Cov tshuaj antihypertensive rau hom 2 mob ntshav qab zib mellitus raug xaiv ib tus zuj zus, muab nws cov nyhuv rau kev ua haujlwm ntawm lub raum, cov nyhuv ntawm cov metabolism hauv cov rog thiab carbohydrates. Arterial hypertension accompanies 80% ntawm cov neeg kev txom nyem los ntawm hyperglycemia. Cov kab mob sib xyaw ua rau kev ua haujlwm ntawm lub plab hnyuv siab raum, cuam tshuam rau lub ntuj tsim ntawm cov metabolism.
Nta
Cov tshuaj ntawm cov tshuaj siab rau cov neeg mob ntshav qab zib yog qhov nyuaj los ntawm qhov tsis xav tau yam tsis txaus ntseeg, qhov kev cia siab uas tshwm sim los ntawm cov tshuaj tiv thaiv kab mob hauv lub cev.
Kev xaiv cov tshuaj rau kub siab nrog hyperglycemia yog raws li cov xwm txheej:
- Ua kom tiav ntau tshaj plaws, yam tshuaj tiv thaiv yam tsawg kawg nkaus;
- Cardio thiab nephroprotective effect (tiv thaiv lub plawv thiab lub raum);
- Tsis muaj dab tsi cuam tshuam rau kev mloog ntawm lipids thiab cov piam thaj hauv cov ntshav.
Ceev ua yeeb yam tshuaj
Yog tias koj nquag nco dheev txog ntshav siab, cov tshuaj uas haum rau cov ntshav qab zib hauv ntshav qab zib yuav tsum nyob ntawm koj.
Yog tias xav tau kev pab thaum muaj xwm ceev, siv txhais tau tias nws cov txiaj ntsig ntawm lub cev kav ntev tsis tshaj 6 teev. Cov tshuaj muaj yees uas yog ib feem ntawm cov npe lag luam tshuaj:
- Captopril;
- Nifedipine;
- Clonidine;
- Anaprilin;
- Tus thawj coj.
Cov tshuaj kho rau siv kaw lus
Tus nyeem tas mus li sab saud 130/80 hli Hg. Kos duab. rau cov mob ntshav qab zib yog fraught nrog microvascular cov teeb meem, kev txhim kho ntawm atherosclerosis, qhov muaj tshwm sim ntawm cov mob ntshav qab zib angiopathies. Hauv qhov no, kev siv cov tshuaj tsis tu ncua yog pom zoo, thaum ua raws li kev noj ntsev thiab carbohydrate. Qhov cuam tshuam ntawm cov tshuaj tiv thaiv siab rau ntshav qab zib yuav tsum du. Kev poob rau hauv cov ntshav siab tom qab los ntawm kev dhia tawm yog ua kev puas tsuaj txawm tias cov kab mob hlab plawv ntawm tus neeg noj qab haus huv.
ACE inhibitors
Rau cov kev kawm tiav ncua zuj zus ntawm kev nthuav qhia kev mob ntshav siab, tshuaj thaiv angiotensin-hloov pauv enzyme (ACE) yog siv, uas ua rau cov synthesis ntawm angiotensin tshwm sim. Los ntawm kev txo qis ntawm cov tshuaj angiotensin, cov qog adrenal ua cov tshuaj hormones tsawg dua aldosterone, uas khaws cov ntsev thiab dej hauv lub cev. Vasodilation tshwm sim, cov kua dej ntau dhau thiab cov ntsev raug nthuav tawm, cov nyhuv hypotonic yog manifested.
Yam tshuaj uas thaiv ACE:
- Enalapril;
- Perindopril;
- Quinapril;
- Fosinopril;
- Trandolapril;
- Ramipril.
Qhov tsis zoo ntawm cov tshuaj tiv thaiv yog qhov muaj peev xwm ncua kev tshem tawm cov poov tshuaj thiab ncua cov hauj lwm zoo. Qhov cuam tshuam hauv daim ntawv thov raug soj ntsuam tsis muaj ntxov tshaj ob lub lim tiam tom qab tau teem tseg.
Angiotensin Receptor Blockers (ARBs)
Lawv thaiv cov kev sib txuas ntawm cov renin, uas ua rau muaj qhov hloov pauv ntawm angiotensin, uas ua rau kom txoj kev ntshav ntawm lub phab ntsa kom tsawg. ARBs raug tshuaj yog tias tsis haum rau ACE inhibitors yog tsim los. Tus txheej txheem ntawm lawv cov kev siv tshuaj biochemical sib txawv, tab sis lub hom phiaj yog zoo ib yam - kom txo tau cov kev cuam tshuam ntawm angiotensin thiab aldosterone.
Cov pab pawg hu ua sartans ntawm qhov kawg ntawm cov npe ntawm cov tshuaj nquag:
- Losartan;
- Valsartan;
- Irbesartan
- Candesartan.
Kev tshuaj ntsuab
Cov tshuaj kho ntshav qab zib muaj cov nyhuv hypotonic me me, yog raug kho tshwj xeeb hauv kev sib koom ua ke siv lwm yam tshuaj rau cov ntshav qab zib.
- Voj diuretics (furosemide, lasex) ua ke zoo nrog ACE inhibitors, tsis txhob cuam tshuam rau theem ntawm qab zib, lipids, thiab tsim nyog siv rau luv luv siv los tshem tawm cov nqaij mob loj heev. Kev tswj tsis siv siv provokes nrawm tshem tawm cov poov tshuaj, uas tuaj yeem ua rau kev nce hauv hypokalemia thiab mob plawv dhia tsis xwm yeem.
- Vim tias cov nyhuv diuretic me me, thiazide-zoo li diuretics (indapamide) tsis mob siab qhov sib npaug ntawm cov piam thaj, rog rog, poov tshuaj qib, thiab tsis cuam tshuam rau lub cev ua haujlwm ntawm lub raum.
- Thiazide diuretics (hypothiazide) hauv kev noj tshuaj txhua hnub ntau dua 50 mg tuaj yeem nce siab ntxiv thiab qib roj. Lawv tau txiav txim siab nrog ceev faj hauv kev txhaj tshuaj tsawg kawg vim tias qhov tshwm sim ntawm qhov tsis zoo lub raum tsis ua haujlwm thiab mob gout.
- Cov poov tshuaj-sparing tshuaj (veroshpiron) tsis pom zoo siv rau hauv hom 2 mob ntshav qab zib mellitus, nrog los ntawm kev ua haujlwm tsis zoo hauv lub raum.
Beta blockers
Tus nab npawb ntawm cov tshuaj uas thaiv kev tsim kho ntawm adrenoreceptors los ntawm adrenaline thiab norepinephrine tau raug kho feem ntau rau kev kho mob ischemia, cardiosclerosis, lub plawv tsis ua haujlwm. Nrog hyperglycemia, ntsiav tshuaj rau kub siab yog xaiv nrog cov nyhuv ntxiv vasodilating:
- Labetalol;
- Carvedilol;
- Nebivolol.
Calcium antagonists
Cov calcium calcium blockers - ib pawg tshuaj uas txo cov tshuaj calcium calcium ions. So kom txaus thiab nthuav cov phab ntsa hauv cov hlab ntsha, cov hlab ntsha, cov leeg hlwb muaj zog. Conditionally muab faib ua pab pawg:
- Verapamil, diltiazem. Cuam tshuam kev ua haujlwm ntawm myocardium thiab lub siab mob hlwb, txo qis kev mob plawv. Kev siv yooj yim nrog cov beta-blockers yog contraindicated.
- Cov khoom siv ntawm dihydropyridine - nifedipine, verapamil, nimodipine, amlodipine. Lawv so lub phab ntsa ntawm cov leeg hlwb txhim kho, ua kom lub plawv dhia.
Calcium antagonists tsis cuam tshuam rau cov kev ua kom rog, lipid metabolism. Thaum siv los ua tshuaj rau tswj siab, hom ntshav qab zib hom 2 txaus siab, tab sis muaj tus lej ntawm contraindications. Nifedipine yog contraindicated hauv angina pectoris, lub siab thiab lub raum tsis ua haujlwm, haum rau ib qho kev daws teeb meem ntawm kev nyuaj. Amlodipine yuav txhawb o. Verapamil muaj qhov ua tau zoo rau kev ua haujlwm ntawm lub raum, tab sis nws tuaj yeem ua rau bronchodilators.
Cov tshuaj tiv thaiv ib leeg
Antihypertensive tshuaj tau ua ke nrog txhua lwm yam, xaiv noj rau hauv tus account concomitant kab mob, tshuaj noj. Tawg siab, nrog rau kev mob ntshav qab zib ua txhaum ntawm cov metabolism hauv plab, ua rau muaj kev tsis haum tshuaj ntau yam.
Ua ntej siv, koj yuav tsum kawm cov npe ntawm cov kev mob tshwm sim, cov hau kev ntawm kev tshem tawm lawv.
Thaum noj, lub zog ntawm cov ntshav siab yog pom. Nyob rau tib lub sijhawm, qib ntawm glycated hemoglobin, cov roj cholesterol, triglycerides, yoo cov kua nplaum thiab tom qab noj tau soj qab. Undesirable deviations los ntawm qib txais yuav tsum tau hloov ntawm cov tshuaj.
