Helitaanka Daaweynta Cadaadiska Dhiig Sarreeya ee "Dhiig" ee ugu Fiican
Liistada daroogada iyo isku darka daroogada inta badan loo isticmaalo daaweynta dhiig-karka (cadaadiska dhiigga sareeya) waa mid aad u dheer.
Xaqiiqda ah in ay jiraan daroogo badan oo lagu kala doorto macnaheedu waa ugu yaraan laba waxyaalood. Marka hore, macnaheedu waa ma jirto daroogada ugu fiican "hypertension", taas oo ah, ma jirto daroogo si fiican u shaqeeya qof kasta oo aan keenin waxyeello aan la aqbali karin.
Haddii ay jireen, shirkadaha daroogada ayaa joojin lahaa dadaalkooda lagu horumarinayo daroogooyinka cusub ee antihypertensive-ka hor inta aan-iyo liiska daawooyinka la ansixiyay ayaa noqon doona mid aad u gaaban.
Marka labaad, daawooyin badan oo aad kala doorato, ilaa iyo inta adiga iyo dhakhtarkaagu aad u dulqaadan kartid oo joogto ah, waxay u badan tahay in ficil-celin ku habboon oo loo dulqaadan karo daaweyntaada hypertension. Si kale haddii loo dhigo, iyada oo aysan jirin daweyn "guud" oo loogu talagalay hypertension, waxaa laga yaabaa in ay kuu fiican tahay daaweynta "ugu fiican".
Maqaalkani, waxaanu ku sharaxi doonaa noocyada daawooyinka loo isticmaalo dhiig-karka, iyo tallaabooyinka uu dhakhtarkaagu ku qaato doorashada marka laga soo doorto (laga soo bilaabo doorashooyinka ugu wanaagsan ee xulashada) daaweyntaada ugu wanaagsan. Ugu dambeyntii, waxaanu bixin doonaa liis dhamaystiran oo ku saabsan dhammaan daawooyinka hadda laga isticmaalo Maraykanka (iyo dalalka ugu horumarsan) ee loogu talagalay daaweynta hypertension.
Doorashada Daaweynta Xuquuqda ee Dhiirigelinta
Dhakhaatiirtu guud ahaan waxay isticmaalaan hab nidaamsan oo lagu doorto daaweyn habboon oo loogu talagalay hypertension.
Talaabada 1aad: Dadka loogu talaalay qandho yar ama dhexdhexaad ah , waa muhiim in la bilaabo soo jeedinta isbeddelka hab-nololeedka ee lagu muujiyay in lagu caawiyo dhimista cadaadiska dhiigga. Kuwaas waxaa ka mid ah isbeddelka cuntada , xaddidaadda cusbada , jimicsiga joogtada ah, iyo joojinta sigaarka.
Talaabada 2aad: Haddii tallaabooyinkan hab-nololeedka ahi aysan keenin xakameyn cadaadis dhiig oo kugu filan dhawr toddobaad kadib, badanaa waa waqti aad ku dari karto daaweynta dawada.
Habka Aasaasiga ah ee loo Isticmaalayo Daaweynta Dawada ee Dhiirigelinta
Waxaa jira shan qaybood oo waaweyn oo daawooyin ah oo lagu caddeeyey inay wax ku ool u leeyihiin daawaynta dhiig-karka. Kuwani waa:
- Cudurka diirka ee Thiazide
- Cuncadeenta Angiotensin oo badalaya enzymes (ACE)
- Calcium Blockers
- Beta blockers
- Xayiraadaha anjiotensin (ARBs)
Daaweynta Dawada Keli ah
Haddii aad qabtid heer maskaxeed (hypertension) (halkaasoo cadaadiska wadnahaagu uu ka yar yahay 160 mm Hg, iyo cadaadiskaaga diimeedkuna ka yar yahay 100 mm Hg), talada guud waa in laga bilaabo hal daroogo mid ka mid ah shanta qeybood.
Guud ahaan, mukhaadaraad kasta oo ka mid ah fasaladaas (marka laga reebo beta-blockers, kuwaas oo guud ahaan waxtar u leh hal daroogo hal ah) waxay u muuqdaan inay si siman uga shaqeeyaan xakamaynta dhiig-karka. Gaar ahaan, waxaa jira qiyaas ahaan 50-50 fursad ah in daroogo gaar ah ay u shaqeyn doonto si ku filan qof kasta oo la siiyay oo leh heerka sare ee dhiig karka.
Si kastaba ha noqotee, shakhsiyaadka ayaa ka jawaabi doona si ka duwan kan daawooyinkaas. Jim waxaa laga yaabaa in uu si fiican uga jawaabo thiazide, laakiin waxa uu ku fashilmay xakameyn calcium ah, kiiskana leh Jane waxaa laga yaabaa inay noqoto mid sax ah. Guud ahaan ma jirto waqti ka hor inta aan la saadaalin Karin ee qofku ku habboon yahay nooca daawada. Sidaa darteed, waxa dhakhaatiirta iyo bukaannada laga tagay waa hab-barbaarin-iyo-khibrad waxbarasho.
Inay "qiyaasaan" daawada ugu horreysa ee lagu tijaabiyo, ayaa khabiirada intooda badani waxay ku talinayaan in ay bilawdaan midkood xitaa qanjidhada kaadida (sida caadiga ah chlorthalidone ama hydrochlorothiazide), xakameyn calcium dheer, ama ACE inhibitor. ARBs waxaa guud ahaan loo arkaa inay yihiin bedelaadayaasha xanuunka ACE, guud ahaanna waxaa loo isticmaalaa oo kaliya marka xanuujiyeyaasha ACE si liidata loo dulqaado.
Ma jiraan sharciyo adag oo dhakhso ah oo ku saabsan dawooyinka ay isticmaalaan dadka, laakiin waxaa jira dareeno gaar ah oo ka faa'iideysanaya xulashada daaweyn hal dawo ah:
- Bukaannada da 'yarta ah ayaa badanaa si fiican uga jawaab celiya xanuunka ACE.
- Bukaannada madow iyo bukaanada waayeelka ah waxay u muuqdaan inay ku fiicnaadaan tiyaatada diiretics ama blast kalsiyum.
- Bukaannada madow waxay u muuqdaan inay si xun u shaqeynayaan xanuunka ACE.
- Beta blockers ayaa badanaaba ah xulasho aan fiicneyn oo loogu talagalay daaweynta hal dawo, waxaana guud ahaan loo isticmaalaa haddii ay jirto sabab caafimaad oo kale oo loo isticmaalo beta blockers (sida baahida loo qabo in lagu daweeyo angina ama wadnaha wadnaha , ama si loo xakameeyo garaaca wadnaha ee qof oo leh fibrillada atrial ).
Guud ahaan, dawooyinka hoose ee daawada cadaadiska dhiigga ayaa ah mid waxtar u leh qiyaasta sare, waxayna keenaysaa waxyeelo yar. Marka, markaad isku dayeyso in aad hesho daaweyn hal-mar ah oo daaweyn ah, dhakhtarrada ayaa caadi ahaan bilaabaya qiyaas yar. Waxaa laga yaabaa inay go'aansadaan in ay kordhiyaan qiyaasta haddii qiyaasta bilawga ah aysan waxtar lahayn - laakiin marar dhif ah ayay u leedahay faa'iido ay ku leedahay "riix" qiyaasta daaweynta hal dawo ee daroogada sare. Taa bedelkeeda, haddii daroogadu ay ku fashilmeen inay ka shaqeeyaan qadar hooseeya, waa waqtigii loo beddeli lahaa qiyaas yar oo ah daroogo kala duwan.
Iyadoo la adeegsanayo noocyadan tijaabo-iyo-qalad ah, qiyaastii 80% dadka qaba heer-sare dhiig-baxa ayaa ugu dambeyntii loola dhaqmaa si ku filan hal daroogo oo keliya.
Isku-darka Daroogada
Isticmaalida wax ka badan hal daawo oo lagu daaweeyo dhiig-karka ayaa lagama maarmaan u ah laba xaaladood. Marka hore, daaweynta isku dhafan ayaa loo adeegsadaa dadka qaba heer-sareeya dhiig-karka iyo ugu yaraan laba ama saddex isku-day lagu guulaysan waayay si loogu daaweeyo cadaadiska dhiigooda daaweynta hal-daawada.
Marka labaad, daaweynta isku dhafka ah waxaa loo isticmaalaa dadka qaba marxaladda 2aad ee hypertension (taas oo ah, cadaadiska wadnehoodu waa 160 mm Hg ama ka sareeya, ama cadaadiskooda diimeedka 100 mm Hg ama ka sareeya.) Daaweynta kaliya ee daawada maahan mid aad ufiican , markaa daaweynta isku dhafan ayaa badanaa laga soo doortaa bilowgii.
Iyada oo daroogo badani ay kala doortaan, sidee dhakhaatiirtu u go'aansadaan daawooyinka ay isku daraan? Nasiib wanaag, dhowr tijaabo oo caafimaad ayaa la qabtay kuwaas oo bixiya hagid wax ku ool ah oo ku saabsan xulashada daaweynta isku dhafan ee loogu talagalay hypertension.
Caddaymaha ugu fiican (laga bilaabo maxkamadaynta ACCOMPLISH) waxay soo jeedinaysaa in natiijooyinka kiliinikada (oo ay ku jirto khatarta istaroogga , wadnaha wadnaha iyo dhimirka wadnaha) ay ku fiicnaadaan daaweynta isku dhafan marka barqadka calcium dheer oo lala isticmaalo ACE inhibitor ama ARB. Sidaas, maanta, dhakhaatiirta intooda badani waxay isku dayi doonaan isku-dhafkan.
Haddii cadaadiska dhiiggu uu sare u kacsan yahay daaweynta isku dhafan adoo isticmaalaya kalooriye xeeldheer iyo daroogada ACE ama ARB, daroogada thiazide ayaa inta badan lagu daraa daroogada saddexaad. Haddii ay isku dhafkan weli ku fashilmeen inay xakameyaan cadaadiska dhiigga, daroogada afaraad (sida caadiga ah spironolactone, diuretic non-thiazide) ayaa lagu dari karaa.
Inta badan bukaannada qaba hypertension waxay helayaan daaweyn guulo ah ka hor inta aan la tixgelin baahida daroogada saddexaad ama afaraad. Qofka naadirka ah ee ku fashilmay in uu si haboon uga jawaab celiyo daaweynta isku dhafka ah waa in loo gudbiyaa takhasusle sareeya.
Ka fogaanshaha saameynta xun ee ka yimaada daroogada
Mid kasta oo ka mid ah daawooyinka loo isticmaalo in lagu daaweeyo dhiig-karka ayaa leh dhibaatooyin keenaya. Markaad dooratid daawada ugu fiican "daweynta" ee loogu talagalay daaweynta qof qaba hypertension, waa muhiim in la helo daroogo (ama daroogo) oo aan si fudud u yarayn karin cadaadiska dhiigga, laakiin sidoo kale waa loo dulqaadan karaa.
Sababtan awgeed, waxay ahayd mid aad waxtar u leh in la isticmaalo dawooyinka hooseeya ee daroogada dhiig-miirtu ay waxtar u leedahay isticmaalka qiyaasta sare. Awoodda ay u leedahay in la helo qiyaaso yar oo aad u yar ayaa aad u yareeya khatarta waxyeelo xun.
Hase yeeshee, daroogooyinkaasi waxay sababi karaan dhibaatooyin, waana muhiim inaad adiga ka war hayatid dhibaatooyinka iman kara. Inkasta oo mid kasta oo ka mid ah daawooyinka dhiig-miir-qabadku uu leeyahay shakhsiyadiisa "saameyn dhinaca saameynta ah," inta badan saameynta xun ee daawooyinkaan waxay ku xiran tahay qaybtooda. Dhibaatooyinka xun ee ku xiran qaybaha category:
- Dhiig-baxa Thiazide: hypokalemia (heerarka potassium-ka hooseeya), kaadida joogtada ah, ka sii darista gout
- Cunnayaasha ACE: qufac, lumid dareenka dhadhanka, hyperkalemia (heerarka potassium ee sareeya)
- Calcium Blockers: caloosha, bararka lugaha, madax xanuun
- Beta blockers: ka sii darista xanuunka dyspnea ee dadka qaba xanuun joojiyaha joogtada ah ama neefta , cillad jinsi, daal, niyad-jabka, ka sii darista calaamadaha dadka qaba cudur halbowlaha ah
- ARBs: dareen-celinta xasaasiyadda, dawakhaad , hyperkalemia
Daawooyin badan oo aad kala doorato, waa dhif in dhakhtarku uu waydiin doono qof qaba hypertension inuu u dulqaato waxyeelo xun. Haddii lagugu daaweynayo dhiig-karka oo aad la kulantid waxyeello waxyeelo leh, waa inaad hubsataa inaad la hadasho dhakhtarkaaga sidii aad u heli lahayd hab daweyneed oo aad u dulqaadan kartid.
Liistada Mukhaadaraadka Daawooyinka Dheeriga ah ee Ugu Muhiimsan
Sida lagu xusay bilawga qodobkan, liiska daawooyinka loo oggolaaday daaweynta dhiig-karka ayaa ah mid aad u dheer. Halkan waa liis dhammeystiran oo dhammeystiran oo ah daroogooyinkaas. Magaca guud ee daroogada kasta ayaa horay loo taxay, kadibna magacyada ganacsiga.
Diuretics
Diuretics ("kaniiniyada biyaha") waxay kordhisaa qiyaasta sodium iyo biyaha oo ka soo baxa kaadida kelyaha. Waxaa loo maleynayaa in ay hoos u dhigto cadaadiska dhiigga intiisa badan iyada oo la yareeyo mugga dheecaanka ee ku jira maraakiibta dhiigga.
Diuretics caadi ahaan loo isticmaalo hypertension:
- Acetazolamide - Diamox
- Chlorthalidone - Thalidone, sidoo kale waxaa loo iibiyaa sida Tenoretic iyo Clorpres
- Hydrochlorothiazide - HydroDiuril, waxay sidoo kale iibisay Microzide iyo Esidrix
- Indapamide - Lozol
- Metolazone - Zaroxolyn, oo sidoo kale lagu iibiyey Mykrox
Diyaalo yaryar oo aan caadi ahayn ayaa loo isticmaalaa dhiig-karka:
- Amiloride hydrochloride - Midamor
- Bumetanide - Bumex
- Ethacrynic acid - Edecrin
- Furosemide - Lasix
- Spironolactone - Aldactone
- Torsemide - Demadex
- Triamterene - Dyrenium
Beta-blockers
Beta blockers ayaa xannibaya saameynta adrenaline ee nidaamka wadnaha, hoos u dhigi kara garaaca garaaca wadnaha, iyo dhimista cadaadiska wadnaha iyo xididdada.
- Acebutolol - Sectral
- Atenolol - Tenormin
- Betaxolol - Kerlone
- Bisoprolol - Zebeta, sidoo kale waxaa lagu iibiyey Ziac
- Carteolol - Cartol
- Carvedilol - Coreg
- Labetalol - Normodyne, oo sidoo kale lagu iibsaday Trandate
- Metoprolol - Lopressor, oo sidoo kale lagu iibiyo Topol
- Nadolol - Corgard
- Penbutolol - Levatol
- Propranolol - Inderal, Inderal LA
- Timolol - Blocadren
Calcium Channel Blockers
Bloodyaaliyeyaasha Calcium channel waxay hoos u dhigi karaan cadaadiska dhiigga iyagoo dilaya halbowlayaasha iyo, xaaladaha qaarkood, yaraynta xoogga wadnaha ee wadnaha.
- Amlodipine - Norvasc, sidoo kale waxaa loo iibiyey Caduet iyo Lotr
- Diltiazem - Cardizem, sidoo kale waxaa loo iibiyey Dilacor iyo Tiazac
- Felodipine - Plendil
- Isradipine - DynaCirc
- Nicardipine - Cardene
- Nifedipine - Procardia XL, sidoo kale waxaa loo iibiyey Adalat
- Nisoldipine - Sular
- Verapamil hydrochloride - Isoptin, waxa kale oo lagu iibiyaa Calan, Verelan, iyo Covera
Angiotensin Isugeynta Isugeyntii Enzyme
Hoos u dhicidda angiotensin ee enzyme inhibitors ("ACE inhibitors") waxay hoos u dhigi kartaa cadaadiska dhiigga adoo adkaynaya halbowlayaasha.
- Benazepril - Lotensin
- Captopril - Capoten
- Enalapril - Vasotec, ayaa sidoo kale loo iibiyey sidii Vaseretic
- Fosinopril - Monopril
- Lisinopril - Prinivil, sidoo kale waxaa loo iibsaday Zestril
- Moexipril - Univasc
- Quinapril - Dhaqanka
- Ramipril - Altace
- Trandolapril - Mavik
Angiotensin II Qalabaynta Xaaladaha
Blood-ridayaasha anjiotensin II ("ARBs") ayaa sidoo kale hoos u dhigaya cadaadiska dhiigga iyadoo la marinayo xididdada halbowlayaasha.
- Candetsartan - Atacand
- Irbesartan - Avapro
- Losartan - Cozaar
- Telmisartan - Micardis
- Valsartan - Diovan
Waxyaabaha kale, Caadi ahaan Isticmaal Daroogooyinka Dhiirigelinta
- Clonidine - Catapres
- Doxazosin - Cardura
- Guanabenz - Wytensin
- Guanfacine - Tenex
- Hydralazine hydrochloride - Apresoline
- Methyldopa - Aldomet
- Prazosin - Minipress
- Reserpine-a ee Serpasil
- Terazosin - Hytrin
Daroogooyinka Isugeynta ee Dhiirigelinta
Daawooyinka daroogada ah ee la isku daro ayaa lagu iibiyaa qandhada, waana wax aan suurtogal ahayn in lala socdo kuwa cusub ee soo socda, ama kuwa duugoobay ee soo daata. Kuwa soo socdaa waa liis dhammaystiran oo buuxa ee daawooyinka isku dhafan ee loo isticmaalo isticmaalka hypertension.
- Amiloride iyo hydrochlorothiazide - Moduretic
- Amlodipine iyo benazepril - Lufat
- Atenolol iyo chlorthalidone - Tenoretic
- Benazepril iyo hydrochlorothiazide - Lotensin HCT
- Bisoprolol iyo hydrochlorothiazide - Ziac
- Captopril iyo hydrochlorothiazide - Capozide
- Enalapril iyo hydrochlorothiazide - Vaseretic
- Felodipine iyo enalapril - Lexxel
- Hydralazine iyo hydrochlorothiazide - Apresazide
- Lisinopril iyo hydrochlorothiazide - Prinzide, ayaa sidoo kale lagu iibiyaa Zestoretic
- Losartan iyo hydrochlorothiazide - Hyzaar
- Methyldopa iyo hydrochlorothiazide - Aldoril
- Metoprolol iyo hydrochlorothiazide - Lopressor HCT
- Nadolol iyo bendroflumethiazide - Corzide
- Propranolol iyo hydrochlorothiazide - Inderide
- Spironolactone iyo hydrochlorothiazide - Aldactazide
- Triamterene iyo hydrochlorothiazide - Dyazide, sidoo kale waxaa loo iibiyey Maxide
- Verapamil sii daayo sii-deyn) iyo trandolapril - Tarka
Ereyga
Dhiirrigelintu waa dhibaato caafimaad oo caadi ah oo keeni karta cawaaqib xun haddii aan loola dhaqmin si ku filan. Si kastaba ha noqotee, xulashooyin badan oo daaweynta ah, waa inaad ka filataa dhakhtarkaagu inuu helo daaweyn caafimaad oo si weyn u yareeya khatarta ah natiijada xun ee ka yimaada hypertension, iyada oo aanad carqaladeeynin nolol maalmeedkaaga.
> Ilo:
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> Jamerson KA, Bakris GL, Wun CC, iyo al. Muuqaalka iyo Naqshadeynta Dhacdooyinka Ka Hortagga Wadnaha Iyadoo la adeegsanayo Daaweynta Iskudarka ee Bukaan-jiifka Qalitaanka Dhiig-Jir-Xeedhiga (ACCOMPLISH) Maxkamad: Kala-Bixinta kowaad ee la xakameynayo si loo isbarbardhigo saameynta cudurka natiijooyinka ka hortagga isku-dhafka. Am J Hypertens 2004; 17: 793.
> Mancia G, Fagard R, Narkiewicz K, iyo al. 2013 Tilmaamaha ESH / ESC ee Maareynta Dhibaatada Qalodheerta: Hagaajinta Xoogga ee Maaraynta Jirrada Jirrada ee Bulshada Yurubiyanka ee Dhiirrigelinta (ESH) iyo Bulshada Yurub ee Wadnaha (ESC). J Hypertens 2013; 31: 1281.
> Weber MA, Schiffrin EL, White WB, iyo al. Tilmaamaha Tababarrada Caafimaadka ee Maareynta Dhiirrigelinta Bulshada ee Warbixinta ay soo saartey Jaaliyada Maraykanka ee Dhiirrigelinta iyo Bulshada Caalamka ee Dhiirrigelinta. J Hypertens 2014; 32: 3.