Dr. Alex Jimenez Anopa: Sei Hypertension Inotsanangurwa

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ziviso

Dr. Alex Jimenez, DC, anopa kuti hypertension inobata sei muviri wemunhu uye zvimwe zvikonzero zvinogona kuwedzera hypertension muvanhu vakawanda mune iyi 2-part series. Isu tinoendesa varwere vedu kune vane certified varapi vanopa akawanda aripo marapirwo kune vanhu vazhinji vanorwara nehypertension yakabatana nemoyo uye immune system inobata muviri. Isu tinokurudzira mumwe nemumwe wevarwere vedu nekuvataura kune vanobatana nevanorapa maererano nekuongorora kwavo zvakakodzera. Isu tinonzwisisa kuti dzidzo inzira inofadza kana uchibvunza vatinopa mibvunzo pakukumbira nekunzwisisa kwemurwere. Dr. Jimenez, DC, anongoshandisa ruzivo urwu sebasa rekudzidzisa. Disclaimer

 

Maitiro Ekutsvaga Hypertension

Dr. Alex Jimenez, DC, anopa: Ngatidzokerei kumuti wesarudzo kuitira kuti utange kufunga nezvekuti uchashandisa sei go-to-it modhi mumishonga inoshanda kune hypertension uye kuti unotanga sei kuongorora munhu ane hypertension zviri nani pane kuvaudza kuti BP yavo yakakwira. . Muviri unopesvedzerwa nekuzvimba, oxidative kusagadzikana, kana immune system? Iri kukanganisa endothelial basa kana vascular smooth muscle kubva kune iwo matatu mapoka ekuita, kuzvimba, oxidative kusagadzikana, kana immune system? Isu tinosarudza diuretic calcium channel blocker kana ACE inhibitor here? Uye kuti uite izvozvo, zvakakosha muchikamu chedu chekuunganidza. Kutora nhoroondo yekurapa uye nguva yeBP yavo, iwe unowana ruzivo nezve kukuvadzwa kwenhengo kune mibvunzo. Iwe uri kutarisa kune avo anthropometrics.

 

Izvi zvinosanganisira mibvunzo inotevera:

• Ndezvipi zviratidzo zvekuzvimba?
• Chii chinonzi biomarkers uye zviratidzo zvekiriniki?

 

Izvo zvinotsanangurwa kuburikidza nekiriniki sarudzo muti. Uye uchitoita izvozvo, uchawedzera uye gadzirisa lens yako pane zvaungaone mumurwere wako ane hypertension. Ngati wedzerei kuchirongwa chenguva kuti hypertension inotanga rinhi? Nguva yakatarwa yehypertension inotanga chaizvo panguva yekuzvara. Zvakakosha kubvunza murwere wako kana aive ezera rekutanga kana rakakura redzidzo. Amai vavo vaiva nestress here? Vakakurumidza kuzvarwa here kana kuti nguva isati yakwana? Paive nekushushikana kwekudya pamuviri wavo here? Kana vakazviziva, unogona kuita vanhu vaviri vane saizi yeitsvo yakafanana, asi munhu akange asina mapuroteni akakwana panguva yekuzvitakura anogona kuita 40% shoma glomeruli. Kuziva izvo zvinoshandura magadzirisiro aunoita mushonga makumi emakore gare gare kana uchiziva kuti vanogona kunge vane 40% shoma glomeruli.

 

Nguva Yekudzvanywa Kweropa

Dr. Alex Jimenez, DC, anopa: Saka zvakakosha kutora nguva yeBP yavo. Zvadaro zvakakoshawo kuziva zviri kuitika patinotanga kuronga uye kuunganidza data kuburikidza ne biomarkers; iwo ekutanga biomarkers anokupa zviratidzo zvekuti vane nyaya ne insulin lipids, vangave vaine matambudziko nevascular reactivity, autonomic nervous system balance, kusaenzana, coagulation, kana immune toxin mhedzisiro. Saka ichi chinhu chine musoro kudhinda nekuti, mumurwere wako ane hypertension, izvi zviri kuburikidza neiyo biomarkers iwe unogona kutanga kuwana ruzivo rwekuti ndedzipi nzvimbo dzekusashanda dzinokanganisa kuzvimba, kushushikana kweoxidative, uye mhinduro yekudzivirira uye kuti ma biomarker aya anoratidza sei izvozvo. ruzivo kwauri. Izvi zvine musoro kuti uve pamberi pako kuti ubatsire kushandura pfungwa dzako nezve hypertension uye zvakare zvinoita kuti iwe ugone kunatsa humwe hunhu hwemunhu ari kune rimwe divi re stethoscope yako nenzira yakasarudzika, chaiyo.

 

Asi ngatitangei pakutanga. Murwere wako ane high blood pressure here? Isu tinoziva kuti zvichienderana nekuguma kwenhengo mhedzisiro yecomorbidities yavo, unogona kumhanyisa mumwe munhu kukwira kweropa kana uine dambudziko rakakura muuropi neitsvo kana moyo, asi mamwe nhungamiro iripo. Yedu 2017 American Heart Association mirayiridzo yezvikamu zveBP yakanyorwa pano. Vakanyungudika uye vadzikira kumashure nekudzoka kwemakumi emakore apfuura, asi izvi zviri pachena. Sezvo yakakwira BP, chero chinhu chiri pamusoro pe120, chakanyatso chinja kuti vangani vanhu vatinotanga kuona kana kufunga nezve zvikonzero zveBP yavo. Saka tichadzoka kune izvi, kunyanya munyaya yekutibatsira kutarisa kuti tinoisa sei vanhu vane nyaya dzeBP.

 

Mamiriro Ekuita Kuyera Kuwedzera Kweropa

Dr. Alex Jimenez, DC, anopa: Nhanho yekutanga ndeipi? Ndizvo here kuti BP yako inotorwa sei? Vanoriongorora kumba here? Vanouya nenhamba idzodzo kwauri here? Unoongorora sei kukwira kweropa mukiriniki yako? Unowana sei kuverenga chaiko mukiriniki yako? Heano maitiro ekuyera nemazvo BP uye mibvunzo yekufunga kana uri kuita zvese izvi. 

• Iwe unobvunza murwere wako kana vanga vaine caffeine muawa yekupedzisira?
• Kuti vakamboputa muawa yapfuura here?
• Vakapinzwa muutsi muawa yokupedzisira here? 
• Nzvimbo yauri kutora BP inodziya uye yakanyarara here?
• Vagere vakatsigira musana pachigaro vakaisa makumbo pasi here?
• Iwe unoshandisa roll-yakatenderedza tafura yekurembera ruoko rwako padanho remoyo?
• Vagere patafura yebvunzo makumbo avo akarembera, uye mubatsiri mukoti anosimudza ruoko rwavo oisa mupete yavo yeaxillary kuti vabate ruoko rwavo ipapo?
• Tsoka dzavo dziri pasi here? 
• Vagarapo kwemaminitsi mashanu here? 
• Vaita maekisesaizi here mumaminetsi makumi matatu apfuura? 

 

Iwe unogona kunge uine systolic blood pressure kana zvese zviri mumaitiro. Heino dambudziko. Kune 10 kusvika 15 millimeters emercury yakakwirira kana zvasvika pakugara nekutora ropa. Zvakadini nekukura kwecuff? Tinoziva makore zana apfuura; vanhu vakuru vazhinji vaive nedenderedzwa repamusoro remaoko risingasviki masendimita makumi matatu nematatu. Vanopfuura 33% yevanhu parizvino vane denderedzwa repamusoro remaoko rinodarika masendimita makumi matatu nematatu. Saka saizi yecuff yakasiyana kune inotenderedza 61% yevarwere vako vakuru, zvichienderana nehuwandu hwako. Saka iwe unofanirwa kushandisa cuff yakakura. Saka tarisa kuti BP inounganidzwa sei muhofisi yako. Ngatitii BP yakakwira muvarwere vako; saka tinofanira kubvunza, zviri normal here? Hukuru.

 

Mhando dzakasiyana dzeHypertension

Dr. Alex Jimenez, DC, anopa: Yakakwira nekuda kwewhite-coat hypertension? Vane BP yakajairika, yakakwira kunze kwekiriniki, kana hypertension yakavharwa? Kana kuti vanongogara vaine hypertension zvinova zvinonetsa? Tichataura nezvazvo. Saka kana iwe uchidudzira, zvakakoshawo kufunga ambulatory blood pressure yekutarisa. Saka kana uine munhu ane hypertension uye usingazive kana BP ichidzika uye uri kuyedza kuona kuti vane hypertension, unogona kushandisa maawa makumi maviri nemana ekutarisa BP. Zvinorehwa masikati ropa pamusoro pe24 pamusoro pe130 ndeye hypertension iyo inoreva husiku hweropa kupfuura 80 pamusoro pe110 ndeye hypertensive. Saka nei izvi zvakakosha? Huwandu hweBP inodzika kusvika pa65% husiku nekuda kwenyaya yekudonha kweropa. Kutadza kudonha kweropa paunenge wakarara usiku kunogona kukonzera matambudziko anogona kukanganisa munhu zuva rese. 

 

Kana murwere wako akarara usiku, inofanira kudonha inenge 15% pavanenge vakarara. Kana vasina-dipping blood pressure, inosanganiswa necomorbidities. Ndeapi mamwe eaya comorbidities mukusanyudza BP yeropa? Mamwe emamiriro anoenderana nekusanyura kweropa kunosanganisira:

• Congestive Heart Disease
• Mwoyo Mwoyo
• Cerebrovascular Disease
• Kukanganisa Mwoyo Kusakundikana
• Kutadza Kwerenal Kusingaperi
• Silent Cerebral Infractions

Co-morbidities Yakabatana Nekusina-Ropa Kuwedzera

Dr. Alex Jimenez, DC, anopa: Aya ndiwo macomorbidities ane chekuita nekusakwira kweropa. Tose tinobvuma kuti kukwira kweBP hakuna kunaka mumamiriro ese iwayo. Saka kana iwe ukatarisa kumapoka evanhu vakasiyana kana mamwe macomorbidities, kusadonha kweropa kunonyanya kusanganiswa nevanhu vane sodium-sensitive, vanhu vane renal insufficiency, vanhu vane chirwere cheshuga, vanhu vakasiya ventricular hypertrophy, vanhu vane refractory hypertension. kana autonomic nervous system dysfunction uye pakupedzisira, kufema kwehope. Saka, kusadonha kweropa kunowedzera kushamwaridzana kwako ne subclinical cardiac kukuvara. Zvakanaka, Reverse dipping zvinoreva kuti iwe unowedzera hypertension usiku uye inokwira zvakanyanya kupfuura masikati ine hukama nehemorrhagic sitiroko. Uye kana uine mumwe munhu ane nocturnal hypertension, unofanira kutanga kufunga pamusoro pezvinhu zvakadai se carotid arteries uye kuwedzera carotid, mukati memukati makobvu. Iwe unotanga kufunga nezve kuruboshwe ventricular hypertrophy uye unogona kuzviona paEKG. Hezvino izvo zvatinoziva nezve nocturnal hypertension. Nocturnal hypertension iropa rehusiku rinopfuura 120 pamusoro pe70. Inobatanidzwa nekufungidzira kukuru kwehutano hwemwoyo uye kufa.

 

Kana uine hypertension yehusiku, inowedzera njodzi yako yekufa kubva kuchirwere chemoyo ne29 kusvika 38%. Tinofanira kuziva zviri kuitika usiku kana takarara, handiti? Zvakanaka, chii chimwe kunatsa? Kumwe kunatsa kuziva kuti kuzorora kweropa kunodzorwa nerenin-angiotensin system yako. Kumuka kweropa kunodzorwa nehurongwa hwako hwekunzwira tsitsi. Saka ngatitaure pamusoro pekuti renal angiotensin system yavo inofambisa sei hypertension yavo yehusiku, uye iwe unofunga nezvemishonga yavari kutora. Iwe unogona kushandura dosing yemishonga kusvika manheru. Zvakanaka, zvidzidzo zvakaratidza kuti kana uine hypertension yehusiku uye usiri-dipper, zviri nani kutora yako ACE inhibitors, ARBs, calcium channel blockers, uye mamwe mabeta blockers usiku usati warara. Asi zvine musoro kuti iwe haungafambise diuretics yako kusvika husiku, kana iwe uchave nekukanganisa kurara.

 

Kugadzirisa Masikati & Husiku Hwekudzvanywa Kweropa

Dr. Alex Jimenez, DC, anopa: Saka kana tikasagadzirisa BP yemasikati neyehusiku, tinofanira kufunga nezvezvinokonzeresa BP. Ndeipi avhareji yeBP yemazuva ese uye yako ine mwero yekurara yeropa. Isu tinoziva kuti kukwira kweropa muvanhu vechidiki vane hypertensive chete inosvika 9% yenguva. Saka zvichireva kuti systolic mutoro ungangoita 9% kupesana nevakura, ingangoita 80% yeropa remutoro ndeye systolic. Uye saka kana iwe uine yakakwira systolic mutoro, iwe une mamwe matambudziko uye magumo-organ kukuvara. Saka zvatiri kutaura nezvazvo kubatsira kuziva murwere wako ane hypertension; nguva yavo ndeyei? Chii chinonzi phenotype yavo? Vanongori nehypertension masikati here, kana kuti vari hypertensive husiku futi? Tinofanira kutarisa kuti chii chinobatsira kuenzanisa izvozvo.

 

Heino imwe pfungwa, ingangoita 3.5% yevanhu vane hypertension ndiyo ine genetic chikonzero. Chete 3.5% yevanhu majini avo anokonzera hypertension. Simba riri pazasi pematrix uye nekuziva mapatani aya, handiti? Saka iwe unotarisa kurovedza muviri, kurara, kudya, kushushikana, uye hukama. Saka tinoziva kuti aya mana anozvimiririra anobatsira kuona BP. Isu tichaongorora renal angiotensin system, plasma vhoriyamu painobatirira pane yakawandisa mvura, yechipiri munyu mutoro, uye endothelial kusagadzikana. Kusagadzikana mune chero ipi zvayo kunogona kukonzera hypertension. Isu tanga tichitaura nezve imwe inogona kutungamira kune hypertension: chinongedzo pakati pe insulin kuramba uye hypertension.

 

Iyi diagrammatically inokupa iwe pfungwa yekusangana kwe physiologic pakati pe insulin kuramba uye hypertension. Inokanganisa kuwedzera kwekunzwira tsitsi uye kuwedzera renal-angiotensin system chiyero. Saka ngatitorei maminetsi mashoma pane renin-angiotensin system nzira angiotensinogen yakadzika kusvika kuangiotensin maviri. Isu tinotora mukana weaya ma enzymes nekupa inhibitors kune angiotensin-inoshandura enzymes muvarwere vedu vane hypertensive. Yakakwira angiotensin maviri inotungamira kune yemoyo hypertrophy, inotungamira kune tsitsi chikamu constriction, kuwedzera vhoriyamu yeropa, sodium fluid, kuchengetwa, uye aldosterone kuburitswa. Unogona here kubvunza nezvemurwere wako biomarkers? Unogona here kubvunza kana vakakwirisa renin mazinga?

 

Tarisa Zviratidzo

Dr. Alex Jimenez, DC, anopa: Zvakanaka, unogona. Iwe unogona kutarisa plasma renin basa uye aldosterone mazinga. Zvakakosha kuita izvi kana murwere wako ane hypertensive uye asati ambotora mishonga nokuti apa ndipo apo nitrous oxide yakakosha. Apa ndipo pane yako endothelial nitric oxide synthase iripo. Apa ndipo paunenge uine sheer uye hemodynamic stress. Apa ndipo panowanikwa kudya kwearginine kana nharaunda inobata nitric oxide inoita basa rakadaro muhutano hweiyi layer ye endothelia. Kana ukaiisa pamwe chete neimwe nzira, nenzira inoshamisa, kana kuti muziso repfungwa dzako, inovhara matare etenisi matanhatu muavhareji mukuru. Inzvimbo huru yepamusoro. Uye izvo zvinokonzeresa endothelial dysfunction haisi nhau nyowani kune vanhu mune inoshanda mushonga. Kuwedzera oxidative kusagadzikana uye kuzvimba zvinhu zviviri zvatataura zvinotamba mhedzisiro.

 

Uye zvino, tarisa zvimwe zvezvimwe zvikamu izvi, ADMA yako ichikwidziridzwa uye yakabatana ne insulin kuramba. Zvose zvinotanga kuumba pamwe chete mumatrix inopindirana. Saka iwe unotarisa imwe comorbidity mu cardiometabolic syndrome, uye inokanganisa imwe comorbidity. Iwe unoerekana waona kudyidzana pakati pavo kana hyperhomocysteinemia, inova imwe-kabhoni metabolism marker, zvichireva kuti uri kutarisa kukwana kwefolate, b12, b6, riboflavin, uye icho chiitiko chenyu-carbon metabolism. Saka ngatitarisei mamwe eaya ari kubuda enjodzi mamaki ekuvandudza uye kuronda muvarwere vane hypertension. Ngationgororei zvakare ADMA zvakare. ADMA inomirira asymmetric dimethyl arginine. Asymmetric, dimethyl arginine ndeye biomarker ye endothelial dysfunction. Iyo molecule inhibits nitric oxide synthase apo inokanganisa endothelial basa, uye mune zvose zvinokonzerwa ne cardiometabolic syndrome, ADMA inogona kukwidziridzwa.

mhedziso

Saka, sekuongorora nekukurumidza, L-arginine inoshandurwa kuita nitric oxide kuburikidza ne nitric oxide synthase, uye nitric oxide kukwana inotungamira kune vasodilation. ADMA inovharisa shanduko iyi. Uye kana yako ADMA mazinga akakwira uye yako nitric oxide mazinga akadzikira, saka wadzikira nitric oxide platelet aggregation inowedzera muLDL oxidation. Saka zvinhu zvakawanda zvinoderedza nitric oxide kana kuti zvinosanganisirwa neakadzika nitric oxide mazinga, apnea yekurara, low dietary arginine, protein, zinc insufficiency, uye kuputa.

 

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