Kupeza "Mphamvu Yabwino" Yopanikiza Magazi kwa Inu
Mndandanda wa mankhwala osokoneza bongo ndi mankhwala omwe amagwiritsidwa ntchito kwambiri pochiza matenda (kuthamanga kwa magazi) ndilolitali kwambiri.
Chowonadi chakuti pali mankhwala ochuluka kwambiri oti asankhe pa njira zosachepera ziwiri. Choyamba, zikutanthauza kuti palibe mankhwala abwino kwambiri omwe amawopsa kwambiri, ndiko kuti, palibe mankhwala omwe amagwira ntchito pafupifupi pafupifupi aliyense popanda kuchititsa zotsatira zosavomerezeka.
Zikanakhalapo, makampani osokoneza bongo angayesetse kuyambitsa mankhwala atsopano a antihypertensive kale-ndipo mndandanda wa mankhwala ovomerezeka ukhala wochepa kwambiri.
Chachiwiri, ndi mankhwala ambiri omwe mungasankhe, malinga ngati inu ndi dokotala muli opirira ndi olimbikira, ndizotheka kwambiri kuti regimen yothandizira ndi yovomerezeka idzapezeka chifukwa cha matenda anu oopsa. Mwa kuyankhula kwina, ngakhale palibe mankhwala abwino kwambiri a "matenda abwino" a matenda oopsa, paliponse kukhala "mankhwala abwino" kwa inu.
M'nkhani ino, tidzakambirana za mitundu yosiyanasiyana ya mankhwala omwe amagwiritsidwa ntchito pafupipafupi, komanso zomwe adokotala ayenera kuchita posankha (kuchokera ku zosankha zambiri). Pomalizira, tidzakhala ndi mndandanda wathunthu wa mankhwala omwe tsopano akugwiritsidwa ntchito ku US (ndi m'mayiko ambiri otukuka) kuti azitha kuchipatala.
Kusankha Chithandizo Chabwino cha Kuthamanga kwa Mthupi
Madokotala amagwiritsa ntchito njira yodalirika yopangira chithandizo chabwino cha matenda oopsa.
Khwerero 1: Kwa anthu amene apezeka ndi matenda oopsa kwambiri , ndi bwino kuyamba ndi kuyamikira kusintha kwa moyo komwe kwawonetsedwa kuti kuthandizidwe kuchepetsa kuthamanga kwa magazi. Izi zikuphatikizapo kusintha kwa zakudya , kuchepetsa mchere , kuchita masewero olimbitsa thupi, ndi kusuta fodya.
Khwerero 2: Ngati miyeso ya moyo imeneyi siimayambitsa matenda a magazi pambuyo pa milungu ingapo, nthawi zambiri nthawi yowonjezera mankhwala owonjezera.
Njira Yeniyeni Yosankha Mankhwala Osokoneza Bongo
Pali mitundu ikuluikulu isanu ya mankhwala omwe atsimikiziridwa kuti ikugwira ntchito pochiza matenda oopsa. Izi ndi:
- Thiazide diuretics
- Angiotensin amatembenuza ma enzyme (ACE) inhibitors
- Calcium blockers
- Ophwanya Beta
- Angiotensin receptor blockers (ARBs)
Mankhwala Ochepetsa Mankhwala Osakwatira
Ngati muli ndi nthenda yapamwamba yambiri yapamwamba (pamene systolic yanu imakhala yosakwana 160 mm Hg, ndipo vuto lanu la diastolic ndilopitirira 100 mm Hg), malingaliro onsewa ndi kuyamba ndi mankhwala amodzi kuchokera m'modzi mwa magulu asanuwa.
Kawirikawiri, mankhwala osokoneza bongo kuchokera ku magulu onsewa (kupatulapo beta-blockers, omwe sagwiritsidwa ntchito mofanana ngati mankhwala osakaniza) amagwira ntchito mofanana poletsa kuthamanga kwa magazi. Mwachindunji, pali mwayi wokwana 50-50 kuti mankhwala alionse adzagwira ntchito mokwanira kwa munthu aliyense yemwe ali ndi gawo 1 lachiwopsezo chachikulu.
Komabe, anthu adzalandira mosiyana kwambiri ndi mankhwalawa. Jim angayankhe bwino thiazide, koma amalepheretsa calcium blocker, ndipo nkhaniyi ndi Jane ingakhale yeniyeni. Nthaŵi zambiri palibe nthawi yochuluka yodziwiratu kuti ndi ndani yemwe angapange bwino mankhwala amtundu wanji. Kotero, ndi madokotala ati ndi odwala omwe atsala nawo ndi njira yophunzitsira-kuyesera.
Mu "kuganiza" poyambitsa mankhwala osokoneza bongo oyambirira kuti ayesetse, akatswiri ambiri amalimbikitsanso kuyamba ndi thiazide diuretic (kawirikawiri chlorthalidone kapena hydrochlorothiazide), kaccium blocker, kapena ACE inhibitor. Ma ARB amalingaliridwa ngati m'malo mwa ACE inhibitors, ndipo kawirikawiri amagwiritsidwa ntchito pokhapokha ngati ACE inhibitors sakulekerera.
Palibe malamulo ovuta komanso ofulumira omwe mankhwala omwe angagwiritsidwe ntchito ndi anthu, koma pali zizolowezi zina zomwe zimathandiza popanga mankhwala osakaniza okha:
- Odwala achichepere kawirikawiri amayankha bwino ACE inhibitors.
- Odwala wakuda ndi odwala okalamba amayamba kuchita bwino ndi thiazide diuretics kapena calcium channel blockers.
- Odwala wakuda amakonda kuchita bwino ndi ACE inhibitors.
- Odziletsa Beta kawirikawiri amakhala osasankha bwino pa mankhwala osakaniza okha, ndipo amagwiritsidwa ntchito pokhapokha ngati pali chifukwa china chamankhwala chogwiritsira ntchito beta blockers (monga kufunika kochiza angina kapena mtima kusalowola , kapena kuchepetsa mtima wa munthu muyeso ndi matenda a atrial fibrillation ).
Kawirikawiri, kuchepa kwa magazi kumagwira ntchito moyenera komanso kumayambitsa zotsatira zochepa. Choncho, poyesera kupeza mankhwala ogwiritsira ntchito mankhwala okhaokha, madokotala amayamba ndi mlingo wochepa. Angasankhe kuonjezera mlingo pang'ono ngati mlingo woyambirira sungatheke - koma sizothandiza kwambiri "kukankhira" mlingo wa mankhwala osakaniza amodzi muzitsulo zapamwamba. M'malo mwake, ngati mankhwala akulephera kugwira ntchito pa mlingo wotsika kwambiri, ndi nthawi yosinthana ndi mlingo wa mankhwala osiyana.
Pogwiritsa ntchito njira imeneyi, anthu pafupifupi 80% omwe ali ndi siteji yoyamba yapamwamba kwambiri angathe kuchiritsidwa mokwanira ndi mankhwala osokoneza bongo.
Njira Yothandizira Mankhwala Osakaniza
Kugwiritsira ntchito mankhwala opitilira limodzi kuti muthe kudwala matenda oopsa kwambiri n'kofunika pansi pazifukwa ziwiri. Choyamba, mankhwala ophatikizana amagwiritsidwa ntchito kwa anthu omwe ali ndi nthenda yapamwamba yapamwamba 1 ndipo osachepera awiri kapena atatu omwe adalephera kuyesa kuthamanga kwa magazi ndi mankhwala osakaniza.
Chachiwiri, mankhwala othandizira mankhwalawa amagwiritsidwa ntchito kwa anthu omwe ali ndi siteji yachiwiri yapamwamba (kutanthauza kuti mphamvu yawo ya systolic ndi 160 mm Hg kapena apamwamba, kapena mphamvu yawo ya diastolic 100 mm Hg kapena kuposa. , mankhwala omwe amagwiritsidwa ntchito nthawi zambiri amasankhidwa kuyambira pachiyambi.
Ndi mankhwala ambiri oti musankhe, madokotala angasankhe bwanji mankhwala omwe angagwirizane? Mwamwayi, mayesero ambiri a chipatala apangidwa omwe amapereka chitsogozo chachikulu posankha mankhwala othandizira odwala matenda oopsa.
Umboni wabwino kwambiri (kuchokera ku COMPOMPLISH trial) umasonyeza kuti zotsatira zachipatala (kuphatikizapo chiopsezo cha kudwala , matenda a mtima ndi imfa ya mtima) zimapindula kwambiri ndi mankhwala ophatikizana pamene kaccium blocker ikugwira ntchito limodzi ndi ACE inhibitor kapena ARB. Kotero, lero madokotala ambiri amayesa kusakaniza uku poyamba.
Ngati kuthamanga kwa magazi kukupitirirabe ndi mankhwala osakaniza pogwiritsa ntchito calcium blocker kuphatikizapo mankhwala a ACE kapena ARB, mankhwala a thiazide nthawi zambiri amawonjezeredwa ngati mankhwala atatu. Ndipo ngati kusakanikiranaku sikungathetsere kuthamanga kwa magazi, mankhwala amodzi (makamaka spironolactone, osakhala thiazide diuretic) akhoza kuwonjezeredwa.
Odwala ambiri omwe ali ndi matenda oopsa kwambiri adzapindula bwino chisanafike mankhwala atatu kapena achinayi akuyenera kuganiziridwa. Munthu wamba yemwe samalephera kuyankha mokwanira kwa mankhwalawa akuyenera kutumizidwa kwa katswiri wa matenda oopsa.
Pewani Zotsatira Zopweteka Kuchulukitsa Mankhwala Osokoneza Bongo
Mankhwala onse ogwiritsidwa ntchito pochiza matendawa amatha kuyambitsa mavuto. Ndipo posankha mankhwala abwino kwambiri ochizira mankhwala pochiza munthu amene ali ndi matenda oopsa, n'kofunika kupeza mankhwala (kapena mankhwala osokoneza bongo) omwe amachepetsa kuponderezedwa kwa magazi, komanso amalekerera.
Pachifukwa ichi, zakhala zothandiza kwambiri kuti kugwiritsa ntchito mankhwala ochepa a mankhwala opatsirana kwambiri ndi othandiza ngati kugwiritsa ntchito mlingo waukulu. Kukwanitsa kuchita ndi mankhwala ochepa kumachepetsa chiopsezo chachikulu.
Komabe, mankhwalawa angayambitse mavuto, ndipo ndikofunikira kuti muzindikire zotsatira zomwe zingasokoneze. Ngakhale kuti mankhwala ambiri okhudzana ndi matenda oopsa kwambiri amakhala ndi "mbali yokhudza mbiri," makamaka chifukwa cha mankhwalawa akugwirizana ndi gulu lawo. Zotsatira zazikulu zokhudzana ndi gulu ndi:
- Thiazide diuretics: hypokalemia (m'munsi otsika potaziyamu), kusamba nthawi zambiri, kuwonjezeka kwa gout
- ACE inhibitors: chifuwa, kutayika kwa kukoma kwabwino , hyperkalemia (mazinga a potassium okwera)
- Anthu oteteza calcium: kudzimbidwa, kutupa kwa miyendo, kumutu
- Ophwanya Beta: Kuwonjezeka kwa dyspnea kwa anthu omwe ali ndi matenda osokoneza bongo kapena mphumu , matenda osokoneza bongo, kutopa, kupsinjika maganizo, kuwonjezereka kwa zizindikiro kwa anthu omwe ali ndi matenda a mitsempha
- ARBs: zotsatira zowopsya, chizungulire , hyperkalemia
Ndi mankhwala ambiri omwe mungasankhe, si zachilendo kuti dokotala adzafunse munthu yemwe ali ndi matenda oopsa kwambiri kuti athe kulekerera zotsatira zake zoipa. ngati mukudwala matenda oopsa kwambiri ndipo mukukumana ndi zotsatira zovuta, muyenera kulankhula ndi dokotala wanu za kupeza mankhwala omwe mungathe kupirira nawo.
Mndandanda wa Ambiri Amene Amagwiritsa Ntchito Mankhwala Osokoneza Bongo
Monga tafotokozera kumayambiriro kwa nkhani ino, mndandanda wa mankhwala omwe amavomerezedwa kuti azitha kuchiza matendawa ndi yaitali. Pano pali mndandanda wathunthu wa mankhwalawa. Dzina lachibadwa la mankhwala aliwonse ndilo loyambirira, lotsatiridwa ndi mayina ogulitsa.
Diuretics
Diuretics ("mapiritsi a madzi") yonjezerani kuchuluka kwa sodium ndi madzi osakanizidwa mu mkodzo ndi impso. Iwo amaganiza kuti amachepetsa kuthamanga kwa magazi makamaka mwa kuchepetsa kuchuluka kwa madzi m'zigawo zamagazi.
Diuretics omwe amagwiritsidwa ntchito kwambiri pa matenda oopsa:
- Acetazolamide - Diamox
- Chlorthalidone - Thalidone, wogulitsidwa monga Tenoretic ndi Clorpres
- Hydrochlorothiazide - HydroDiuril, ogulitsidwa monga Microzide ndi Esidrix
- Indapamide - Lozol
- Metolazone - Zaroxolyn, ogulitsidwa monga Mykrox
Zochepa za Diuretics zomwe zimagwiritsidwa ntchito kwambiri pa matenda oopsa:
- Amiloride hydrochloride - Midamor
- Bumetanide - Bumex
- Ethacrynic acid - Edecrin
- Furosemide - Lasix
- Spironolactone - Wachilombo
- Torsemide - Demadex
- Triamterene - Dyrenium
Beta-blockers
Olemba Beta amalepheretsa zotsatira za adrenaline pamaganizo a mtima, kuchepetsa mtima, komanso kuchepetsa nkhawa pamtima ndi mitsempha.
- Acebutolol - Sectral
- Atenolol - Tenormin
- Betaxolol - Kerlone
- Bisoprolol - Zebeta, wogulitsidwa ngati Ziac
- Mapolol - Cartrol
- Carvedilol - Coreg
- Labetalol - Normodyne, komanso wogulitsidwa monga Trandate
- Metoprolol - Lopressor, ogulitsidwa monga Toprol
- Nadolol - Corgard
- Penbutolol - Levatol
- Propranolol - Inderal, Inderal LA
- Timolol - Blocadren
Malonda a Channel ya Calcium
Mankhwala a calcium amatha kuchepetsa kuthamanga kwa magazi mwa kuchepetsa mitsempha ndipo, nthawi zina, kuchepetsa mphamvu ya mtima.
- Amlodipine - Norvasc, ogulitsidwa monga Caduet ndi Lotrel
- Diltiazem - Cardizem, ogulitsidwa monga Dilacor ndi Tiazac
- Felodipine - Zambiri
- Isradipine - DynaCirc
- Nicardipine - Cardeni
- Nifedipine - Procardia XL, yogulitsidwa monga Adalat
- Nisoldipine - Sular
- Verapamil hydrochloride - Isoptin, ogulitsidwa monga Kalan, Verelan, ndi Covera
Angiotensin Kutembenuza Mavitamini a Enzyme
Mankhwala otchedwa angiotensin omwe amatembenuza tizilombo toyambitsa matenda ("ACE inhibitors") akhoza kuchepetsa kuthamanga kwa magazi mwa kuchepetsa mitsempha.
- Benazepril - Lotensin
- Captopril - Capoten
- Enalapril - Vasotec, ogulitsidwa monga Vaseretic
- Fosinopril - Monopril
- Lisinopril - Prinivil, yogulitsidwa monga Zestril
- Moexipril - Univasc
- Quinapril - Accupril
- Ramipril - Altace
- Trandolapril - Mavik
Angiotensin II Receptor Blockers
Mankhwala a angiotensin II ("ARBs") amathandizanso kuchepetsa kuthamanga kwa magazi mwa kuchepetsa mitsempha.
- Candesartan - Atacand
- Irbesartan - Avapro
- Losartan - Cozaar
- Telmisartan - Micardis
- Valsartan - Diovan
Zina, Zochepa Zomwe Zimagwiritsidwa Ntchito Mowa Mwauchidakwa
- Clonidine - Catapres
- Doxazosin - Cardura
- Guanabenz - Wytensin
- Guanfacine - Tenex
- Hydralazine hydrochloride - Apresoline
- Methyldopa - Aldomet
- Prazosin - Minipress
- Reserpine -Ã, Serpasil
- Terazosin - Hytrin
Mankhwala Osokoneza Bongo Ambiri Opatsirana Maganizo
Mankhwala ophatikiza ambiri akhala akugulitsidwa chifukwa cha matenda oopsa, ndipo n'kosatheka kusunga zatsopano zomwe zimabwera, kapena zakale zomwe zimatha. Zotsatirazi ndi mndandanda wathunthu wa mankhwala omwe amagwiritsidwa ntchito pafupipafupi.
- Amiloride ndi hydrochlorothiazide - Moduretic
- Amlodipine ndi benazepril - Lotrel
- Atenolol ndi chlorthalidone - Tenoretic
- Benazepril ndi hydrochlorothiazide - Lotensin HCT
- Bisoprolol ndi hydrochlorothiazide - Ziac
- Captopril ndi hydrochlorothiazide - Capozide
- Enalapril ndi hydrochlorothiazide - Vaseretic
- Felodipine ndi enalapril - Lexxel
- Hydralazine ndi hydrochlorothiazide - Apresazide
- Lisinopril ndi hydrochlorothiazide - Prinzide, ogulitsidwa monga Zestoretic
- Losartan ndi hydrochlorothiazide - Hyzaar
- Methyldopa ndi hydrochlorothiazide - Aldoril
- Metoprolol ndi hydrochlorothiazide - Lopressor HCT
- Nadolol ndi bendroflumethiazide - Corzide
- Propranolol ndi hydrochlorothiazide - Inderide
- Spironolactone ndi hydrochlorothiazide - Aldactazide
- Triamterene ndi hydrochlorothiazide - Dyazide, komanso kugulitsidwa monga Maxide
- Verapamil anamasulidwa kumasulidwa) ndi trandolapril - Tarka
Mawu Ochokera
Kuthamanga kwa magazi ndi vuto lalikulu lachipatala limene lingakhale ndi zotsatira zoopsa ngati sichikuchiritsidwa mokwanira. Komabe, pokhala ndi njira zamankhwala zambiri, muyenera kuyembekezera dokotala kuti apeze mankhwala ochiritsira omwe angachepetse chiopsezo chachikulu cha matenda oopsa, popanda kusokoneza moyo wanu wa tsiku ndi tsiku.
> Zotsatira:
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> Jamerson KA, Bakris GL, Wun CC, ndi al. Kulingalira ndi Kukonzekera kwa Kupewa Zochitika Zamtima Pogwiritsa Ntchito Chithandizo Chakumagwirizanitsa Odwala Odwala Matenda Oopsa (ACCOMPLISH) Mayesero: Choyamba Choyesa Kuyesa Kuyesa Kufanizitsa Zotsatira za Zotsatira Za Zotsatira Za Zotsatira Za Zotsatira Za Zotsatira Za Zotsatira za Njira Zochiritsira Zamagulu Akumayambiriro. Am J Hypertens 2004; 17: 793.
> Mancia G, Fagard R, Narkiewicz K, ndi al. Malangizo a ESH / ESC a Management of Hypertension Arterial: Task Force yoyang'anira matenda oopsa kwambiri a European Society of Hypertension (ESH) ndi European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281.
> Weber MA, Schiffrin EL, White WB, et al. Malangizo Othandizira Amagulu Omwe Amagwira Ntchito Yopangitsa Kuthamanga kwa Mthupi Mumtundu Wachikhalidwe Ndondomeko ya American Society of Hypertension ndi International Society of Hypertension. J Hypertens 2014; 32: 3.