsa - kupitilira muyeso yokhudza thupi (ndipo ndi osachepera 140 mmHg), komanso kupanikizika kwa diastolic (pomwe minofu yamtima ipuma pakati pa contractions) ikakhazikika pa 90 mmHg Art.

Matenda amtunduwu amapezeka kwambiri mwa anthu okalamba, makamaka kwa akazi. Ndipo, makamaka, mwa odwala ambiri omwe ali ndi zaka zopitilira 60, amakhala okha osakanikirana oopsa omwe amawonedwa.

Ofufuzawo adakhazikitsa kufunikira kwa kuthamanga kwa systolic mu 1990s, pomwe zinafika kuti kuthamanga kwa magazi kwa diastolic kumasinthira pang'ono, komanso kuthamanga kwa systolic komwe kumawonjezeka moyo wonse kumatha kukhala pachiwopsezo cha matenda a mtima ndi sitiroko.

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Epidemiology

Malinga ndi ziwerengero kuchokera ku Unduna wa Zaumoyo ku Ukraine, anthu miliyoni 12.1 miliyoni azindikira matenda oopsa, omwe amaposa 37.2% mchaka cha 2000.

Komanso, kupatula kwa systolic kwamankhwala odwala a zaka 60-69 zaka kuyambira 40% mpaka 80% ya milandu, ndi zaka zopitilira 80 - 95%.

Malinga ndi Journal of Hypertension, ma systolic arterial hypertension okalamba ndi omwe amapangitsa kuti matenda ena azikhala ndi mtima, ngakhale magazi azikhala ndi ma 150-160 mm Hg. Art., Yomwe imayambitsa zovuta zamtima zomwe zilipo mu gawo limodzi mwa magawo atatu a odwala.

Matenda oopsa a arterial ndi chifukwa chachikulu chodwala komanso kufa chifukwa chogwirizana ndi matenda a mtima, matenda a mtima komanso kulephera kwaimpso. Kafukufuku wasonyeza kuti matenda oopsa ndi chinthu chachikulu kwambiri chodwalitsa anthu 500,000 odwala ku North America (theka lawo amathera muimfa) ndipo pafupifupi miliyoni miliyoni amawonongedwa pachaka. Odwala omwe ali ndi kuthamanga kwa magazi, kuchuluka kwazomwe zimakhazikika pakapita zaka 10 ndi 10% mwa amuna ndi 4,4% mwa akazi.

Ndipo chidziwitso cha NHANES (The National Health and Nutrition Examination Survey) chikuwonetsa kuti kuchuluka kwa systolic kwa achinyamata (azaka 20-30) kwachulukanso kuposa kawiri makumi angapo aposachedwa - mpaka 2.6-3.2% ya milandu.

Kuchuluka kwa systolic koopsa mu hyperthyroidism ndi 20-30%.

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Zimayambitsa matenda a Systolic Hypertension

Zomwe zimayambitsa matenda osokoneza bongo omwe amakhazikitsidwa ndi azachipatala ndi zokhudzana:

ndi kuchepa kwokhudzana ndi zaka zaka m'makutu amitsempha yayikulu chifukwa cha kuchuluka kwa mafuta (cholesterol) m'matumbo am'mbali mwa chotengera (atherosulinosis),
ndi aortic insufficiency - kuphwanya kwa msempha wa mtima (komwe kumachokera ku msempha kuchokera kumanzere kwamitsempha),
ndi granulomatous autoimmune arteritis wa kungʻambika Chipilala (Takayasu aortoarteritis),
ndi hyperaldosteronism (ntchito yowonjezera ya adrenal cortex ndi kuchuluka kwa mahomoni aldosterone, omwe amachititsa kuti magazi azungulira magazi).
ndi kuwonjezeka kwa ntchito ya chithokomiro (thyrotooticosis kapena hyperthyroidism),
Ndi matenda a impso, makamaka, aimpso.
ndi metabolic syndrome
ndi magazi m'thupi.

Pankhaniyi, systolic matenda oopsa ndi kungʻambika valavu kukanika, arteritis ya kungʻambika Chipilala, hyperthyroidism kapena kuchepa magazi amawonedwa chizindikiro kapena yachiwiri.

Mwa zina mwazifukwa zambiri zomwe zimapangitsa kuti matenda asakanizike kwambiri mwa achinyamata angakhazikike, akatswiri amatcha kusintha kwokhudzana ndi zaka. Komabe, matenda oopsa paubwana ndi zaka zapakati zimawonjezera chiopsezo cha matenda amtima wamtsogolo mtsogolo.

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Zowopsa

Pakukula kwa matenda oopsa, gawo lofunikira limaseweredwa ndi zinthu zoopsa monga kukalamba, kusachita masewera olimbitsa thupi, kuzunza mafuta, mchere ndi mowa, mafuta ambiri a calcium, kuchepa kwa calcium m'thupi, matenda a shuga komanso kunenepa kwambiri.

Kuchepa kwa matenda oopsa a systolic kumawonjezereka ngati matendawa alipo m'magazi a magazi, popeza mawonekedwe ena a kayendedwe ka magazi amayambitsidwa ndi majini.

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The pathogenesis ya chitukuko cha systolic matenda oopsa amafotokozedwa zingapo zosokoneza za zovuta kupanga ndi kuwongolera kuthamanga kwa magazi - chifukwa cha mtima kutulutsa ndi zokhudza mtima kukana.

Ndi matenda oopsa, kapena kuwonjezeka kwa mtima, kapena kuwonjezeka kwamitsempha yama mtima kukana, kapena zonse ziwiri, zitha kuwonedwa munthawi yomweyo.

Kuwongolera kwa Neurogenic kwa kuthamanga kwa magazi kumachitika ndi pakati pa vasomotor - gulu la medulla baroreceptors, lomwe limayankha khoma litatambasulidwa, kukulira zochitika zogwirizana. Izi, zimachepetsa ntchito yachifundo komanso zimathandizira kamvekedwe ka mitsempha ya vagus, komwe kumachepetsa kugunda kwa mtima komanso mitsempha yamagazi ikukula. Komabe, ndi zaka, chidwi cha baroreceptors chimachepa, komwe ndi gawo lazophatikizira mu okalamba.

Kupsinjika kwa magazi ndi kayendedwe ka magazi konse kamayendetsedwanso ndi dongosolo la renin-angiotensin la thupi. Mothandizidwa ndi renin, puloteni ya peri-buccal zida za impso, kusintha kwachilengedwe kwamitsempha yolimbitsa timadzi ta angiotensin kukhala gawo la angiotensin I peptide kumachitika. lumen yamitsempha yamagazi ndi kutulutsidwa kwa corticosteroid timadzi ta adrenal cortex aldosterone. Nawonso kuwonjezeka kwa kuchuluka kwa aldosterone m'magazi kumapangitsa kuti magazi azungulira, kuchuluka kwa sodium ions (Na +) ndi potaziyamu (K +) m'magazi, komanso kuchuluka kwa magazi. Izi ndizomwe zimachitika ndi hyperaldosteronism.

Mwa njira, kutulutsidwa kwa renin kumachulukanso ndi kukondoweza kwa β-adrenergic receptors of the sensorative system system ndi catecholamines (adrenaline, norepinephrine, dopamine), omwe amatulutsidwa mopitirira muyeso panthawi yolimbitsa thupi kwambiri, mkhalidwe wopitilira nthawi yayitali wa psycho-maikutlo overexcitation, komanso kuvutira kwambiri.

Atrial natriuretic peptide (ANP), yomwe imapumitsa minofu ya makoma amitsempha yamagazi, imatulutsidwa kuchokera ku ma myocardial cell (cardiomyocyte) ya atria pamene yatambasulidwa ndikuyambitsa kukodza (diuresis), kuchulukitsa kwa Na ndi impso komanso kutsika kwakukulu kwa kuthamanga kwa magazi. Ndi zovuta ndi myocardium, kuchuluka kwa ANP kumachepa ndipo kuthamanga kwa magazi kumakwera mu systole.

Kuphatikiza apo, odwala omwe ali ndi matenda amtunduwu, ma cell endothelial cell ntchito amatha kusokonezeka. Kupendekeka kwam'mimba kwa endothelium kumapangika endothelin, mankhwala amphamvu kwambiri a vasoconstrictor peptide. Kukula kwawo kaphatikizidwe kapena kamvekedwe ka endothelin-1 kungayambitse kuchepa kwa mapangidwe a nitric oxide, omwe amachititsa kuti vasodilation - kumasuka kwa makoma amitsempha yamagazi.

Ndipo pathogenesis yachilendo systolic hypertension mu hyperthyroidism imachitika chifukwa chakuti mahomoni triiodothyronine amathandizira kutulutsa kwamtima ndi kuthamanga kwa magazi panthawi yamtima.

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Isolated systolic hypertension - ndi chiyani

Matenda oopsa yotchedwa matenda omwe amakweza magazi kwambiri. Chimodzi mwazinthu zake ndizosiyana ndi systolic hypertension, yomwe imadziwika ndi kuwonjezeka kwa kuthamanga komanso kutsika pang'ono. Ngakhale zomalizirazi zitha kupitilira malire.

Pansi kupanikizika kwa systolicamatanthauza kuthamanga kwa magazi panthawi yomwe mtima umakankhira magazi. Chizindikiro chake chimatengera kukana komwe kumachokera makoma amitsempha yamagazi, pafupipafupi komanso mphamvu yamphamvu yamtima.

Kukakamiza kwa diastolic chikuwonetsa kupanikizika kwamitsempha yamagazi panthawi yopumula minofu yamtima. Miyezo yake ndi malire osachepera ndikuwonetsa kulimba kwa kukana kwa zotumphukira.

Isolated systolic matenda oopsa amayambitsa:

kudya mchere wambiri
kusuta
kudya zakudya zamafuta
chibadwire
nyengo
kumangokhala
kupsinjika pafupipafupi
kumwa mowa
kunenepa.

Ngakhale zifukwa zomwe zatchulidwazi zili ponseponse pazaka zilizonse, nthawi zambiri zimayambitsa matenda mwa achinyamata.

Okalamba amadziwika ndi kutayika kwa mtima wamankhwala wokhala ndi zaka., zomwe sizimalola kuti azilabadira zovuta zomwe mitsempha ya munthu wathanzi imachita.

Ndikofunikira kuganizira kuwonjezeka kwa atria pambuyo pazoyenda zaka 50, zomwe zimakhudzanso kuwonjezeka kwa kupanikizika kwa systolic.

Dziwani za ana ndi akulu

Mutha kudzipatsanso nokha. Kuti muchite izi, ndikokwanira kukhala ndi zida zoyesera kuthamanga kwa magazi pafupi.

Mutha kugula tanometer ku pharmacy iliyonse. Muyeso wathunthu wazizindikiro umaganiziridwa 120/80.

Komabe, mwa anthu osiyanasiyana, zizindikirozi zimasiyana. Chifukwa chake, ndikofunikira kugwiritsa ntchito tantometer pokhapokha ngati mukumva bwino, komanso munthawi yofananira kuti mudziwe kupanikizika kwakokwanira m'thupi lanu.

Ndikofunika kuti musamadye chakudya, osachita masewera olimbitsa thupi, osamwa mowa ndi fodya musanayezedwe, apo ayi zonse zomwe zili pamwambazi zingakhudze zomwe zikuwonetsa ndikuzisintha.

Zotsatira zake, mudzalandira zambiri zabodza. Ngati zizindikirozo ndizosiyana kwambiri ndi momwe zimakhalira, muyenera kufunsa katswiri ndipo adzathandizanso kudziwa ngati ali ndi matenda. Popeza kuti ndi zaka, chiopsezo cha kuphatikiza matenda osokoneza bongo chikukula mwadongosolo, muyenera kulankhulana ndi dokotala kuti mupewe kupewa.

Mu chipatala, ngati matenda akuwakayikira lemberani electrocardiography (ECG).

Chithandizo cha okalamba

Chithandizo cha matenda enaake okalamba okalamba sayenera kukhala aukali. Chithandizo cha mankhwala osokoneza bongo chimatha kubweretsa zovuta m'matumbo a mtima, motero amayesa kugwiritsa ntchito mankhwalawo mwapadera.

Koma ngati mankhwala akupangidwabe, ndikofunikira kwambiri kudziwa mulingo woyenera. Ndi kuwonjezeka pang'ono kwa kupanikizika kwa systolic, akulangizidwa kuti musinthe moyo, kutsatira zakudya zochizira, kusiya zizolowezi zoipa, ndikuchita masewera olimbitsa thupi mopepuka.

Zotsatira zake, simungangokulitsa magazi, komanso kumanganso thupi lonse.

Isolated systolic hypertension mu achinyamata - Zizindikiro

Mwa anthu achinyamata, matenda oopsa a systolic amadziwika ndi mutu, kusakhutira kwina konse kwa thupi, komanso kutopa kwambiri.

Ndikosavuta kuzindikira matenda oopsa, popeza odwala ambiri amakhulupirira kuti mavuto omwe amakumana ndi okalamba ndi ambiri. Ndipo zizindikilo zake ndizotsatira zoyipa zokha m'moyo.

Njira Zochizira Achichepere

Njira yamankhwala imatengera gawo la matendawa komanso kutha kwa zizindikiro zake. Mitundu yofatsa, zakudya zimayikidwa, amalangizidwa kuti azitsatira malamulo a moyo wathanzi ndipo ndikulimbikitsidwa kuti nthawi ndi nthawi mukaonane ndi dokotala kuti muwone momwe matendawa amayendera. M'mitundu yoopsa, njira ya mankhwala imayikidwa.

Kuchiza ndi wowerengeka azitsamba

Chithandizo cha kupatula matenda oopsa ndi wowerengeka azitsamba amangochitika ndi mitundu yake yofatsa.

Zina mwazomwe zimapezeka kwambiri ndi uchi, adyo, chokeberry, mbewu za mpendadzuwa, ndimu, mkaka, masamba a birch ndi bearberry. Decoctions amapangidwa kuchokera kwa iwo ndipo ma tinctures amapangidwa.

Ndikofunika kulabadira kusintha pang'ono komwe kumachitika m'thupi chifukwa chomangodzipangira nokha. Ngati alipo, funsani katswiri.

Chimodzi mwazomwe zimagwira bwino kwambiri mankhwala decoction wa grated mabulosi a muzu: supuni imodzi ya chinthu imathiridwa mu malita 0,5. madzi, wiritsani, tsimikizirani tsiku, zosefera ndi kumwa m'malo mwa madzi.

Mankhwala osokoneza bongo ogwirizana a systolic

Mwakufuna kwa katswiri, zoletsa zoletsa za ACE zitha kutumikiridwa poyamba.

Zodyetsa monga Arifon ndi Hypothiazide.

Omwe akutsutsana ndi calcium omwe mavuto ake amawonedwa ngati othandiza kwambiri Nicardipine, Lomir, Verapamil ndi Felodipine.

M'tsogolomu, kuwonjezera kukhathamika kwa mitsempha, mankhwala osokoneza bongo amalembedwa.

Ndi omwe mankhwalawa adzapangidwira ndipo pazomwe kuphatikiza kumangotengera chisankho cha katswiri. Ndipo iye, adzafotokozera njira zamankhwala molingana ndi msinkhu wa wodwalayo, gawo la matendawo, tsankho la munthu payekha ndi zinthu zina.

Isolated systolic hypertension: chithandizo kwa achinyamata ndi achikulire

Momwe kuchuluka kwa systolic kukwera (kuchuluka kwa 140 mmHg), komanso kuthamanga kwa diastolic ndikwabwinobwino kapena pang'ono pang'onopang'ono (osakwana 90 mmHg), kupezeka kwa mankhwalawa "ndikokha systolic hypertension". Nthawi zambiri pamakhala kuchuluka kwamtima.

Kuti muchepetse chizindikiritso cha systolic ndikuletsa kukula kwa zotsatira, mankhwala a magulu osiyanasiyana amalembedwa (sartan, beta-blockers, etc.), komanso zakudya zapadera komanso masewera olimbitsa thupi. Ndi chithandizo chanthawi yake, matendawo ndi abwino.

Zomwe zimayambitsa matendawa

Ngati m'mbuyomu tinkakhulupirira kuti matenda oopsa oopsa ndi matenda opezeka mwa anthu achikulire, tsopano amakula pazaka zilizonse. Komabe, chinthu chachikulu chomwe chikuthandizira kuwonjezeka kwa kuthamanga kwa magazi (BP) ndi kusintha kokhudzana ndi zaka.

Mwa okalamba, pali kuchepa kwa zotupa za mtima chifukwa cha kuchuluka kwa kollagen, glycosaminoglycans, elastin ndi calcium pamakoma awo. Zotsatira zake, mitsempha imasiya kuyankha kusintha kwa kuthamanga kwa magazi.

Zaka zimakhudzanso kuwonongeka kwa kugwira ntchito kwa mtima, impso ndi mtsempha wamagazi. Chifukwa chake, mavuto amayamba monga kuchepa kwa chidwi cha adreno- ndi barroreceptors, kuchepa kwa mtima, komanso kuwonongeka m'magazi a magazi ndi impso yamagazi.

Kuyambira kuyambira zaka za 50, kuchuluka kwa atria kumachulukitsa, kufalikira kwa impso, kusefera kwawo kumachepa, ndipo palibe kupangika kwa zinthu zotsalira za endothelium.

Kukula kwa njira yodziyimira ya systolic hypertension (ICD-10 ISAG) imakhudzidwanso ndi kutengera kwa majini.

Matendawa amatuluka m'mitundu iwiri - yoyamba komanso yachiwiri. Fomu yoyamba imadziwika ndi ma pathologies omwe amathandizira kuwoneka kuti oopsa. Fomu yachiwiri ya ISAG imawonetsedwa ndi kuwonjezeka kwa voliyumu ya mtima. Kuphatikiza apo, kufalikira kwa valavu, kuchepa kwa magazi, chipika cha atrioventricular, etc. akhoza kujowina.

Kuphatikiza pa kusintha kokhudzana ndi zaka komanso chinthu chamtundu, zomwe zimayambitsa ISAH zimaphatikizapo:

Kupsinjika komwe kumakhalapo nthawi zambiri kumapangitsa chidwi cha zinthu zosiyanasiyana kukhala mwa anthu.
Moyo wotsika ntchito m'munsi momwe zombo sizilandira katundu wofunikira, potero zimataya nthawi yayitali.
Chakudya chopanda malire: kugwiritsa ntchito mchere, mafuta kapena mafuta osukidwa kumayipa dongosolo la mtima.
Kukhalapo kwa matenda ena omwe amakhudza mkhalidwe wamitsempha, mwachitsanzo, matenda a shuga, kusokonezeka kwa impso, ndi zina zambiri.
Zovuta za chilengedwe komanso kusuta fodya, zomwe zimayipa kwambiri m'magazi.
Kuperewera kwa mchere m'thupi monga magnesium, komwe kumalepheretsa thrombosis, ndi potaziyamu, komwe kumachotsa mchere wambiri ndikupanga zoperewera.

Zomwe zimayambitsa matendawa zimatha kunenepa kwambiri, pomwe ziwiya zimayamba kugwira ntchito mwamphamvu, zimatopa msanga.

Chithandizo cha okhazokha systolic matenda okalamba

Kuti nthawi zonse mukhale ndi vuto la 120 ndi 80, onjezerani madontho angapo kumadzi.

Isolated systolic hypertension ndi njira yamatenda a mtima momwe chapamwamba, kupanikizika kwa systolic kumachulukitsidwa modabwitsa, ndipo m'munsi kumakhalabe kwachibadwa. Nthawi zambiri, odwala matenda oopsa amawona mitengo ya 160/90 mm Hg pa tonometer. Gulu lamavuto limaphatikizapo anthu okalamba: mwayi wazopeza matendawa wayandikira 30%. Kuperewera kwakanthawi kochepa kwamankhwala kungayambitse mtima wam'mimba, infarction yam'mimba, sitiroko, mtima. Kuti mupewe izi, muyenera kudziwa momwe mungathanirane ndi matenda ena opatsirana okalamba omwe ali okalamba?

Gulu la matenda

World Health Organisation yathetsa ISAG ngati njira yodziyimira payokha. Tsopano matendawa amatengedwa ngati mtundu wa matenda oopsa. Kutengera ndi kukula kwa kupanikizika kwa systolic, madigiri otsatirawa a matendawa amasiyanitsidwa:

ngati zizindikiro za SBP zili pamtunda kuchokera pa 140 mpaka 159 mm Hg, wodwalayo amakonza 1 degree ya matenda,
ngati zizindikiro za systolic zili pagulu kuyambira 160 mpaka 179 mmHg, 2nd degree of hypertension yodziwika bwino yapezeka,
ngati kupanikizika kwa systolic kufikira 180 mmHg ngakhale kuposa pamlingo wachitatu matenda.

Madokotala amasiyanitsa mtundu wina wa matenda - mzere wamalire. Imadziwika ndi ma systolic anzawo amtundu wa 140 mpaka 149 mmHg, pomwe kukakamiza kwa diastolic kumatsikira mpaka 90 mmHg. ndi pansipa. Kukhazikitsidwa kuti pakalibe kulowererapo kwa mankhwala pakapita nthawi, matenda oopsa a m'malire amtundu amatha kukhala vuto, ndikusintha kukhala magazi oopsa.

Kafukufuku ambiri akuwonetsa kuti chachikulu chomwe chimayambitsa matendawa ndi kusinthika kwakanthawi kamisempha. Kutanuka kwa mitsempha yamagazi, makamaka, ma capillaries, amachepetsa pazaka, izi zimaphatikizapo kuchepa kwa magazi othamanga. Kuphatikiza apo, mandimu ofunikira amasintha chifukwa cha ma cholesterol, omwe amalepheretsanso kuyenda kwa magazi. Kukula kwa matendawa kumakhudzidwa ndi kukwera kwamphamvu kwa magazi. Amadziwika kuti anthu onenepa kwambiri amadwala mwachangu.

Mu achinyamata, systolic matenda oopsa amakhala, nthawi zambiri, chifukwa cha kuperewera kwa zakudya m'thupi. Ngati chakudyacho chili ndi zakudya zomwe zimakhala ndi mafuta ambiri, izi zimapangitsa kuti pang'onopang'ono kuchepetsedwa kwa ziwiya ndi matenda. Zizolowezi zoipa (mowa ndi kusuta) zimakulitsanso chiopsezo cha matenda. Kukhalapo kwa zinthu zotere kumatha kukhudza chitukuko cha matenda:

matenda a mtima
osakwanira aortic vala ntchito
matenda ashuga
njira zina zamagetsi zamagetsi (mwachitsanzo, atherosulinosis),
hyperthyroidism
kuwonongeka kwa zolandilira kwaortort zone ndi nthambi zake,
ischemia ya gawo laubongo lomwe limayang'anira kuthamanga kwa magazi,
matenda a impso, zilonda zam'mimbazo,
Zotsatira za stroko,
kuchuluka kwa mantha
otsika a potaziyamu ndi magnesium m'thupi lamadzi, calcium yambiri ndi sodium.

Nthawi zambiri, kuyambika kwa matendawa mwa azimayi omwe adalowa nthawi ya kusamba kumadziwika. Pakadali pano, kukana kwa thupi kumachepa chifukwa cha kuchepa kwa kapangidwe ka mahomoni enaake.

Zizindikiro

Isolated systolic hypertension sangamveke ndi odwala. General malaise sabweretsa nkhawa ngakhale ndi kuthamanga kwa magazi, ndichifukwa chake nthawi yoyambira matendawa imasowa. Zizindikiro zazikulu za matendawa ndizopitilira mutu m'malo a temporital kapena occipital, kupweteka kwa mtima. Kuphatikiza apo, ISAG ikuwonetsedwa:

kuwonongeka kowoneka, mawonekedwe a malo ndi mawanga m'munda wowonera,
kugona kwambiri
tinnitus
dyskinesia m'mimba, mseru,
chizungulire ndi kukomoka,
kusokoneza masitayidwe a malo.

Mwa odwala okalamba, kupezeka kwa matendawa kumatha kuwonetsedwa ndi kupanikizika usiku kapena m'mawa. Matenda oopsa kwambiri ndi chizindikiro cha kupita patsogolo kwa matenda.

Njira zoyesera

Ndi dokotala yekha yemwe ali woyenera kuti azindikire bwinobwino. Musanabwere ku phwando, muyenera kuwunika kusintha kwa kuthamanga kwa magazi. Kuti muchite izi, mkati mwa masiku 1-2, panthawi yofanana, kuyeza ndikuwongolera kuthinikizidwa m'manja onse. Kuwerengera kwa tonometer m'mawa ndi usiku kuyenera kuthandizidwa mwachidwi. Katswiri wachigawo azitsogolera anamnesis, kudziwa kukhalapo kwa phokoso mumtima.

Ali mwana

Chiwopsezo chotenga matendawa muubwana ndichokwera. Mukazindikira, zizindikiritso za thupi zimatsimikiziridwa, chifukwa zimakhudza kuchuluka kwa magazi omwe amatulutsidwa kulowa m'magazi. Dokotala amayenera kudziwa kukula, kulemera, kuchuluka kwa thupi. Izi zikuthandizira kumvetsetsa momwe amachepetsera zotumphukira zamitsempha, ngakhale zimayambitsa kuchuluka kwa systolic.

Pamene mbiri iyenera kuganizira za kukhalapo kwa kulimbitsa thupi kwambiri, zimakhudzanso chitukuko cha IHC. Kuti mumalize, muyenera kuchita ECG, kuyesa kwa mtima, kuyezetsa magazi ndi mkodzo, kuphunzira shuga.

Mwa anthu achikulire

Kuti mupeze chithandizo choyenera kwa wodwala wokalamba, dokotala angafunike zotsatira za maphunziro awa:

pozindikira kusokonezeka kwa mtima - ma electrocardiograms,
kudziwa momwe magwiridwe antchito ndi makoma amtima - echocardiography,
pozindikira kuchuluka kwa mitsempha yamagazi m'mitsempha mu ubongo - transcranial dopplerography,
kuyezetsa magazi konse
kusanthula kwamkodzo ka matenda a kwamikodzo,
biochemical zikuchokera magazi.

Kuzindikira kwa matenda okhazikika a systolic okalamba kumafuna njira yolumikizidwa ndikuwonetsetsa kwa nthawi yayitali.

Momwe tiyenera kuchitira

Kuti muthane ndi matenda oopsa a systolic, muyenera kuyamba mwachangu kuti muchepetse chiopsezo cha kusokonezeka kwa metabolic. Izi zikuthandizira kuchepa kwa magwiridwe antchito a ziwalo zomwe mukufuna, kuchepetsa mikwingwirima, vuto la mtima, kufa chifukwa cha zovuta zamtima komanso kuperewera kwa mtima.

Kusankhidwa kwa mankhwala kumaganizira za umunthu wake. Mlingo woyambirira wa mankhwalawa uyenera kukhala wocheperako pang'onopang'ono kuchepa kwa systolic, kuti pasamawononge thanzi la wodwalayo ndikusakwanira kwa ntchito ya impso ndi mantha amkati. Kuwunika momwe ziwalo zimagwirira ntchito kuyenera kukhala kosadukiza, sikungoyesa kuchuluka kwa kuthamanga kwa magazi m'malo osiyanasiyana (kunama ndikukhala), komanso kuyezetsa magazi ndi mkodzo pafupipafupi.

Popanda iwo, chithandizo chazokha cha systolic matenda oopsa sichingatheke. Ngakhale kutsutsana pakati pa madokotala sikungokhala chete pakuchita bwino kwawo, ma diuretics ndiye chinthu chachikulu chothandizira kuchiritsa magazi. Mankhwalawa okwera mtengo amaloledwa bwino ndi odwala okalamba, amakhala ndi mphamvu zochepa zama kagayidwe ndipo amatha kuchepetsa bwino SBP. Chiwopsezo cha kukhala ndi vuto la mtima mukamatulutsa diuretics imachepetsedwa ndi 2 times. Diuretics - mankhwala ofunika kwambiri pochiza matendawa. GIH ikaperekedwa:

Beta blockers

Mankhwalawa amalepheretsa kugwira ntchito kwa beta-adrenergic receptors, pambuyo pake, kukana kwamitsempha yamagazi kumawonjezeka, mphamvu ndi mphamvu yama contractions amtima imachepa, ndipo kamvekedwe ka mitsempha yaying'ono imakulanso. Mankhwala amakhudza mkhalidwe wa zolandilira mu aorta ndi nthambi zake, zomwe zimayendetsa kukakamiza. Mankhwala amalimbikitsa malo opangira ubongo omwe amayambitsa minyewa ya vasomotor ya minofu yosalala ya ziwiya.

Beta-adrenergic blockers othandizira atsimikiziridwa kuti abwezeretsanso odwala pambuyo poyambira myocardial infarction. Mankhwala osokoneza bongo a gulu ili ndi omwe amaperekedwa (ngati palibe matenda a shuga, mphumu, bronchitis) kwa odwala azaka zonse. Itha kukhala:

Otsutsa a calcium

Mankhwala amadziwika ndi zochita za vasoprotective komanso kupezeka kwa mndandanda wazotsatira zoyipa. Zimalepheretsa kukula kwa lamanzere lamitsempha, kuchepetsa mtima, motero zimakhudza kufalitsa kwa ziwalo, komwe ndikofunikira pakukonza kwa okalamba. Mankhwalawa amachepetsa kukhudzika kwa magazi, kuchepetsa calcium, momwemo, komanso kupewa kaphatikizidwe ka magazi ndi ziwalo zamagazi. Izi zikuphatikiza:

Nifedipine, analogue Adalat,
Verapamil
Isradipine.

ACE zoletsa

Mankhwala a gululi amabweza chikhodzodzo cha mtima, kuletsa kuchulukitsa kwa maselo, kusintha magazi ndi impso, komanso magazi akuyenda mkati mwa mantha. ACE inhibitors amalepheretsa kuwonongeka kwa vasodilators, omwe amachititsa vasodilation. Kuti mupeze zotsatira zowonjezera zamagazi mu okalamba odwala, mosamala:

Kupewa

Muyeso woyamba wa mankhwalawa a ISH ndi malamulo azakudya. Kuchokera muzakudya muyenera kuchotsa zinthu zonse zomwe zimakhala ndi mafuta a nyama, zotsekemera, mchere komanso zosuta. Izi zikuthandizira polimbana ndi kunenepa kwambiri, komwe nthawi zambiri kumayendera limodzi ndi matendawa. Kusuta kumawononga thanzi la ISH. Ndikofunikira kupatula zakumwa zoledzeretsa, khofi wamphamvu ndi tiyi. Shuga uyenera kulowedwa ndi uchi wambiri.

Kuphika kuyenera kukhala ndi kuchepa kochepa kwa zopatsa thanzi chifukwa cha izi, chifukwa ngati nkotheka, masamba ndi zipatso sayenera kuphika. Zipatso zatsopano, zopatsa mphamvu zamafuta a mkaka ochepa, nyama zopanda mafuta ziyenera kukondedwa. Mafuta amatha kukhala nsomba zokha, mumakhala mafuta omega-3 mafuta acids.

Matenda amtunduwo amathandizira kuti pakhale mpweya wabwino komanso kuchita masewera olimbitsa thupi. Zonsezi kuphatikiza kugona tulo kwa nthawi yayitali kumakonzanso michere ya m'thupi ndikuchotsa poizoni m'thupi. Zizindikiro za kupanikizika zimayendetsedwa ndi kukhalapo kwa zochitika zopsinjika; kuchepetsa kuthamanga kwa magazi, kuchuluka kwa mantha ndi kuchuluka kwa magazi kuyenera kupewa. Mankhwala achikhalidwe amakhalanso ndi ndalama zokwanira zomwe zimachepetsa kuthamanga kwa magazi.

Pakakhala mankhwala osokoneza panthawi yake, pamakhala chiopsezo chowonjezeka cha zovuta zamagulu ogwira ntchito komanso kukula kwa zovuta m'matumbo a mtima. Amatha kubweretsa stroke, kugunda kwa mtima, matenda oopsa, omwe, amachititsa kulumala ngakhale kufa.

Nthawi yomweyo, chithandizo chimathandizira kukhalabe ndi thupi lokwanira ndimaganizo, chimathandizira kukhazikika kwakakhalidwe.

Kodi ISH imathandizidwa bwanji okalamba?

Dongosolo lakale lamankhwala lothandizira likufuna kutsata magawo awiri a systolic magazi (SBP). Akatswiri a mtima amalimbikitsa kuchitira chithandizo mu magawo awiri omwe ali ndi mitundu yambiri ya mankhwala: thiazides, diuretics, calcium antagonists, ACE inhibitors. Pa chithandizo, ndikofunikira kuyang'anitsitsa kuthamanga kwa magazi.

Okalamba ndi omwe amamwa mankhwala ochepetsetsa kwambiri pamayambiriro a mankhwala. Ngati wodwalayo sakuyenda bwino, ndiye kuti muyezo wake umachuluka kutengera mphamvu ya systolic. Ngati mankhwalawa sagwira ntchito (pomwe SBP sinasinthe mtengo wake), ndikofunikira kubwereza njira yothandizira.

Chithandizo cha matenda oopsa okalamba mwa okalamba ali ndi ntchito zotsatirazi:

Kutsitsa kuthamanga kwa magazi kuzisonyezo zathanzi kwambiri,
Kupewa matenda a mtima
Kuchepetsa kuopsa kwa stroko, mtima,
Kuchepetsa chiopsezo cha kufa, chomwe chimayambitsa kugonjetsedwa kwa ziwalo zamkati motsutsana ndi kuthamanga kwa magazi.

Ngakhale zaka 10 zapitazo, akatswiri a mtima samawona kuti ndizoyenera kuchitira ISH mwa okalamba. Cholinga chake ndikuti odwala amapanga njira yowuma yamitsempha yamagazi ndi mitsempha chifukwa cha kusintha kwokhudzana ndi zaka. Ndikovuta komanso koopsa kuchiza matenda oopsa pakukalamba, popeza pamakhala chiopsezo chambiri chotsatira chotsatira mukamamwa mankhwala.

Chithandizo cha odwala omwe ali ndi mankhwala amakono a antihypertensive amatha kuchepetsa kuchuluka kwa stroko, zovuta zamtima, komanso kuchepetsa kufedwa kwa odwala.

Odwala omwe ali ndi ISH wazaka 60 ndi kupitilira ayenera kulandira mankhwala omwe ali ndi vuto latsopanolo. Chifukwa chake, moyo wamankhwala ochita bwino kwambiri, patsogolo.

Mfundo za mankhwala a ISH

Ntchito yoyamba yakukhudzana ndi mtima ndi kuchepetsa kuthamanga kwa magazi ndi 30%. Sizikulimbikitsidwa mwapadera kuti muchepetse kuthamanga kwa magazi ndi mayunitsi 40 kapena kupitirira, popeza wodwalayo wasokoneza magazi, matenda a impso, komanso kulephera kwa ubongo.

Mfundo zina zochizira matenda oopsa okalamba mwa okalamba ndi:

Muyeso wopanikizika mutagona, kuyimirira. Chifukwa chake, ndikotheka kupewa hypotension ya orthostatic - kutsika kwakukali kwa mavuto,
Ndikofunikira kuyamba kumwa mankhwala a antihypertensive ndi mlingo wotsika kwambiri. Kuchulukitsa mlingo wa mankhwalawa kungapangitse kuwonongeka kwakukuru m'moyo wabwino,
Malangizo a mankhwalawa akhale osavuta,
Ndikulimbikitsidwa kuphatikiza mankhwala othandizira osokoneza bongo ndi zovuta zazing'ono zolimbitsa thupi, njira zolimbitsa thupi. Mothandizidwa ndi adotolo, mankhwala achikhalidwe amaloledwa,
Mankhwala amasankhidwa malinga ndi chiwembu, malinga ndi mbiri ya wodwalayo, kupezeka kwa matenda ena osachiritsika.

Ngati dokotala wa mtima apanga mtundu wa chithandizo kwa wodwala, ndikofunikira kuganizira zaka za wodwalayo komanso momwe amasokonekera okodzetsa okalamba mwa okalamba. Chifukwa chiyani?

Kafukufuku waposachedwa wokhudzana ndi chithandizo cha ISH mwa okalamba akuwonetsa kuti kuwongolera kwawo chifukwa cha kugwiritsa ntchito mankhwala a antihypertensive kumakhala kotsika kuposa kwa achinyamata, azaka zapakati.Cholinga chake ndikuti mu okalamba, kuchuluka kwa renin kupanga mu plasma kumachepetsedwa kapena kulemala. Koma, ngati muchita ndi adrenergic receptors ndi calcium blockers, ndiye kuti kuthandizira kudzakhala kwakukulu.

Mwa okalamba, kulumpha mu kuthamanga kwa magazi kumasinthasintha, komwe kumakhala kovuta kuwaletsa ndi antihypertensive mankhwala. Komanso, pali kuphwanya magwiridwe antchito a reflexes osakanikirana ndi hypotension.

Kuchepa kwa kuthamanga kwa magazi mwa okalamba

Wodwala yemwe ali ndi ISH ayenera kudziwa zomwe akukumana nazo ndikuwonetsa kuti ndi zofunika kuzichepetsa. Pali National Committee yomwe imawunika, kuzindikira, ndikuwalangiza za chithandizo cha matenda oopsa. Malinga ndi iwo, matalikidwe oyenera ochepetsa kuthamanga kwa magazi siopitilira magawo 20, malinga ngati chidziwitso choyambirira cha systolic chinali pafupifupi 160-180 mm Hg. Mwachitsanzo, magazi a systolic adapezeka kuti adapezeka wodwala wazaka zapamwamba ngati 180 mmHg, ndipo motero, ndikofunikira kuti achepetse mpaka 160 (poyambira chithandizo).

Zofunika! Chithandizo cha matenda oopsa okalamba mu okalamba chimakhala ndi kuchepa kwa kuthamanga kwa magazi ndi 10% (pazipita 15%) kuchokera ku mtengo woyambira. Kutsika kwa kuthamanga kwa magazi mpaka 30% panthawi yamankhwala kumawerengedwa kuti ndi koopsa komanso ngakhale kuwopseza thanzi la munthu ndi moyo.

Pali dongosolo la odwala omwe ali ndi ISH: ngati munthu alibe matenda ogwirizana ndi matenda a mtima (CHD), ndiye kuti amachepetsa kuthamanga kwa magazi, kutalikirana kwa nthawi yayitali kwa wodwalayo. Koma, ngati wodwala wapezeka ndi matenda am'mitsempha yamagazi, ndiye kuti kuchepa kwambiri kwa zovuta zaumoyo kumatha kufalitsa kufooka kwa magazi.

Kuchepa kocheperako kwa myocardial infarction kumakhalapo pokhapokha ngati kupanikizika kwa diastolic kusungidwa pa 90 mm Hg.

Kutsika kwakukulu kwa kuthamanga kwa odwala omwe ali ndi ISH kumabweretsa:

Matenda a mitsempha
Ngozi zapamsewu,
Kulephera kwa mtima
Zotsatira za Lethal.

Kuchepa kwa kuthamanga kwa magazi kwa odwala omwe ali ndi zaka zopitilira 60 ayenera kuchitika pakatha miyezi yochepa. Kutalikirana kotereku kumawonedwa ngati koyenera. Chithandizo chikuyenera kuchitika ndi mankhwala angapo: okodzetsa, olimbana ndi calcium, angiotensin inhibitors.

Chithandizo cha diuretic

Ma diuretics amalembedwa kwa odwala oopsa omwe ali ndi ISH chifukwa cha kuthamanga kwambiri, zotsatira zochepa zoyipa, komanso kusinthasintha kwa okalamba. Mlingo woyambirira wa diuretic wa hydrochlorothiazide diuretic wamba uyenera kukhala 12,5 ml. Kugwiritsa ntchito kumawonetsedwa kamodzi patsiku. Ngati wodwala salola kulandira mankhwalawo, ndiye kuti mlingowo uyenera kuchepetsedwa kapena dongosolo liyenera kuchepetsedwa masiku ochepa pa sabata.

Malinga ndi ziwerengero zapadziko lonse lapansi pochiza matenda oopsa, okodzetsa amakhala pamalo otsogolera othandizira achire. Mankhwala osokoneza bongo ali ndi phindu pa kagwiridwe ka ntchito zamtima, komanso pakuchepetsa kuopsa kwaimfa. Ma diuretics amachepetsa mwayi wokhala ndi stroko, kugunda kwa mtima, matenda a mtima.

Odwala oopsa amathiridwa mankhwala: hydrochlorothiazide, indapamide. Mitundu ina ya mankhwalawa masiku ano imawoneka kuti yatha chifukwa cha zomwe zimachitika pakhungu ndi zotsatira zake zoyipa.

Ma diuretics amakhudzana ndimitsempha yamagazi, kukulitsa katulutsidwe ka maselo am'magazi ndi ma prostaglandins. Indapamide imawonetsedwa kwa odwala omwe ali ndi vuto loleza shuga, popeza mitundu ina ya okodzetsa imayambitsa kulephera uku.

Njira yabwino yothandizira ISH yokhala ndi okodzetsa: otsika mlingo wa chlortalidone (osapitirira 12,5 mg / tsiku) wophatikizana ndi atenolol. Zotsatira za chithandizo chotere, wodwalayo amachepetsa kukwiya, kugunda kwa mtima, matenda amitsempha, zotupa zam'minyewa.

Chithandizo cha calcium calcium Antagonist

Calcium antagonists (AKs) amapatsidwa odwala kuti azichiza matenda oopsa a systolic. Mankhwalawa ndi antihypertensive, osakhudzanso zomwe zikuwonetsa kupanikizika kwa diastolic, popanda mavuto. AK sasintha magawo amwazi amwazi, osasokoneza kutuluka kwa magazi mu impso, osasintha minofu yamitsempha yamanzere.

Oyimira amakono a AK ndi mankhwala a nifedipine. Mankhwalawa samayambitsa tachycardia, kupweteka mutu, nseru, mosiyana ndi mankhwala omwewo. Zotumphukira za nifedipine - dihydropyridine. Kusiyana kwakukulu pakati pa mankhwalawa ndi ma AK ena ndikutulutsa pang'onopang'ono mitundu yamagulu, kuphatikiza kwawo minofu, chifukwa chake, wodwalayo angafunike Mlingo wochepa wa mankhwalawa. Odwala ochita kupanikizika ndi mankhwala amapatsidwa mankhwala othana ndi calcium monga Adalat SL kapena Procardia XL.

Ma calcium antagonists ndi oyenera njira zamankhwala odwala okalamba omwe ali ndi vuto la concomitant: matenda a shuga, kulephera kwa mtima, mtima mphumu, matenda a mtima, matenda amitsempha yamagazi. Monga monotherapy yoyambirira, amlodipine amadziwitsidwa muyezo wa 5 mg. Mankhwala a mzere woyamba wa AK ndi: isradipine (kipimo 2,5 mg), verapamil (mlingo wa 240 mg), nifedipine (mlingo 30 mg).

Chithandizo ndi b-blockers, ACF zoletsa

B-blockers amagwiritsidwa ntchito ngati mankhwala othandizira antihypertensive monga momwe amathandizira azaka zonse. Zotsatira zamankhwala zimachitika chifukwa cha kuchepa kwa myocardial ejection, blockade of adrenergic receptors, kuchepa kwa kupanga norepinephrine, kuchepa kwa magazi a venous kupita ku myocardium. Musanagawire odwala a zaka zopitilira 60, ndikofunikira kuwunika momwe impso ndi chiwindi zilili. Njira zochizira matenda oopsa a ISH zimaphatikizapo mankhwala omwe amachokera mndandanda: proranolol, atenolol, metoprolol, betaxolol osachepera 5 mg.

Ma ACF zoletsa akuwonetsedwa chifukwa cha kuchepa kwa ntchito ya renin. Mphamvu ya antihypertensive imachitika ndikumakanikiza kupanga kwa ACF, angiotensin, aldosterone komanso kuwonjezeka kwa munthawi yomweyo potaziyamu yam'madzi. Pankhaniyi, wodwalayo sasokoneza kayendedwe ka magazi ka ziwalo zofunika: ubongo, impso, ndi ziwalo za myocar. Ma ACF inhibitors amapatsidwa mankhwala osokoneza bongo omwe amakhala ndi matenda osokoneza bongo a ubongo. Isolated systolic hypertension mwa okalamba amathandizidwa malinga ndi chiwembu: Captopril (mlingo 25 mg), enalapril (5 mg), ramipril (mlingo 5 mg), fosinopril (10 mg).

Pomaliza, ndikofunikira kukumbukiranso kuti GIH mwa okalamba imathandizidwa malinga ndi chiwembu chophweka kwambiri. Chithandizo cha mankhwalawa chimayamba ndi mlingo wotsika kwambiri wa mankhwala. Pangakhale mavuto, mankhwalawa akhoza kuchuluka. Sitikulimbikitsidwa kuti muchepetse kuthamanga kwa wodwala ndioposa 10-15% ya zoyambirira zoyambira. Kutsika kwa kuthamanga kwa magazi ndi 30% ndikofunikira kwa okalamba omwe ali ndi matenda a ISH.

Kodi systolic matenda oopsa ndi chiani?

Mwa okhazikika a systolic hypertension (matenda oopsa), kapena ISH (ISAG), timamvetsetsa mawonekedwe a matenda oopsa, omwe amachititsa kuti chiwopsezo cha systolic (chapamwamba) choposa 140 mm Hg. Art., Pomwe diastolic imapanikizika ili mkati mwa 90 mm RT. Art. ndipo kupitilira sikukwera. Mwa odwala ena, kuthamangitsidwa kwa diastolic kumachepetsedwa pang'ono.

Malinga ndi ziwerengero, pafupifupi 1/3 ya anthu omwe ali ndi matenda oopsa amakhala ndi matendawa. Mwa anthu okalamba, ISH imapezeka mu 25% ya milandu. Mwa achichepere, matenda azachipatala ndi ochepa, mwa pafupifupi 3% ya anthu ochepera zaka 40. Hypertension yamtunduwu ndiowopsa poyerekeza ndi zotsatira zakupha kuchokera ku mtima ndi mtima - zovuta zamatenda, sitiroko, kuphwanya myocardial. Chifukwa chake, chiopsezo cha matenda a stroko chikuwonjezeka ndi 2,5, chiwopsezo cha kufa kwamtima - ndi katatu - kasanu.

Madigirii otsatira a matendawa ndi osiyana:

Borderline ndi kukakamiza kwa 140 - 149 mm RT. Art.
Choyamba ndi kukakamiza kwa 140 - 159 mm RT. Art.
Chachiwiri ndi kukakamiza kwa 160 - 179 mm RT. Art.
Chachitatu ndi kupanikizika kwa zoposa 180 mm RT. Art.

Kupsinjika kwapansi kwa diastoli sikukwera pamwamba pa 90 mm Hg. Art.

Zimayambitsa matenda a Systolic Hypertension

Kuwonjezeka kwa kuthamanga kwa magazi sikuzindikirika ngati zotsatira zachilengedwe, komabe kuvala kwamankhwala ndichinthu chofunikira kwambiri pakulimbikitsa matenda oopsa. Mwa anthu okalamba, matenda a zam'magazi amadziwika kuti amakula nthawi zambiri. Ndi m'badwo, kutanuka kwa makoma amitsempha kumachepa, zolembera za atheroscrotic ndi calcium zimayikidwa pa iwo. Izi zimapangitsa kuwonongeka poyankha ziwiya kukakamiza kusintha kwa systole.

Njira zina mthupi zomwe zimayambitsa kuwoneka kwa ISH ndi zaka ndi izi:

kutsika kwa impso, minofu ndi magazi a m'matumbo chifukwa chakuchepa kwa zotuluka mu mtima,
kutsika kwa kuchuluka kwa kusefera,
kuchepa kumverera kwa ma receptor enieni mumitsempha ndi mtima.

Ngati palibe zifukwa zomveka zowonjezera kuchuluka kwa ma systolic apezeka, matenda oopsa amadziwika kuti ndiwo oyamba. M'mbuyomu, matenda am'mimba angayambike mwa kusuta anthu, osokoneza bongo, kumwa mafuta ambiri, amchere komanso zakudya zina zoyipa. Nthawi yapakati, mayi wachichepere amatha kukhala ndi zizindikiro za ISH, ndikusowa yekha atabereka.

Hypertension yachiwiri imayamba chifukwa cha kuchuluka kwa matenda ndi mikhalidwe, yayikulu:

matenda ashuga
mitsempha ya mitsempha,
kulephera kwamtima,
sitiroko
kutalika kwa valavu
hyperthyroidism
kuchepa magazi kwambiri
kutentha kwanthawi yayitali
AV chitima cha mtima,
kupunduka kwa mtima
msempha
zotupa za adrenal tiziwongo, impso,
Itsenko-Cushing's syndrome,
aakulu aimpso kulephera
kuchuluka kwa calcium, sodium m'magazi,
kupsinjika.

Pali ISAH yachipatala - matenda omwe mulingo wamba wabwinobwino amakwera chifukwa chogwiritsa ntchito mankhwala ena (makamaka mahomoni a steroid, zoletsa kulera).

Zizindikiro za matendawa

Nthawi zambiri, mawonetseredwe ofunikira kwambiri a systolic hypertension samatengera zaka, ngakhale mwa achinyamata sadzipangitsa kuti azimva kutalikirana kwambiri.

Odwala omwe ali ndi matenda oopsa amatha kudandaula za kupweteka kwa mtima, makamaka kosakhazikika, kupweteka, kawirikawiri - kununkha, kolimba. Mwa zizindikiro zofala, pali kufooka, kuchepa kwa ntchito, komanso kugona. Mphamvu yolekerera zolimbitsa thupi ngakhalenso zochitika zatsiku ndi tsiku zimatsika kwambiri.

Mwa amuna, GIH imatha kupita patsogolo mwachangu, zomwe zimagwirizanitsidwa ndi kuchuluka kwa kusuta, kuperewera kwa chakudya komanso kumwa mowa kwambiri. Mwa akazi, kukula kwa matendawa nthawi zambiri kumachitika mu kusintha kwa thupi, pomwe chitetezo chachilengedwe chamitsempha chamagazi chimatha ndi mahomoni ogonana.

Akuluakulu amakhala ndi chidziwitso cha matendawa, monga, chiwopsezo chotenga zovuta zazikulu. Izi ndichifukwa cha nthawi ya kukhalapo kwa ISH komanso kuthinikizidwa kwakukulu. Anthu achikulire nthawi zambiri amakhala ndi matenda opatsirana - matenda ashuga, atherosulinosis, gout, kunenepa kwambiri ndi ena. Mwakutero, okalamba nthawi zambiri amakhala opanda matenda oopsa, kapena kupumula matenda oopsa. Kuwonjezeka kwadzidzidzi kwamphamvu pambuyo podzuka kuli kakhalidwe. Zizindikiro zotere zimayenderana ndi harbinger a zovuta zovuta - ischemic ndi hemorrhagic stroke, myocardial infarction.

GHI, monga mitundu ina ya matenda oopsa, imatha kudziwonetsa ngati mavuto oopsa. Kupanikizika kwapamwamba kumakwera kwambiri mpaka 200 mm Hg. Art. ndipo pamwamba, otsikira amakhalabe osasintha. Vutoli limayambitsa kupanikizika kwa ziwiya zaubongo ndipo limatha kutha. Koma nthawi zambiri mavuto osokoneza bongo amatha msanga, kupsinjika kumakhala kwabwinobwino.

Dziwani za ISH

Kuzindikira kumachitika kwa munthu yemwe, akamayendera dokotala katatu pakapita masabata atatu kapena atatu kapena pamayeso akunyumba, mulingo wake ndi 140/90 mm RT. Art. ndi zina zambiri. Ngati pali zizindikiro zosonyeza matenda oopsa, koma sizingatheke kukonza zovuta, kuwunika tsiku ndi tsiku kuyenera kuchitika, kulabadira makamaka zizindikiro usiku, m'mawa.

Kuti mupeze zomwe zimayambitsa matendawa, tsimikizirani / kupatula kupezeka kwa matenda oopsa, mayeso ena ambiri adalembedwa:

ambiri, kuyezetsa magazi pamagazi,
kuwerenga kwa zigawo za impso,
mbiri ya lipid
ECG ndi ultrasound yamtima, ziwiya zama mtima,
Ultrasound a impso ndi adrenal glands,
kusanthula kwa mahomoni a chithokomiro, etc.

ISAG ali mwana

Ndikofunikira kwambiri kuzindikira nthawi yochepa kwa achinyamata, chifukwa chiopsezo chokhala ndi matenda a mtima chikuchulukirachulukira, monganso ngozi yakufa ndi matenda opha ziwalo (poyerekeza ndi anthu amibadwo yofananira). Achinyamata amasuta pafupipafupi, amamwa mowa, amapanikizika, chifukwa chake, kupita patsogolo kwa ISAH ndikotheka.

Matenda oopsa okalamba

Odwala a zaka zapuma pantchito amafunika njira yapadera, chifukwa ali ndi matenda ena ambiri, kupatula kuthamanga kwa magazi. Zotsatira zakuzindikirazi zitha kukhudzidwa ndi mankhwalawa omwe atengedwa, chifukwa chake, ndikofunikira kwambiri kusonkhanitsa anamnesis molondola ndikuganizira zonse zomwe zingachitike pangozi.

Mukamayesa kupsinjika mwa munthu muukalamba, ndikofunikira kupopera mpweya mpaka 250 mm Hg. Art., Kenako iduleni pang'onopang'ono. Njira yoyezera iyenera kuchitika mutakhala ndikuyimirira (kumbuyo komaliza, mphindi imodzi mkono umodzi ndi mphindi 5 mkono wina wachiwiri mutakhala wolunjika). 25% ya okalamba ali ndi chovala choyera chokwanira, ndipo kuchuluka kwake kwa mavuto sikungawonetse chithunzi chenicheni.

Chithandizo cha matenda oopsa

Chithandizo: Thanani ndi matendawa ndikuchepetsa chiopsezo cha stroke, kugunda kwa mtima, matenda oopsa, kufa mwadzidzidzi kwamtima. Kuti muchite izi, munthu amapatsidwa mankhwala angapo omwe amasankhidwa yekha.

Njira zochizira zosagwiritsa ntchito mankhwala ndizofunikira kwambiri. Zakudya zokhala ndi kuchepa kwa zakudya zamafuta, zakudya zamchere ndizomwe zimayikidwa. Muyenera kusiya kusuta, kumwa khofi, mowa, tiyi wamphamvu. Ndikofunikira kulimbana ndi kunenepa kwambiri, kumwa mankhwala apadera kuchokera ku hyperlipidemia (mwachitsanzo, Krestor, Rosuvastatin). Zochita zolimbitsa thupi, kuyenda, njira zingapo zowonjezera kukana kupanikizika ndi mankhwala.

Mankhwala ochepetsa kuthamanga kwa magazi ndi ISAG amayenera kungochotsera kupanikizika kwa systolic, ndipo diastolic sayenera kuyatsidwa kusinthasintha kwamphamvu. Mwa anthu omwe ali ndi matenda ashuga, ndikofunikira kukwaniritsa kuchuluka kwapamwamba mpaka 120 mm Hg, kupumula - mpaka 140 mm Hg. Ndikofunikira kuti muchepetse kuthamanga kwa magazi pang'onopang'ono kuti musataye mtima, kugwa, sitiroko.

Zododometsa za matenda oopsa

Nthawi zambiri, okodzetsa ndi mankhwala a mzere woyamba pochizira ISH. Anapatsidwa pafupifupi odwala onse, pamene amachepetsa kuthamanga kwa mtima, kuchepetsa kuchuluka kwa madzi am'magazi, kutsegula kukula kwa makoma a zotengera. Ma diuretics atsimikizira kukhala abwino kwambiri pamankhwala a odwala omwe matenda oopsa amaphatikizidwa ndi kulephera kwa mtima.

Pali mitundu ingapo ya ma diuretics:

thiazide (chlorothiazide),
kuphatikiza (triampur),
loopback (Lasix),
potaziyamu woteteza (Veroshpiron).

Nthawi zambiri, okodzetsa amaphatikizidwa ndi beta-blockers pochiza ISH, yomwe imapereka zotsatira zabwinoko.

B-blockers

Mukamamwa, zinthu zomwe zimagwiritsidwa ntchito ndi mankhwalawa zimayamba kutseka ma beta receptors, potero zimalepheretsa zovuta zingapo zamtima, kuphatikizapo kuchepetsera chiopsezo chokhala ndi matenda a mtima.

Mankhwalawa nthawi zambiri amawayikidwa limodzi ndi mankhwala ena, ngakhale atangoyamba kumene matenda oopsa oletsa kupanikizika amatha kuthana ndi mavuto. Mankhwala odziwika kwambiri a gululi ndi Betalok, Logimax, Metoprolol-Teva.

Kodi kuphatikiza matenda oopsa?

Awa ndi matenda omwe amadziwika ndi kukwezedwa kwa systolic (chisonyezo chapamwamba), pomwe kukakamiza kwa diastolic kumakhalabe kwabwinobwino kapena kuchepetsedwa. Mofanananso ndi izi, mwa odwala ena pamakhala chiwonjezeko cha kukoka kwa mtima.Chiwopsezo chodwala anthu okalamba ndichulukirachulukira kuposa kwa achinyamata: mwa odwala azaka zopitilira 65, kufufuzaku kumapangidwa pafupifupi 50%. Isolated arterial hypertension ndi owopsa chifukwa amakhala ndi chiopsezo chachikulu cha kufa chifukwa cha mtima ndi misempha yovuta (stroko, mavuto, kugunda kwa mtima).

Monga lamulo, zizindikiritso za systolic hypertension sizimadalira zaka, komabe, mwa achinyamata sadzionetsera kutalika kwake ndipo mitundu yayikulu ya matendawa siziwoneka. Chizindikiro chofala kwambiri cha matenda ndi mutu, womwe umapezeka m'makachisi ndi khosi. Pamodzi ndi ululu matenda tingaone:

chizungulire
kusanza, kusanza,
ntchentche pamaso panu
kukomoka
kupweteka mumtima wamunthu wopweteka, wosakhazikika,
kufooka
kuchepa kwa magwiridwe
kuphwanya mgwirizano
kugona

Chithandizo cha matenda okhazikika a systolic kwa achinyamata ndi achikulire

Matenda oopsa a magazi ndi matenda ofala kwambiri a mtima. Pathology imatha kuchitika mwa azimayi ndi abambo achichepere, ndipo mu ukalamba imapezeka pafupifupi aliyense wachiwiri.

Ngati chiwopsezo cha mpaka 130/85 mmHg chimawoneka chabwinobwino. Art., Kenako ndi matenda oopsa, chizindikirocho chimakwera - pang'ono kapena kwakukulu. Isolated systolic hypertension ndi amodzi mwa mitundu ya matenda, owopsa pakupanga zovuta.

Zolemba zotayikira

Mwa amuna, matenda oopsa a systolic amapita patsogolo msanga, chifukwa cha kusadya bwino komanso zizolowezi zoyipa. Mwa akazi, kukula kwa matenda amawonedwa nthawi ya kusamba, ndikuchepa mphamvu yachilengedwe yoteteza mitsempha yamagazi ndi mahomoni ogonana. Odwala okalamba, matendawa amaphatikizidwa ndi chiopsezo chowonjezeka cha zovuta. Izi ndichifukwa cha nthawi ya kukhalapo kwa ISH komanso kuthinikizidwa kwambiri. Kuphatikiza apo, anthu opitilira 65 amakhala ndi matenda opatsirana - gout, matenda ashuga, matenda atherosclerosis, komanso kunenepa kwambiri.

Matendawa amachititsa kuti anthu okalamba azitha kuwonetsa chiwonetsero cha usiku (kupumula kwa matenda oopsa). Kuphatikiza apo, odwala oterewa amawona kuthamanga kwapanthawi yayitali podzuka. Chizindikiro ichi chikuwonetsa zovuta zomwe zikubwera - hemorrhagic ndi ischemic stroke, myocardial infarction. Kutalikirana kwa systolic koopsa kumatha kudziwonetsa ngati mavuto osokoneza bongo, pomwe kukakamira kwapamwamba kumadumpha molimba mpaka 200 mm Hg. Art. Pamwamba, ndipo m'munsi simunasinthe. Mavuto amabweretsa vasospasm, yomwe imatha kubweretsa stroko.

Kuwonjezeka kwa chiwonetsero cha tonometer sichinthu chachilengedwe chifukwa cha kukalamba kwa thupi, koma kuvala kwamankhwala ndizofunikira kwambiri pakulimbikitsa matenda oopsa, chifukwa chake, mwa anthu okalamba, matendawa amapezeka pafupipafupi. Ndi zaka, makoma a mitsempha amachepa kwambiri, calcium ndi mapangidwe amtundu wa cell atakhala pa iwo, zomwe zimapangitsa kuwonongeka poyankha mitsempha yamagazi kukakamiza kusintha kwa systole. Njira zina mthupi zomwe zimapangitsa kuti magazi azikhala ochepa:

kutsika kwa magazi mu impso, musculoskeletal system, minofu chifukwa chakuchepa kwa kutulutsa kwamtima,
kuwonongeka kwa chidwi cha zolandilira zapadera m'matumbo, mtima,
Kuchepetsa kusefera gawo.

Palibe zifukwa zomveka zowonjezera kuchuluka kwa ma systolic, matenda oopsa amadziwika kuti ndiwo oyamba. Kwa achinyamata, matenda a zam'mimba amatha kuwoneka chifukwa cha kusuta, kugwiritsa ntchito mafuta osokoneza bongo kapena zakudya zamchere, kudya mowa pafupipafupi. Zotsatira zamkati zamtundu wa systolic zimatha kuyambitsa zovuta zambiri. Maonekedwe a matendawa amakhudzidwa ndi zinthu zoyipa izi:

kutalika kwa valavu
kuchepa magazi kwambiri
kupunduka kwa mtima
matenda ashuga
kulephera kwamtima,
mitsempha ya mitsempha,
sitiroko yapitayo
kutentha kwanthawi yayitali
hyperthyroidism
AV chitima cha mtima,
zotupa za adrenal glands kapena impso,
Itsenko-Cushing's syndrome,
msempha
kulephera kwa impso,
kupsinjika kwanthawi yayitali
kuchuluka kwa sodium, calcium m'magazi.

Mitundu yamatenda

Dokotala pakuthandizira kuti adziwe amatha kupeza mtundu wina wa systolic hypertension. Pathology imatchulidwa m'mitundu iyi:

Choyamba kapena chofunikira. Zomwe zimayambitsa matendawa sizinakhazikitsidwe, pomwe matenda olembetsa magazi samachitika chifukwa cha ma pathologies ena amitsempha yamagazi kapena ziwalo zina. Monga lamulo, chachikulu chokhacho cha systolic choopsa chimatengedwa.
Chachiwiri kapena chodziwitsa. Chimawonekera motsutsana ndi maziko a ubongo, impso, ndi zina zambiri.
Mitundu yabodza ya systolic yokhazikika yozungulira. Izi zimaphatikizapo "chovala chovala choyera," chomwe chimapezeka mwa anthu omwe amawopa madokotala, komanso orthostatic, yomwe imayambitsa kuvulala pamutu.

Isolated systolic hypertension mwa okalamba

Isolated systolic hypertension amafotokozedwa ngati kuwonjezeka kwa systolic kuthamanga kwa magazi mwanjira yotsika kapena yotsika ya diastolic. Ndi matendawa, pali kuwonjezeka kwa kuthamanga kwa zamkati, komwe kumatanthauza kusiyana kwa magazi a systolic ndi diastolic. Isolated systolic hypertension itha kuperekedwa ngati njira yosiyanasiyana yamatenda oopsa, omwe amawoneka kuti ndi okalamba, kapena kukhala a sekondale (yachiwiri kwaokha systolic matenda oopsa), ndikuwonetsedwa kwa zochitika zosiyanasiyana zamatenda, kuphatikiza kozama komanso koopsa kwa msempha, kuchepa kwa magazi, kuchepa magazi m'thupi komanso kuwonongeka kwa impso. . Pankhani yachiwiri matenda oopsa, pochotsa mizu, normalization wa magazi ndi kotheka.

Kuthamanga kwa magazi kwa diastolic kwakhala kukuchitika kwa zaka zambiri ngati chikhomo cha matenda oopsa, ndipo maphunziro ambiri adawonetsedwa pakuwunika mphamvu ya kupsinjika kwa diastolic pazovuta zamtima ndi kufa. Komabe, njirayi yatsimikizira kukhala yopanda nzeru ndipo yasintha mogwirizana ndi zotsatira za kafukufuku wamkulu waposachedwa. Adawonetsa kutsogolera kwa kuthamanga kwa magazi mu kukula kwa zotupa zamtima. Chifukwa chake, zidawonetsedwa kuti kukakamizidwa kwa systolic kwakukulukulu kuposa kukakamiza kwa diastoli kumatsimikizira kuchuluka kwa stroko ndi matenda amtima wamunthu mwa anthu azaka zopitilira 45. Malinga ndi kafukufukuyu, mwa anthu omwe ali ndi vuto losakanizika kwa matenda enaake, chiopsezo cha matenda amtima komanso kufa kwa anthu ambiri ndizochulukirapo katatu. Kuphatikiza apo, chiwopsezo chachikulu cha kusokonezeka kwa mtima ndi ubongo chinachitika ngakhale kuwonjezeka pang'ono kwa magazi a systolic (osaposa 160 mm Hg). Ndi zaka, gawo la kudalirika kwa magazi a systolic limakula.

Kodi mphamvu yanu yophatikiza magazi ndi yolimba motani?

Kuzindikira kwa "okhazikika systolic hypertension" amapangidwa m'magazi a systolic magazi kwambiri kuposa kapena ofanana ndi 140 mmHg. Art., Yokhala ndi milingo yamapanikizidwe a diastolic pansi pa 90 mm RT. Art. Pali magawo anayi a systolic hypertension kutengera milingo ya systolic magazi:

Zindikirani Ndi mulingo wina uliwonse wama systolic oopsa, kuthamanga kwa magazi kwa diastolic ("m'munsi") sikudutsa 90 mm Hg. Art.

Kuchuluka kwa kuchuluka kwa ma systolic koopsa m'magulu osiyanasiyana kumasiyana kwambiri (kuyambira 1 mpaka 43%), zomwe zimachitika chifukwa cha kuchuluka kwa anthu ophunzira. Pali chiwonetsero chodziwika bwino cha kuchuluka kwa mitundu yayitali yogwirizanitsa ndi matenda amisempha. Kafukufuku wazaka 30 wazaka Framingham adawonetsa kupezeka kwa vutoli mwa 14% ya amuna ndi 23% ya amayi, pomwe mwa anthu opitilira 60 adawonetsedwa mu milandu 2/3.

Njira zabwino zochiritsira matenda oopsa (mwachangu, zosavuta, zathanzi, popanda mankhwala omwe ali ndi "mankhwala"
Hypertension ndi njira yodziwika bwino yobwereranso ku gawo 1 ndi 2
Zoyambitsa matenda oopsa komanso momwe mungazithetsere. Kuyesa kwa matenda oopsa
Kugwiritsa ntchito mankhwala popanda matenda oopsa

Ndi zaka, kuwonjezereka kwa magazi a systolic kumawonedwa mwa munthu, pomwe palibe kuwonjezeka kwakukulu kwa kuthamanga kwapakati, popeza pambuyo pa zaka 70 pali kuchepa kwa kukakamira kwa diastolic, chifukwa cha kukhazikika kwa kuuma.

Njira zopangira chitukuko cha matenda okalamba mu okalamba zimawoneka zovuta komanso pamapeto pake sizimadziwika. Kukula kwa matenda oopsa m'magazi kumalumikizidwa ndi kuchepa kwa caliber ndi / kapena ochepa mitsempha ndi ma arterioles, omwe amachititsa kuwonjezeka kwa zotumphukira zamitsempha. Kuchulukitsa kwina kwa magazi a systolic kungakhale chifukwa cha kuchepa kwa kugonjera komanso / kapena kuchuluka kwa mitsempha yamagazi. Kuphatikiza apo, zinthu monga kusintha kwokhudzana ndi zaka mu renin-angiotensin dongosolo, ntchito yaimpso komanso ma elekitirodi a electrolyte, komanso kuwonjezeka kwa minofu ya adipose imathandizira pakukula kwa matenda oopsa a systolic.

Chifukwa cha zotupa za atherosulinotic zam'mitsempha, kukwera kwa magazi a systolic ndi kukoka kwa mapapu, zimapangitsa kukulira kwa "kutopa" kwamakina kwa khoma lakale. Izi zimathandizira kukulitsa ziwopsezo zam'mitsempha, ndikupangitsa kukhazikitsidwa kwa "ozungulira oyipa". Kuuma kwa msempha ndi mitsempha kumabweretsa kukula kwa kumanzere kwamitsempha yama mtima, mtima, kuchepa kwamitsempha komanso kufooka kwa magazi kufikira mtima.

Dziwani matenda enaake ogwirizana

Monga mitundu ina ya matenda oopsa, kuzindikira kwa matenda oopsa a systolic sikuyenera kupangidwa chifukwa chokhazikitsidwa ndi muyeso umodzi wokha. Ndikulimbikitsidwa kukhazikitsa kukhalapo kwa khola yokhazikika pokhapokha pakubwera kwachiwiri kwa nkhaniyi, zomwe ziyenera kuchitika pakatha masabata angapo pambuyo paulendo woyamba. Njirayi imalimbikitsidwa pamitu yonse, kupatula anthu omwe ali ndi kuthamanga kwa magazi (kupanikizika kwa systolic pamtunda wa 200 mmHg) kapena mawonetseredwe azachipatala a matenda a mtima ndi / kapena matenda a arteriosulinosis.

Kwa okalamba omwe ali ndi vuto lalikulu la zotupa zam'mitsempha yamagazi, zomwe zimalepheretsa kupindika kwa tonometer cuff ndikuwonjeza kukakamizidwa, mawu akuti "pseudohypertension" amagwiritsidwa ntchito.

Kuchulukana kwakanthawi kwa magazi pomwe wodwala atayang'ana dokotala, wotchedwa "matenda oyera ovala", sayenera kuonedwa ngati matenda oopsa kwambiri. Kulongosola bwino matendawa pazochitika, kuyang'anira kuthamanga kwa magazi kukuwonetsedwa.

Nthawi zina, kuphatikiza mankhwala osokoneza bongo samapezeka munthawi yake. Cholinga cha izi chikhoza kukhala kupezeka kwa atherosulinosis yozama ya subclavian mtsempha wamagazi, womwe umawonetsedwa ndi kusiyana kwakukulu mu kupanikizika kwa systolic kumanja ndi kumanja. Muzochitika zotere, kuthamanga kwa magazi pa mkono kuyenera kuwonedwa ngati kupsinjika kowona, komwe kuthamanga kwake. Mwa anthu ena okalamba, kuchepa kwa magazi masana mpaka maola awiri, kumathandizidwanso, komwe kungakhale chifukwa cha "pseudohypotension". Pankhaniyi, mukamayesa kuthinana, muyenera kuganizira nthawi yakudya.

Ndipo pamapeto pake, okalamba, orthostatic hypotension nthawi zambiri imachitika. Amapezeka ndi kuchepa kwa magazi a systolic ndi 20 mm RT. Art. ndi zina pambuyo pochokapo pamalo opingasa kapena kukhala pampando kupita kummbali. Orthostatic hypotension (hypotension) nthawi zambiri imalumikizidwa ndi stenosis yamitsempha ya carotid ndipo imatha kutsogola kugwa ndi kuvulala. Kuti muwone kupezeka kwake, ndikofunikira kuyeza kukakamiza kwa mphindi 1-3 mutatha kusintha kosinthika.

Popeza kuti systolic hypertension yokhayokha imatha kukhala yoyamba komanso yachiwiri, kuyeza kuthamanga kwa magazi sikokwanira kufotokoza momveka bwino matenda ake. Malinga ndi zikuwonetsa, kuyesa kowonjezera kwa labotali ndikofunikira.

Matenda opatsirana

Odwala oopsa omwe ali ndi mtundu wina wokha wa systolic yamatenda amafunikira kupenda magazi tsiku ndi tsiku komanso kukonza mankhwala kuti athe kuchepetsa zovuta. Zambiri mwa izo ndi:

kulephera kwa mtima
vuto la mtima
kagayidwe kazinthu ka mtima,
kuchuluka kwa minofu yolimba,
kuchuluka magazi kukana,
sitiroko.

Momwe mungachepetse kupanikizika kwa systolic

Cholinga chothana ndi matenda oopsa a systolic mtundu ndikuyimitsa matenda ndi kuchepetsa ngozi. Kuti muchite izi, wodwalayo amapatsidwa mankhwala osankhidwa ndi dokotala payekhapayekha. Kupanikizika kumayamba kuchepa mukamatenga ACE inhibitors, b-blockers (calcium channel blockers), diuretics, beta-blockers, angiotensin receptor blockers, calcium antagonists. M'magawo oyamba a matendawa, osagwiritsa ntchito mankhwala osokoneza bongo amayesedwa.

Mankhwala osagwiritsa ntchito mankhwala

Njira yovomerezeka yothetsera ISH ndizakudya zomwe zimatanthawuza kuchepetsedwa kwa kudya kwamafuta, zakudya zamchere. Kuphatikiza apo, muyenera kusiya kumwa khofi, mowa, tiyi wamphamvu, kusiya kusuta. Kuti muchepetse kupanikizika, ndikofunikira kuthana ndi kunenepa kwambiri. Dokotala atha kukulembera:

Menyu yamagetsi yamagetsi. Zomwe zimakhazikitsidwa ndi zakudya zamafuta amkaka ochepa, zipatso, mafuta a masamba, chinangwa, nsomba zam'nyanja, nkhuku. Nthawi yomweyo, mafuta achinyama, maswiti, ma pickles amachepetsa. Kugwiritsa ntchito mchere kumachepetsedwa kukhala 2.4 g patsiku, pomwe zomwe zimapezeka muzakudya zomwe zimadyedwa ziyenera kukumbukiridwa.
Kuyenda pafupipafupi, kuchita masewera olimbitsa thupi, masewera. Kusambira koyenera, tennis, cycling, etc.
Njira zowonjezera kukana kupsinjika. Mungafunike thandizo la akatswiri.
Njira zamankhwala azikhalidwe. Gwiritsani ntchito mankhwala azitsamba, kusakaniza kwa zipatso ndi zipatso zamasamba, zopangira njuchi.

Mankhwala ochepetsa magazi a systolic

Mankhwala ochepetsa kupanikizika ndi ISH ayenera kungotsitsa chizindikiro chapamwamba, kusiya otsika osasinthika. Mwa anthu omwe ali ndi matenda ashuga, ndikofunikira kukwaniritsa mtengo wapamwamba kwambiri wamtunda wofika 120 mmHg. Art., Gawo lonse lazachuma liyenera kuwonetsa 140 mm RT. Art. kapena wotsika. Kusintha kwapanikizika kuyenera kuchitika pang'onopang'ono kuti musayambitse kupsinjika kwa ischemic, kulephera kuzindikira, etc. Mankhwala otsatirawa amagwiritsidwa ntchito pochiza matenda oopsa a systolic:

Triampur. Kutengera gulu la mankhwala omwe amatchedwa "diuretics", omwe ali ndi triamteren ndi hydrochlorothiazide. Ma diuretics amachepetsa kubwezeretsanso kwa ayoni a sodium mu distal tubules. Kuphatikiza apo, mankhwalawa amachotsa calcium, chlorine, sodium ndi ayoni amadzi m'thupi, pomwe amachepetsa njira yotsatsira mafuta a calcium ion. Mankhwalawa apadera systolic matenda oopsa, tsiku lililonse mapiritsi 2 mpaka 4 ndi mankhwala.
Betalok. Mankhwalawa ndi gulu la ma B-blockers, omwe, atamwetsa, amayamba kutseka zolandilira beta, kupewa mavuto a mtima. Monga lamulo, amapatsidwa mankhwala ena pamodzi ndi mankhwalawa, komabe, pa gawo loyambirira la systolic hypertension, amatha kudzipulumutsa mwakufuna kwawo. Mlingo wavomerezedwa ndi dokotala.
Nifedipine. Wothandizirayo ndi wa gulu la otsutsana ndi calcium. Zochita za mankhwalawa zimatengera kutsekeka kwa njira za calcium m'maselo, komanso kuphwanya kwa mawonekedwe a ulusi wamitsempha wamitsempha. Zotsatira zake, zombo zimapumula, zomwe sizimayang'ana pang'ono kuzizindikiro zamanjenje ndikusiya kukokana. Ntchito yokhudza kuzungulira kwa mapiritsi itatha Kumayambiriro kwa mankhwalawa, piritsi limodzi limayikidwa katatu patsiku, ngati kuli kotheka, mlingo umawonjezereka mpaka mapiritsi 2 mpaka 2 pa tsiku.
Enalapril. Monga lamulo, mankhwalawa a mtundu uwu (ACE inhibitors) amaperekedwa kwa odwala omwe ali ndi matenda osokoneza bongo komanso anthu omwe ali ndi vuto lochita kupendekera kwamanzere. Chida chimatha kuwongolera zochita za enzyme yomwe imayambitsa vasospasm komanso kukula kwa matenda oopsa. Ndi systolic yokhayokha hypertension, mlingo woyenera wa mankhwalawa ndi 2,5-5 mg, koma angafikire 20 mg malinga ndi dokotala.