Kutsvaga "Yakanakisa" Kuwedzerwa Kweropa Kwemishonga Kwauri
Nhamba yemishonga nemishonga inodhaka yakawanda inowanzoshandiswa kurapa huwandu hwehuwandu hwehupfumi (yakanyanya kuwedzera ropa) inoshamisa kwenguva yakareba.
Ichokwadi chokuti kune mishonga yakawanda kwazvo yekusarudza kubva kune zvingada zvinhu zviviri. Kutanga, zvinoreva kuti hapana "zvakanakisisa" zvinodhaka zvehutachiona, kureva kuti, hapana mishonga inoshanda zvakanaka munenge wese munhu wese usingabvumi nemigumisiro yakaipa.
Kana paivepo, makambani emishonga aizorega kuedza kwavo kukudziridza mishonga yemishonga yakareba kare-uye urongwa hwemishonga yakagamuchirwa ingadai iri shoma shoma.
Chechipiri, uye nemishonga yakawanda yekusarudza kubva, chero bedzi iwe uye chiremba wako uri murwere uye uchiramba uchidaro, zvinonyanya kuitika kuti hurumende inobatsira uye inobvumirwe zvakanaka inowanikwa yehutano hwehutano. Mune mamwe mazwi, kunyange pasina "zvakanakisisa" kurapwa kwehutano hwepfungwa, pane inogona kuva "yakanakisisa" kurapa kwako.
Muchikamu chino, ticharondedzera mhando yemishonga inoshandiswa kuwedzerwa kwehutano, uye matanho api anofanira kuitwa nachiremba pakusarudza (kubva kune zvishamiso zvinoshamisa zvekusarudza kwako) kwako zvakanakisisa kurapwa. Pakupedzisira, tichapa runyoro rwakakwana rwemishonga yose ikozvino inoshandiswa muU.S. (uye mune dzimwe nyika dzakabudirira) yekurapa kwehuwandu hwehutano.
Kusarudza Zvakanaka Kurapa kweHypertension
Vanachiremba vanowanzoshandisa nzira yakarongeka yekusarudza kurapa kwakakwana kwehutachiona.
Nhanho 1: Kune vanhu vakaonekwa kuti vane chirwere chepfungwa chakanyorova kana chengwaru , zvakakosha kutanga nekurumbidza mararamiro ehupenyu akaratidzwa kubatsira kubatsira kuderedza ropa. Izvi zvinosanganisira kuchinja kwezvokudya , kusagadziriswa kwemunyu , kugara uchirovedza muviri, uye kusvuta kusvuta.
Nhanho 2: Kana zviyero izvi zvoupenyu zvisingaiti kukwanisa kukonzerwa kweropa mushure memavhiki akawanda, kazhinji nguva yekuwedzera zvinodhaka.
Nzira Yakakosha Yokusarudza Kurapa Kwemishonga yeHypertension
Pane zvikamu zvishanu zvakakura zvemishonga zvakave zvichiratidzwa zvakajeka mukurapa huwandu hwehutano. Izvi ndezvi:
- Thiazide diuretics
- Angiotensin inoshandura enzyme (ACE) inhibitors
- Calcium blockers
- Beta blockers
- Angiotensin receptor blockers (ARBs)
Kushandisa Drug Therapy
Kana uine danho rekuwedzera kwehutachiona (apo systolic yako ine simba iri pasi pe 160 mm Hg, uye diastolic yako inoderera isingapfuuri 100 mm Hg), mazano anowanzotanga nemumwe mishonga kubva kune imwe yezvikamu zvishanu.
Muzhinji, zvinodhaka kubva kune imwe yezvikoro izvi (kunze kwebheta-blockers, iyo isinganyanyi kushanda semishonga imwe chete) inoshandiswa kushanda zvakaenzana mukudzivirira huwandu hwehutano. Kunyanya, pane chine chikamu che50-50 kuti chero mishonga inoshanda inoshanda zvakakwana mumunhu chero upi zvake ane chirwere chepfungwa yepamusoro 1.
Zvisinei, vanhu vachabvuma kunyatsosiyana nemishonga iyi. Jim anokwanisa kupindura zvakanaka kune thiazide, asi anokundikana ne calcium blocker, uye nyaya naJane ingave yakanyatsopinduka. Iko kazhinji hakuna nzira inotangira nguva yekufanotaura kuti ndeupi munhu achaita zvakanaka nemhando ipi yemishonga. Saka, ndeapi vanachiremba nevarwere vakasara pamwe chete nekudzidzira kuedza-uye-kukanganisa.
Mu "guessing" pane yakanakisisa yekutanga mishonga yemunhu kuti uedze, nyanzvi dzakawanda dzinokurudzira kutanga kutanga pamwe neye thiazide diuretic (kazhinji chlorthalidone kana hydrochlorothiazide), aine-acting calcium blocker, kana kuti ACE inhibitor. ARBs inowanzofungidzirwa sevatsigiri veACE inhibitors, uye kazhinji inoshandiswa chete apo ACE inhibitor isingatenderwi.
Hapana mitemo yakaoma uye inokurumidza iyo mishonga inoshandiswa mune vanhu, asi kune dzimwe tsika dzinobatsira pakusarudza-single-drug therapy:
- Varwere vaduku kazhinji vanowanzoita zvakanaka kune ACE inhibitors.
- Varwere vatsva uye vakwegura varwere vanowanzoita zviri nani ne thiazide diuretics kana calcium channel blockers.
- Varwere vemavara vanowanzoita zvisina kunaka neACE inhibitors.
- Beta blockers kazhinji isarudzo isingararamiki ye-single-drug therapy, uye inowanzoshandiswa chete kana pane imwe chikonzero chekurapa kushandisa beta blockers (zvakadai sekuda kurapa angina kana moyo kusakundikana , kana kuti kudzora kushaya mwoyo mumunhu ne- atrial fibrillation ).
Pakati pese, kuderedza kwemaitiro emishonga emishonga eropa kunobudirira sekuwedzerwa kwepamusoro, uye kunokonzera mashoma emigumisiro. Saka, paanenge achiedza kutsvaga mushonga unoshanda-usingabatsiri, vanachiremba vanowanzotanga nehana shoma. Vanokwanisa kusarudza kuwedzera chiremba zvishoma kana chiyero chekutanga chisina kubudirira - asi hachiwanzobatsiri ku "shandisa" chirwere chema-single-drug therapy mumatunhu akakwirira. Pane kudaro, kana mushonga usingakwanisi kushanda purojekiti yakaderedzwa, inguva yekushandura kune imwe chirwere chechirwere chakasiyana.
Kushandisa nzira iyi yekuedza-uye-kukanganisa kusvika, vanenge 80% yevanhu vane chirwere chepachirwere chetachiona chekupedzisira vanogona kurapwa zvakaenzana nemudzvinyiriri umwe wehutachiona.
Kusanganiswa kweDrug Therapy
Kushandisa zvinopfuura mimwe mishonga yekurapa chirwere chepupemha zvinodiwa pasi pemamiriro maviri. Kutanga, chirwere chinoshandiswa chinoshandiswa kune vanhu vane chirwere chepachipiri chepakati 1 uye zvinenge zviviri kana zvitatu zvisingabudirire kuedza kwakaitwa kurapa ropa ravo neine-drug-therapy.
Chechipiri, kushandiswa kwemishonga inodhaka kunoshandiswa kune vanhu vane chirwere chepachipiri chepamusoro 2 (kureva kuti, systolic yavo inosvika 160 mm Hg kana yakakwirira, kana kuti diastolic yavo inomiririra 100 mm Hg kana yakakwirira.) Kushandiswa kwemishonga isina kukodzera hazvikwanisi kushanda nevanhu ava , so the combination combination is often selected from the beginning.
Neine mishonga yakawanda yekusarudza kubva, vanachiremba vanogona sei kusarudza mishonga ipi yekubatanidza? Ndinofara, mimwe miedzo yekliniki yakatevedzwa iyo inopa mazano makuru mukusarudza kurapa kwakakosha kwakakonzerwa nehutachiona.
Ihwo huchapupu hwakanakisisa (kubva kuC ACCOMPLISH trial) hunoratidza kuti zviitiko zvechipatara (kusanganisira dambudziko rekurohwa , kurwadziwa kwepfungwa uye kufa kwepfungwa) zvinowedzera kuburikidza nehutano husanganiswa apo nguva refu inoshanda calcium blocker inoshandiswa pamwe neACE inhibitor kana ARB. Saka, nanhasi vanachiremba vazhinji vanoedza kusangana uku kutanga.
Kana chirwere cheropa chinoramba chichikwidziridzwa nehutano hwakakosha uchishandisa calcium blocker pamwe neACE kana kuti ARB drug, mishonga inonzi thiazide inowanzowedzerwa sechirwere chechitatu. Uye kana kusanganiswa uku kuchiri kutadza kudzora ropa, chirwere chechina (kazhinji spironolactone, isiri-thiazide diuretic) inogona kuwedzerwa.
Nhamba yakawanda yevarwere vane hypertension ichabudirira kurapwa kwenguva refu musati mutezo wechitatu kana wechina unoda kuonekwa. Munhu asingazivikanwi uyo anokundikana kupindura zvakakwana kune rudzi urwu rwemishonga inobatanidza inofanira kuendeswa kune unyanzvi hwehutano hwehutano.
Kudzivisa Migumisiro Inosvibisa Inokonzerwa neHypertension Zvinodhaka
Chero chemishonga inoshandiswa kurapa huwandu hwehuwandu hwemapfupa inogona kukonzera matambudziko. Uye pakusarudza "zvakanakisisa" mishonga yemishonga yekurapa munhu ane huwandu hwehutachiona, zvakakosha kuwana mishonga (kana zvinodhaka) izvo zvinongobatsira chete kuderedza kuwedzerwa kweropa, asi iyo inobvumirwa zvakanaka.
Nokuda kwechikonzero ichi, zvave zvichibatsira zvikuru kuti kushandisa maitiro mashoma emishonga yehutachiona yakakosha sekushandisa madhigiri akakwirira. Iko kukwanisa kuenderera mberi nehotera yakaderedza kunoderedza zvikuru njodzi yemigumisiro yakaipa.
Kunyange zvakadaro, zvinodhaka izvi zvinogona kukonzera matambudziko, uye zvakakosha kuti iwe uzive zvingave nemigumisiro yakaipa. Kunyange zvazvo chimwe chezvizhinji zvehutachiona hwehutachiona huine humwe huno "rutivi rwehupfumi hwehupfumi," nokuda kwechikamu chikuru icho chinogona kuipa migumisiro yemishonga iyi inobatana neboka ravo. Zvikuru zvakasangana nematambudziko zvakashata ndezvi:
- Thiazide diuretics: hypokalemia (low potassium levels), kazhinji kunyorera, kuwedzera kwegout
- ACE inhibitors: kukanganiswa , kurasikirwa kweruzivo rwekuravira, hyperkalemia (yakakwirira pasiziyamu mazinga)
- Calcium blockers: kubatwa, kuvhara kwemakumbo, musoro wemusoro
- Beta vadziviriri: kuwedzera kweiyo dyspnea kune vanhu vane chirwere chisingaperi chisinganzwisisiki cheplmma kana chirwere cheputi , kusagadzikana kwepabonde, kuneta, kuora mwoyo, kuwedzera kwezviratidzo kune vanhu vane chirwere chetachiona chetachiona
- ARBs: zvinokonzerwa neharagic, chizivo , hyperkalemia
Neine mishonga yakawanda yekusarudza kubva, hazvishamisi kuti chiremba achakumbira munhu ane hypertension kuti ashivirire migumisiro yakaipa yakaipa. kana iwe uri kurapwa nehutachiona uye iwe uri kutarisana nemigumisiro ipi zvayo yakaoma, iwe unofanirwa kutaura nechiremba wako nezvekuwana chirongwa chekurapa iwe unogona kuzvitsungirira zviri nani.
A List of the Commonly Used Hypertension Drugs
Sezvakataurwa pakutanga kwenyaya ino, urongwa hwezvinodhaka izvo zvakagamuchirwa mukurapa kwehuwandu hwehuwandu hwehuwandu hwakareba kwenguva refu. Heino runyorwa rwakakwana rwemishonga iyi. Zita rechizvarwa chemishonga imwe neimwe yakanyorwa pakutanga, inoteverwa nemazita ekutengeserana.
Diuretics
Diuretics ("mapiritsi emvura") kuwedzera muwandu we sodium nemvura yakaderedzwa mumuginho neitsvo. Inofungidzirwa kuti inoderedza ropa rinonyanya kuderedza kuwanda kwemvura mumidziyo yeropa.
Diuretics inowanzoshandiswa kuwedzera kuwedzera kwehutano:
- Acetazolamide - Diamox
- Chlorthalidone - Thalidone, zvakare akatengeswa se Tenoretic neClorpres
- Hydrochlorothiazide - HydroDiuril, inotengeswa se Microzide uye Esidrix
- Indapamide - Lozol
- Metolazone - Zaroxolyn, zvakare inotengeswa seMykrox
Diuretics inowanzoshandiswa kuwedzerwa nehutachiona:
- Amiloride hydrochloride - Midamor
- Bumetanide - Bumex
- Ethacrynic acid - Edecrin
- Furosemide - Lasix
- Spironolactone - Aldactone
- Torsemide - Demadhesi
- Triamterene - Dyrenium
Beta-blockers
Beta blockers vanovhara kuitika kweAdrenaline pamwoyo yematambudziko, kunonoka mwoyo, uye kuderedza kushungurudzika pamwoyo uye arteri.
- Acebutolol - Sectral
- Atenolol - Tenormin
- Betaxolol - Kerlone
- Bisoprolol - Zebeta, zvakare akatengeswa seZiac
- Mapolol - Cartrol
- Carvedilol - Coreg
- Labetalol - Normodyne, zvakare inotengeswa seTrandate
- Metoprolol - Lopressor, inotengeswa seTotrol
- Nadolol - Corgard
- Penbutolol - Levatol
- Propranolol - Inderal, Inderal LA
- Timolol - Blocadren
Calcium Channel Blockers
Calcium channel blockers inogona kuderedza kuwedzerwa kweropa kuburikidza nekuderedza mitsetse uye, pane dzimwe nguva, kuderedza simba rezvinyorwa zvemoyo.
- Amlodipine - Norvasc, zvakare inotengeswa seCaduet naLotrel
- Diltiazem - Cardizem, zvakare akatengeswa seDilacor naTiazac
- Felodipine - Plendil
- Isradipine - DynaCirc
- Nicardipine - Cardene
- Nifedipine - Procardia XL, inotengeswa seAdalat
- Nisoldipine - Sular
- Verapamil hydrochloride - Isoptin, inotengeswa seCalan, Verelan, naCovera
Angiotensin Converting Enzyme Inhibitors
Iyo ingiotensin inoshandura enzyme inhibitors (iyo "ACE inhibitors") inogona kuderedza kushanda kweropa nekuderedza mishonga.
- Benazepril - Lotensin
- Captopril - Capoten
- Enalapril - Vasotec, zvakare inotengeswa seV Vaseretic
- Fosinopril - Monopril
- Lisinopril - Zvinyorwa, zvakare zvinotengeswa seZestril
- Moexipril - Univasc
- Quinapril - Accupril
- Ramipril - Altace
- Trandolapril - Mavik
Angiotensin II Receptor Blockers
I-angiotensin II receptor blockers ("ARBs") inoderedzawo kuwedzerwa kweropa kuburikidza nekuderedza mishonga.
- Candesartan - Atacand
- Irbesartan - Avapro
- Losartan - Cozaar
- Telmisartan - Micardis
- Valsartan - Diovan
Zvimwe, Zvidiki Zvishoma Zvinoshandiswa NeHypertension Drugs
- Clonidine - Catapres
- Doxazosin - Cardura
- Guanabenz - Wytensin
- Guanfacine - Tenex
- Hydralazine hydrochloride - Apresoline
- Methyldopa - Aldomet
- Prazosin - Minipress
- Reserpine -Ã, Serpasil
- Terazosin - Hytrin
Zvinokonzerwa Nezvinodhaka zveHypertension
Zvizhinji zvinodhaka zvinodhaka zvakatengeswa nehutachiona, uye hazvibviri kuchengetedza zvitsva zvinouya, kana kuti zviya zvinopera. Izvo ndeye runyoro rwakakwana rwakakwana rwezvinowanzodiwa zvinoshandiswa zvinodhaka zvinoshandiswa kuwedzerwa kwehutano.
- Amiloride uye hydrochlorothiazide - Moduretic
- Amlodipine uye benazepril - Lotrel
- Atenolol uye chlorthalidone - Tenoretic
- Benazepril uye hydrochlorothiazide - Lotensin HCT
- Bisoprolol uye hydrochlorothiazide - Ziac
- Captopril uye hydrochlorothiazide - Capozide
- Enalapril uye hydrochlorothiazide - Vaseretic
- Felodipine uye enalapril - Lexxel
- Hydralazine uye hydrochlorothiazide - Apresazide
- Lisinopril uye hydrochlorothiazide - Prinzide, zvakare inotengeswa seZestoretic
- Losartan uye hydrochlorothiazide - Hyzaar
- Methyldopa uye hydrochlorothiazide - Aldoril
- Metoprolol uye hydrochlorothiazide - Lopressor HCT
- Nadolol uye bendroflumethiazide - Corzide
- Propranolol uye hydrochlorothiazide - Inderide
- Spironolactone uye hydrochlorothiazide - Aldactazide
- Triamterene uye hydrochlorothiazide - Dyazide, zvakare inotengeswa seMaxide
- Verapamil yakawedzerwa kusunungurwa) uye trandolapril - Tarka
Shoko Rinobva
Hypertension chirwere chinonyanya kukanganisa chirwere chinogona kuva nemigumisiro yakaipisisa kana isingatarisirwi zvakakwana. Zvisinei, neine nzira dzakawanda dzokurapa, unofanirwa kutarisira chiremba wako kuti awane rubatsiro rwekurapa huchaderedza zvikuru dambudziko rako rekuguma kwehutachiona hwehutano hwehutano, pasina kukanganisa hupenyu hwezuva nezuva.
> Sources:
> Ropa Rokumanikidzira Kunyoresa Kutengesa Vatatu 'Kubatana, Turnbull F, Neal B, et al. Migumisiro Yakasiyana-siyana Yokuderedza Kuwedzerwa Kweropa paZviitiko Zvitsva Zvomumuviri muVakuru Nevaduku Vakuru: Meta-analysis yeRandomized Trials. BMJ 2008; 336: 1121.
> Jamerson KA, Bakris GL, Wun CC, et al. Rational uye Kugadziriswa kweKuchengetedza Mwoyo Yezvakagadzirwa Nokurwisana Kwemishonga Muvarwere Vanorarama neSystolic Hypertension (ACCOMPLISH) Chiedzo: Yokutanga Randomized Chirongwa Chichienzanisa Kufananidza Nhengo dzeMakemikari Migumisiro yeChitatu Mutsara Mishonga muHypertension. Am J Hypertens 2004; 17: 793.
> Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH / ESC Zvinyorwa zvekutungamirirwa kweArterial Hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) uye yeEuropean Society of Cardiology (ESC). J Hypertens 2013; 31: 1281.
> Weber MA, Schiffrin EL, White WB, et al. Mishonga yekuita mazano ekugadzirisa kweHypertension muMutauro Chirevo cheAmerican Society of Hypertension uye International Society of Hypertension. J Hypertens 2014; 32: 3.