Izimpawu
Emaphesenti angama-90% ngaphambi kokuqala kwezinkinga, ukucindezelwa kwegazi okungaphezulu akubonakali. Ngezinye izikhathi, nge-hypertension engavamile (ingcindezi ephakeme kakhulu), ukushaya ikhanda, ukukhwabanisa nokubona okungabonakali kungase kwenzeke. Uma kungekho ukwelashwa, ukucindezeleka kwegazi kudala ukulimala ezithombeni zangaphakathi kanye nokuthuthukiswa kwezinkinga (kuma-20% weziguli): isifo senhliziyo nesifo senhliziyo, ukubhujiswa kwe-retinal noma isifo sohlangothi. Uma i-hypertension ingumphumela wesinye isifo, izimpawu zalo zivezwe esithombeni se-pathology engaphansi. Ukushisa ngokweqile yisifo esivamile kakhulu esithinta abantu abangu-10-15%. Izinkinga zomfutho wegazi ophezulu (CD) yizona ezibangela ukufa. Ukuthuthukiswa kwalesi sifo kuhlotshaniswa nezinkinga ezinjengalezi:
• ubudala - izinga le-CD landa ngokukhula, kodwa akufanele kuthathwe njengokujwayelekile kumanani aphezulu e-CD ekugugile;
• isisindo - i-CD iphezulu kubantu abanesisindo somzimba ngokweqile;
• Umncintiswano - amaMelika aseNtshonalanga, isibonelo, isifo somfutho wegazi ophezulu, angaphezu kwalabo abanezimpande zaseYurophu.
I-high blood pressure
Iziguli ezingaphezu kwezingu-90% ezine-high blood pressure zihlushwa yi-hypertension ebalulekile, eqala ngaphandle kwesizathu esicacile. Indima ethile kulokhu idlalwe ngumlando womndeni, ukukhuluphala, ukusetshenziswa kabi kotshwala, kanye nezimo zemvelo.
Ezinye izizathu
• Umfutho wegazi ophuthumayo ubangelwa uhlobo oluthile lokulimala kwesitsha segazi, olubizwa nge-fibrinoid necrosis.
• Ukukhulelwa. I-CD ephezulu iyancintisana cishe ngo-5-10% kokukhulelwa futhi, njengoba iyingxenye yesifo esibi kakhulu enomonakalo we-placenta, ibeka ingozi enkulu kumama nomntwana.
Ukucindezeleka komzimba kungase kube uphawu lwesibili nge:
• i-pathology yezinso;
• izicubu zezinhlayiya ze-endocrine ezifihla ama-hormone athinta umzimba-usawoti wamanzi emzimbeni noma ukukhulula izinto ezifana ne-adrenaline;
• ukuthatha imithi ethile;
• ukungabikho kokuzalwa kwangasese.
Umfutho wegazi ulinganiswa yi-sphygmomanometer. Le divayisi ibhala amanani amabili okucindezela ngamamitha ayi-mercury (mm Hg): owokuqala - ekuphakameni kwenhliziyo ukuchotshozwa - kuyi-systole, okwesibili - nokuphumula kwayo - ku-diastole. Uma kutholakala ukucindezeleka komzimba, kokubili ukuguqulwa kuthathwa njenge-akhawunti. Kuphela kwengxenye yesithathu yamacala e-hypertension angatholakala futhi ahlolwe. Ukuze ukuxilongwa kwanele ukubhaliswa ngokuphindwe kabili kwengcindezi yegazi ngaphansi kwezimo ezahlukene.
Okunye ukuhlola kuhlanganisa:
- ukuhlaziywa kwamanzi emaprotheni;
- Ukuhlolwa kwegazi ngemingcele yezinso zezinso;
- isifuba i-X-ray ne-ECG ukuthola ukukhuliswa kwenhliziyo.
Kunamaphutha ekukala izinga legazi. Izindinganiso eziphezulu zamanga zingatholakala ekamelweni elibandayo, nesigqila esigcwele noma inkomishi encane kakhulu. Iziguli ezidinga ukwelashwa okuphuthumayo zihlanganisa:
• Iziguli ezinegazi lomzimba cishe cishe ngu-250/40 mm Hg. ubuciko. ne-hypertension eyingozi. Bangase babe nezinguquko ezinzima ku-fundus nokungaqiniseki kwe-renal ne-uremia (ukutholakala kwemali ngokweqile ye-urea nezinye imikhiqizo ye-nitrogen egazini);
• Iziguli ezinesilonda sesibili sezitho zangaphakathi (inhliziyo, izinso) kanye nezinga lokucindezela cishe lika-220/110 mm Hg. Art.
Izindlela ezingezona ezomthetho
Iziguli ezinomfutho wegazi ophakeme (ukucindezelwa kwe-diastolic kuze kube ngu-95-110 mm Hg) azikho engozini ngqo, ngakho ungazama ukufeza amanani we-CD okulindelekile ngaphandle kwezidakamizwa usebenzisa ezinye izindlela:
• ukulahlekelwa kwesisindo;
• ukuvinjelwa kosawoti;
• ukuvinjelwa kokudla okunamafutha;
• ukuvinjelwa kokusetshenziswa kotshwala;
• ukwenqaba ukukhulelwa komlomo;
• ukwandisa umsebenzi womzimba.
Uma umphumela oyifunayo awutholakali zingakapheli izinyanga ezintathu, kungadingeka ukuba ubeke izidakamizwa. Ukulawula ukucindezelwa kwegazi, ukuvimbela izidakamizwa kanye ne-calcium channel blockers.
Izinzuzo zokwelashwa
Ukwelashwa kufanele kube isikhathi eside, futhi mhlawumbe, impilo yonke. Ngokuvamile abantu bathatha imithi iminyaka engu-30-40. Izinzuzo zokwelashwa okunengqondo zihlanganisa:
• Ukunciphisa ekufeni, ikakhulukazi phakathi kwabokubhema kwabantu abasha abanomfutho wegazi ophezulu;
• ukunciphisa ubungozi bokuhluleka kwenhliziyo nokubola kwesisu;
• ukunciphisa ingozi yokuhluleka kwezinso.
Kodwa-ke, ngisho nokulawulwa kahle kwezimpawu, umfutho wegazi ophakeme ungase uzizwe ungalungile, ikakhulukazi uma ubhekene nemiphumela emibi yezidakamizwa, okungukuthi:
- ukukhathala - lapho uthatha i-beta-blockers;
- ukukhwehlela owomile - nokusetshenziswa kwe-ACE inhibitors;
- ukuphuza;
- izinkinga nge-potency, okungaba nomthelela ohlangothini wezidakamizwa eziningi.
Ukuqapha ukucindezela
Ngokuvamile, iziguli zikholelwa ngokungaqondile ukuthi zingagcina kalula ukucindezelwa kwegazi. Ukufeza amagugu aseqophelweni eliphezulu kunzima. Naphezu kokutholakala kwezidakamizwa eziningana, kuphela ama-20% amacala angakwazi ukufezekisa ukucindezeleka kwe-diastolic engaphansi kwe-90 mm RT. Art. Ezinganeni ezingu-60%, ukucindezeleka kwegazi kuguquke ezingeni elilinganiselwe (ukucindezeleka kwe-diastolic 90-109 mm Hg), kanti enye i-20% ine imiphumela emibi (engaphezu kuka-110 mm Hg).
Lapho ingcindezi yegazi igxilile, umhlengikazi angakwazi ukubhala kabusha imithi. Imiphumela ye-hypertension ingavinjelwa ngokuxilongwa kwesifo ngokushesha. Uma kungekho ukwelashwa, ukucindezeleka kwegazi kukhulisa ingozi yokufa ngaphambi kwesikhathi (ngaphambi kweminyaka engu-70). Kodwa-ke, ngokuphathwa okwanele, iziguli eziningi zinesikhathi sokuphila esingavamile ngaphandle kwezinkinga. Izimbangela eziyinhloko zokufa e-hypertension zine-stroke (45%) ne-infyoction ye-myocardial (35%). Amaqembu abantu abane-prognosis encane enhle ahlanganisa: iziguli ezincane; amadoda. Abesifazane abathatha izisu zomlomo bangasengozini yokushaywa yisisu noma isifo somzimba, ikakhulu uma bebhema.
Izinyathelo zokuvimbela
Ukuhlaziywa kwedatha ekwelapheni kwe-hypertension encane kubonise ukuthi ukwehla kwe-diastolic ingcindezi ngo-5-6 mm Hg. Art. kuholela emiphumeleni elandelayo:
• ukunciphisa u-38% engozini yokushaywa yisifo;
• ukunciphisa okungu-16% engozini ye-coronary heart disease.
Ukukhipha umfutho wegazi ophezulu, bonke abadala abadala abaneminyaka engama-80 kufanele bahlale njalo (izikhathi ezinhlanu ngonyaka) benze isilinganiso somfutho wegazi. Uma kuhlonza amagugu omngcele noma ukwanda okukodwa kokucindezelwa kwegazi, ukuqapha ngokucophelela kuyadingeka.