Unomfutho wegazi ophakeme kwabesifazane

unomfutho wegazi ophakeme kwabesifazane

VS Tchistov

Okokuqala MGMU-IM Sechenov

unomfutho wegazi ophakeme kuyinto namuhla - esinye sezifo ezivamile: ukuxilongwa "Arterial
nomfutho wegazi ophezulu "ukuzwa namuhla mayelana oyedwa kwaba- yishumi abantu abadala.
Lesi sifo kungaba buthule iminyaka eminingi ukubhubhisa imithambo yegazi nemithambo ye inhliziyo, futhi engekho afanelekayo
ukwelashwa esifike ngesikhathi, kuzoholela isifo senhliziyo, angina, senhliziyo ukuba buthakathaka kwezicubu, ukuze inhliziyo
ukwehluleka, isifo sohlangothi, ubumpumputhe, ukungasebenzi kwezinso ... kulolu hlu ukuqhubeka isikhathi eside kakhulu.
Ngenhlanhla, namuhla kunezindlela eziningi amathuba nje ukwehlisa high blood pressure, kodwa futhi
silondoloze ke isikhathi eside ezingeni elikhulu - wena kuphela kudingeka ekuhlolweni ngesikhathi
futhi ukuthola lesi sifo.
Kuyadingeka ukwazi: namuhla, bonke abantu abadala umuntu yeshumi has high blood pressure, kodwa
nengxenye yesizwe kuphela ukwazi ngenkinga. Futhi abantu nakakhulu abathola ukwelashwa okufanelekile: ezinye
Iziguli ungayiboni isidingo sokwelashwa uphile kahle, abanye abazi ukuthi mayelana nokuba khona kwamakamu yesimanje
ngempumelelo kakhulu futhi ibekezelelwe kahle imithi ukwehlisa wegazi. Phakathi naleso sikhathi, ukuphulukisa
nomfutho wegazi ophezulu kuyadingeka - ngisho noma lesi sifo asymptomatic, kungaholela kakhulu
nemiphumela edabukisayo. Musa engozini impilo yabo ngisho nokuphila kwabo.
Imiphumela nomfutho wegazi ophakeme abesifazane
Gqwa anda blood pressure (ie, umfutho ophakeme wegazi ngaphandle concomitant engcupheni) e
70% amacala kuholela unhlangothi kwabesifazane. Ukuze uqhathanise, ngo amadoda nomfutho wegazi ophezulu ngaphandle ingozi concomitant izici kuphelile
unhlangothi kuphela 30% amacala.
Ukuphumelela yokwelapha antihypertensive in abesilisa nabesifazane ngokufanayo. Nokho, ngeminyaka, ukuphumelela
yokwelapha antihypertensive kwabesifazane kuyehla, okuyinto kubangelwa izici of menopause (ngalokho ngezansi).
Kuze kube manje, ukuxakeka nomfutho wegazi ophezulu ithathe indawo yokuqala, uma sikhuluma nokufa yabesifazane
labantu. Inani systolic blood pressure kubantu besifazane sesibili ezibaluleke kakhulu ingozi factor
ka senhliziyo (CHD).
Ischemic isifo senhliziyo nomfutho wegazi ophezulu e abesifazane
Owesifazane indoda ayivelanga kuphela izici ngokobulili zamabanga aphansi naphezulu, kodwa umehluko futhi abashe
hormone, ufuzo, yokuphila - konke lokhu Yiqiniso, njengoba kubonakala kula Yiqiniso kwezifo ezihlukahlukene, ukuphepha kanye
ukuphumelela ukwelashwa.
Kwaphela iminyaka eminingi kukholakala ukuthi ingozi nesifo senhliziyo nemithambo yayo e abesifazane kakhulu ephansi kunaleyo
amadoda. Eqinisweni akusiyo, e abesilisa nabesifazane, izingozi ziyafana, ngaphezu kwalokho, kukhona ukuthambekela eminyakeni yamuva ukuze
ngokwempilo yangenyama anda isifo senhliziyo ungaphakathi abesifazane.
Ukuze uxazulule le nkinga, kumelwe, okungenani, ukukhomba main engcupheni senhliziyo
izifo abesifazane, kanye khona efuna izindlela ukulungiswa yabo. Evamile, zonke izici eziyingozi ukuze senhliziyo
izifo zingahlukaniswa ngamaqembu amabili: othize (ethize kuya phansi, kulesi simo ngoba
abesifazane), okungezona ethize (jikelele futhi kubantu besifazane kanye amadoda).
Ukuze izici ze-non-ethize zihlanganisa ubudala, kuwukubonakaliswa ekuseni izimpawu izifo zenhliziyo e
izihlobo, ukubhema, isifo sikashukela, ukukhuluphala ngokweqile, ukuphila umzimba, kahle-glucose ukubekezelelana,
ukwandisa in cholesterol Imininingwane, LDL cholesterol, ukwehlisa HDL cholesterol *. Naphezu kweqiniso lokuthi lezi zici azicacile e
izici nethonya layo ukwakheka zokugula kohlelo senhliziyo kwabesifazane kanye namadoda, kunomehluko.
Ngokuphathelene izici ezithile, base akunakubangelwa kwezinso umzimba ngesikhathi ekhulelwe,
menopause, inzalo hormone, gisterovariektomiyu.
It wafakazela ukuthi abesifazane ukukhuluphala futhi awela ingozi eliphezulu zibangele isifo senhliziyo: ingozi
It kukhuphuke ngo izikhathi 4. Izindlela ukuthi sidlale indima le nqubo azikakabi eyaziwa, kodwa ubudlelwano phakathi ukukhuluphala ngokweqile
Unjani umfutho wegazi ncamashi.
Kepha yokuphila, siye wafakazela ukuthi zingenzi lutho olunyakazisa umzimba njalo kwandisa ingozi
ukuvela nokuthuthukiswa izifo zenhliziyo nemithambo yegazi ngesigamu. Kungakhathaliseki ukuthi izinguquko isisindo ngesikhathi ngokomzimba
umsebenzi siyenzeka ukuzinza wegazi. Kukholakala ukuthi kuba nemiphumela emihle
imisebenzi ngokomzimba elihlobene ne izindlela engaqondile neqondile ekhona anomthelela ukuncipha
umfutho wegazi, umoya-mpilo esivimba amanzi ukuhlinzeka, ngaphezu, bonisani nethonya eliyinzuzo
igazi ekunqandeni izici, neqhaza ngcono kwegazi lipid bohlu.
Ngeshwa, ezweni lethu nomfutho wegazi ophezulu phakathi kwabesifazane kusakazeke futhi kwenzeka e 41.1%.
unomfutho wegazi ophakeme kwabesifazane bobudala obungefani
Ngokokuqala ngqá mayelana nomehluko amazinga blood pressure ngekwebulili uyakwazi ukukhuluma
Lapho eneminyaka eyisithupha. Nomfutho ophakeme wegazi ebonwe amantombazane kusukela kwabaneminyaka engamashumi ayisithupha futhi kuze
ukuthomba. Kodwa emva kokuthomba naphambi menopause ingashiwo ngaphezulu
umfutho ophansi wegazi kwabesifazane. Ngemva kokuma ukuya esikhathini, zonke umehluko zinyamalale, futhi
abesifazane babhekene nengozi yokuthola izifo eziphathelene nenhliziyo, umfutho wegazi ophakeme, uma kuqhathaniswa namaphesenti
amadoda.
Ukwanda nomfutho wegazi ophezulu phakathi kwabesifazane abasha akuyona high, kodwa ngemva kokuma ukuya esikhathini, ingozi
futhi ekuthuthukiseni ukwanda isifo kakhulu. Kodwa hhayi wonke owesifazane high blood pressure
It kuvumelana ukuqala involution ngokobulili. Eminyakeni yamuva, umfutho wegazi, futhi amanothi
phakathi kwabesifazane abasha, kubandakanya abesifazane abakhulelwe. Kungase kube kubonakala 15-30% abesifazane abakhulelwe eRussia syndrome abanomfutho wegazi ophakeme
okuholela eziyingozi, hhayi kuphela e yena phakathi nenkathi yokukhulelwa nokubeletha, kodwa futhi unalo omubi
umthelela onalesi sifo isikhathi eside abesifazane. Isikhathi esining impela kwenzeka ukuthi umfutho wegazi ophakeme kwenzeka ngesikhathi
sokukhulelwa ... futhi uhlala nowesifazane phakade.
Kwegazi e abesifazane kanye nezindlela zokuvimbela ukukhulelwa ngomlomo
Ukusebenzisa izinto zokuvimbela inzalo temlomo ingenye yezimbangela ezinkulu ukuthuthukiswa nomfutho wegazi ophakeme
abesifazane. Wafakazela ukuthi abesifazane ukuthatha le mithi, unesifo sikashukela ubuso izikhathi 2-3
kakhulu ukudlula abantu besifazane abangafuni ukwamukela lezo zimali. Ngaphezu kwalokho, ngomlomo ejenti umuthi okwazi
ngaphambili waphawula Sizobabucayi umfutho wegazi ophakeme emithanjeni. I ingozi yomfutho ophakeme wegazi ngesikhathi yokwemukelwa
umuthi ejenti temlomo inyuka kwabesifazane asebevile eminyakeni engu engu-35, uma owesifazane ebhema, kanye / noma ukuba khona
ukukhuluphala.
Okuphakamisiwe indlela-high blood pressure kubantu besifazane ngubani ukulawula lokuzalwa
izidakamizwa Temlomo: anda umzimba mass, umthamo wegazi, kukhona insulin,
sodium imakwe ukubambezeleka emzimbeni.
Kokulinganisa wegazi waphawula ngemva kwamasonto ambalwa ngemuva kokuphela zinsiza. kodwa uma
lo wesifazane isizinda izinto zokuvimbela inzalo isungule umfutho wegazi ophakeme, uma ingozi nemiphumela
kungenzeka ukukhulelwa kungaba kukhulu kune ingozi ukuqhubeka nomfutho wegazi ophezulu, kutuswa ukuba baqhubeke nokuphuza izinto zokuvimbela inzalo nge
ukwelashwa kanyekanye ne izidakamizwa antihypertensive.
Ingozi yokuba nomfutho wegazi ophezulu inyuka uma:
- babe umlando nomfutho wegazi ophezulu umndeni - kukhona ukukhuluphala - kukhona isifo sezinso - owesifazane engaphezu kwengu-35 ubudala - owesifazane enza izinto zokuvimbela inzalo isikhathi eside - uma, ngesikhathi esandulela sokukhulelwa blood pressure wakhushulwa.

Kwegazi e abesifazane ngesikhathi menopause futhi postmenopause
On ukwanda umfutho wegazi phakathi menopause kuthinta izinto eziningi - lokhu kuncipha kwesikhathi sokuphila
umsebenzi ngokomzimba, nomzimba kwesisindo futhi ekusetshenzisweni kakhulu utshwala kanye nosawoti.
Phakathi menopause kwandisa ingozi yesifo senhliziyo. Lokhu kungenxa kabusha
endocrine uhlelo ngalesi sikhathi futhi untula estrogen zamagama, ukuhlinzeka nethonya eliyinzuzo
cardio isimiso semithambo yegazi.
Estrogen ukuntula kungaholela anda nekghono pressor angiotensin II, ushintsho lipid
spectrum legazi phezu isizinda anda cholesterol Imininingwane, lipoproteins density aphansi kakhulu futhi ongaphakeme ukunciphisa
Inani eliphezulu kwabantu lipoproteins.
Phakathi kweziguli abaneminyaka engaphansi 40 isifo unesifo sikashukela, abesifazane baphathwa kancane kaningi kunabantu, kodwa eminyakeni 45-55 isimo
It uyashintsha, kodwa uzitshela isibalo sabesifazane abanomfutho wegazi ophakeme iqala ukuvela.
Ngakho, ukunaka kakhulu manje zikhokhelwe ukufuna imithi iphephile futhi isebenza ngempumelelo ekwelapheni
nomfutho wegazi ophakeme abesifazane postmenopausal - hhayi kuphela ukwehlisa blood pressure, kodwa futhi
ngenjongo ukulungiswa ukubonakaliswa menopausal, esizokunikeza enye yokwelapha hormone.
Ukwelashwa nomfutho wegazi ophakeme abesifazane
Namuhla, le nkinga eziphuthuma kakhulu ukuba uthole ukuthi iyini ubudlelwano phakathi nomfutho wegazi ophezulu kanye ahlukahlukene izifo ngenhloso
ukuthuthukisa elilungile tekubukana ukuba nokwelashwa (Oganov RG, 2007; SG Anikin, 2009; Jakushin SS,
2010).
Kodwa cishe zonke izazi zanamuhla uyavuma ukuthi ukwelapha umfutho ophakeme wegazi
mhlawumbe nika antigipergenzivnuyu yokwelapha.
Indawo ebalulekile amaqhinga besifazane nomfutho wegazi ophezulu kunikezwa impatho-non-kwemithi.
Ngakho, ngokwesibonelo,-kilojoule amaningi yokudla abesifazane ukukhuluphala kungaholela hhayi kuphela kwesisindo, kodwa futhi ukuba
aphansi blood pressure, ngaphezu, ekudleni omuhle kuthinte engcupheni njengesifo sikashukela,
insulin, hypertrophy esivimba amanzi ka-ventricle engakwesobunxele, hyperlipidemia.
Ungayithathi kalula indima lokuzivivinya: ukuhamba abavamile, ukubhukuda, Obonisa ku simulators, ukuzivocavoca zokwelapha
yokuzijwayeza nokunye kuzokusiza ukwehlisa indawo okuvela kuyo izingozi yentuthuko nomfutho wegazi ophezulu.
In parallel yokwelapha non-kwemithi kufanele libekwe izidakamizwa antihypertensive.
Ngaphambi kokubukeza izidakamizwa kakhulu ayethanda namuhla ukusho ukuthi amathemba ukusebenza kwe
hormone yokwelapha kuya kungenzeka nemiphumela elihle blood pressure, abangu kungafaneleki. Ngaphezu kwalokho,
Kwezinye izimo (ngo 9%) Akabonisanga ukwehla nokwanda umfutho wegazi phakathi
i-hormone replacement therapy.
Ngaphezu kwalokho, kufanele kuphawulwe ukuthi naphezu kwezinkinga elalibhekene sasivumela ububanzi, ukukhethwa ezihlukahlukene izidakamizwa antihypertensive,
Namuhla ukuphumelela ekwelapheni nomfutho wegazi ophezulu uhlala ezingeni sasivumela ongaphakeme. Ngaphezu kwalokho, idatha,
okuyinto eyatholakala ezifundweni zamadoda, abesifazane uthumele ngokuzenzakalelayo akunakwenzeka (Podzolkov NM, 2009;
Tkachev KU 2010). Ngenxa yalokho, ukubaluleka okukhulu inkinga yokwelapha umahluko lwemithambo
nomfutho wegazi ophakeme abesifazane, kanye nokuhlola ukusebenza amasu non-koda ezothuthukisa Izibikezelo,
izinga yokwelapha eside. Through ukuthuthukiswa ye-algorithm uzokwazi individualize ukwelashwa
abesifazane.
Kuze kube manje, e umfutho wegazi ophakeme emithanjeni e abesifazane babelwe noma iliphi inxusa antihypertensive (i
kungekho contraindications) yeqembu ngalinye ngesimo inhlanganisela noma wedwa. Ukuthuthukisa hypotensive
umphumela ngokuvamile ebekiwe hydrochlorothiazide (Umhlahlandlela-rohlortiazid). Ngokuvamile ekwelapheni nomfutho wegazi ophakeme abesifazane
ukusetshenziswa isisu: arifon kuthiye ukukhula, arifon, cardioselective beta-blocker (lokren (betaxolol), atenolol,
bisoprolol ngaphansi).
Uma sikhuluma ACE inhibitor, it is ngokuvamile asetshenziselwa moexipril, ngezinye izikhathi - fosinopril (monopril).
Ngokuqondene the omelene calcium ngesimo okuqhubekayo-ukukhululwa unamasu dihydropyridine (plendil, Norvasc,
kordafleks kuthiye), reception yabo kungenzeka, kodwa kumelwe kukhunjulwe ukuthi ezinye iziguli zingavela edema
ngezinyawo zabo, noma bangase babe evelele.

1. Ageev FT, Fomin IV, Mareev Y. et al. Lizinga nomfutho wegazi ophezulu eYurophu eyayiyingxenye ye-Russian
Federation. Lezizifundo AGE, 2003;
2. Shlyakhto EV belousov yb, Kirichenko AA et al. unomfutho wegazi ophakeme kwabesifazane postmenopausal. Nezenhliziyo. 2003;
3. Kobalava sesitimela, Tolkachev VV Moryleva KU izici Clinical kanye nokwelashwa nomfutho wegazi ophakeme abesifazane.
Inhliziyo. 2004;
4. Kuban Ucwaningo Medical Gazette izici Clinical kanye nemisebenzi uhlelo senhliziyo nemithambo yegazi e abesifazane nge nomfutho wegazi ophezulu. 2011;
5. Prokhorovich EA, 2006; Tkachev KU 2010; Oganov RG, 2007; Anikin SG, 2009; Jakushin SS 2010.