arteriuli hipertenzia

nacionaluri gaidlainisruli versia

nacional uri gaidlain i momzad ebulia Se mdegi organiza cie bi s mi er : saqarTv elos hiper te nzi is Semswa vle li sazogadoe ba, saqarTv elos kardiolog Ta koleji da janmr Telobis servis is kvl ev eb is centr i.

avtore bi

prof. beJan winamZR vriS vili – akad. m. winamZRv riS vil is sax. kardiologi is instit utis dire qto ri, saqarT velos hipert enzi is Sems wav leli sazogadoeb is prez ide nti , evropis hipert enzi is sazogadoebis klin ikuri hiperte nz iis special istis programis nacio nalu ri sele qt iuri komit etis Tavmjdo mar e.

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levan yuraSvi li – saqarT velos kardiol ogTa kolejis vicepr ezide nti , joenis samedic ino cen tri

dali trapaiZe - kardio logi is insti tuti , saqarTv elos hipert enzi is Semswa vle li sazogadoeb is arteri uli hipert enzi is kontr olis samuSao jgufis xelmZRva neli .

vaxtang barba qaZe – janmr Telobis serv isis kvl ev eb is cent ri ,T er apiis erovn uli centr i, med .m ec .ka nd.

giorgi kaWarava – saqarTve los kardiolog Ta kolej is prezid ent i, joenis samedic ino cent ri

zaza mgalobl iSv ili - saqarTv elos kardiol ogTa kol eji, joen is samedic ino cent ri

naTia axalaZe - saqarTv elos kardiolog Ta kol eji, joenis samedici no centr i

nata gonjilaSv ili - saqarTve los kardiol ogTa kolej i, joenis samedi cin o centr i

revaz TaTa raZe – jandacvis msofl io organiza ciis programa “CINDI”- s direqt ori saqarTv eloSi , saqarTv elos sazogadoebe bi s kardio vask uluri preve nci is gaerT ian ebuli komi tetis TavmJd omar e, evrop is hipert enzi is sazogadoeb is klini kuri hiperte nz iis specia list is programis nacional uri sele qti uri kom it etis wev ri . med. mec n. kand.

dodo kaWaxiZ e – kardiologi is instit uti , saqarTv elos hiperte nz iis Semswa vle li sazogadoe bis vice- prezid ent i, med . mecn . kand., evr opis hiperte nz iis sazogadoe bis klini kuri hipert enziis special ist i.

Tamar abesaZ e – kardiologi is insti tuti, saqarTv elos hipert enzi is Semswa vle li sazogadoeb is arteri uli hipert nziis kont rol is samuSao jgufi , evropis hipert enzi is sazogadoe bis klin ikuri hipert enzi is specialis ti .

ana rexviaSv ili – saqarT velos hiperte nz iis Sems wavl eli sazogadoebis arteri uli hiperte nz iis kontro lis samuSao jgufi.

nino lolaZe – kardiol ogiis instit uti , saqarT velos hiperte nz iis Semswa vle li sazogadoe bis arteri uli wnev is amb ulat ori uli monit ori re bis samuSao jgufi, med. mec n. kand.

giorgi papiaSvili – saqarTv elos kardiol ogTa koleji , joenis samedic ino centr i

konstantine liluaSvili, med icin is m ec ni ere baTa ka ndidati, T er apiis erovnuli centri,jan mrTelobis s er visis kvleve bis ce ntri (CHSR)

leva n qobliani Ze , Tera piis erovn uli centri ja nmrTelobis servisis kvlevebi s centri (CHSR).

s a r C e v i

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winasityvaoba.............................................................................................................................................................................................. ............5meTodologia......................................................................................................................................................................................................... .7definicia, sinonimebi, terminologia.............................................................................................................................. ......7epidemiologia....................................................................................................................................................................................................... 7etiopaTogenezi.................................................................................................................................................................................. ..................8klinikuri simtomatika.................................................................................................................................................................... ...10arteriuli wnevis klasifikacia.............................................................................................................................. ...............10Mmeoradi hipertenziis mizezebi. (identificirebadi mizezebi)....................................... ..............11mkacri Cvenebebi................................................................................................................................................................................. ..............12arteriuli wnevis gazomva............................................................................................................................................................. ..14arteriuli wnevis ambulatoriuli monitoringi............................................................................... ..............15arteriuli wnevis TviTkontroli.............................................................................................................................. ...........15pacientTa Sefaseba............................................................................................................................................................................. .........16laboratoriuli analizebi da sxva diagnostikuri procedurebi.........................................17 mkurnaloba....................................................................................................................................................................................................... ...17cxovrebis wesis Secvla.......................................................................................................................................................... .......17medikamenturi mkurnaloba................................................................................................................................................. ..............18arteriuli wnevis kontrolis miRweva pacientebSi.................................................................... ...............22Semdgomi monitoringi da meTvalyureoba........................................................................................................... .......22hipertenziis marTva gansakuTrebul SemTxvevebSi..................................................................................... ...23gulis iSemiuri daavadeba ......................................................................................................................................... ..................23stabiluri stenokardia da munji iSemia................................................................................................... ...............23 ............................................................................................................................................................................................................................. ...............23gulis ukmarisoba................................................................................................................................................................................. .......24diabeti da hipertenzia.......................................................................................................................................................... ..............25Tirkmlis qronikuli daavadeba .................................................................................................................................... ........26pacientebi cerebrovaskuluri daavadebebiT............................................................................................. ............26simsuqne da metaboluri sindromi................................................................................................................................. .....27marcxena parkuWis hipertrofia. (LVH).................................................................................................................. ............27periferiuli arteriebis daavadeba ....................................................................................................................... ..........28orTostatikuri hipotenzia.................................................................................................................................................... .........33hipertenzia qalebSi....................................................................................................................................................................... ...........33araorsul qalebSi............................................................................................................................................................................ ....33 ............................................................................................................................................................................................................................ ....33menopauza da arteriuli wneva........................................................................................................................... ................33oraluri kontracefcia da arteriuli wneva................................................................................ ...............34antihipertenziuli mkurnalobis SerCevis principebi qalebSi.......................................... ...34

hipertenzia bavSvebsa da mozardebSi..................................................................................38Labetalol.............................................................................................................................................41Enalaprilat...........................................................................................................................................42Furosemde...........................................................................................................................................42Fenoldopam........................................................................................................................................42Nicardipine..........................................................................................................................................42Hydralazine.........................................................................................................................................42Phentolamine......................................................................................................................................42Captopril.............................................................................................................................................42Amlodipine.........................................................................................................................................42Felodipine...........................................................................................................................................42Isradipine.............................................................................................................................................42

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Prazosin...............................................................................................................................................42damatebiTi mosazrebebi antihipertenziuli medikamentebis arCevis Sesaxeb...........43hipertenziis kontrolis gaumjobeseba...............................................................................44

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winasityvaobaarteriuli hipertenzia warmoadgens gulis, Tavis tvinis da

Tirkmelebis sisxlZarRvovani daavadebebis ganviTarebis

umTavres risk-faqtors orive sqesis, sxvadasxva as akis da

rasobrivi jgufebisaTvis. swored es daa vadebebi gvevlinebian

sikvdilis ZiriTad mizezad saerTo sikvdilobis struqturaSi.

amave dros, STambeWdavia arteriuli hipertenziis gavrcelebis

masStabi msoflioSi. igi aris udidesi arainfeqciuri pandemia

kacobriobis istoriaSi.

farTomasStabiani multicentruli kvlevebiT

dadasturebulia, rom arteriuli hi pertenziis adeqvaturi

kontroli (arteriuli wnevis samizne donis miRweva) amcirebs

populaciur doneze Tavis tvinis insultisa da gulis

koronaruli daavadebis ganviTarebas da am daavadebaTa mizeziT

ganpirobebuli sikvdilobis risks. hipertenziis efeqturi

kontroli uzrunvelyofs sicocxlis xangrZlivobis realur

zrdas dasavleT evropis qveynebsa da aSS-Si. kontrolis es

sistema warmoadgens aRniSnuli miznebis misaRwevad yvelaze

ufro xarj-efeqturi mkurnalobis strategias.

saqarTveloSi arteriuli hi pertenziis problemis

Seswavlas gaa Cnia xangrZlivi istoria, mdidari tradicia da

gamocdileba. gasuli saukunis 40-ia n wlebSi akad. mixeil

winamZRvriSvilis mier SemuSavda “hi pertoniuli daavadebis”

klasifikacia. aRniSnuli klasifikacia gulisxmobda daavadebis

mimdinareobis variantebis (prehipertonia da reversibeluri)

analizs da e. w. “SeuRlebuli” anu Tanmxlebi daavadebebis

klinikur mniSvnelobas. sayuradReboa, rom winamZRvriSvilma

SemoiRo termini “prehipertonia” da daavadebis es faruli

premorbiduli mdgomareoba asaxa klasifikaciur struqturaSi.

aRniSnuli, ukve maSin iZleoda daavadebis riskis gansazRvris

SesaZleblobas da mkurnalobis Cvenebebis gamomuSavebas.

prehipertonia (prehipertenzia), romelic 50-ia n wlebSi didi

debatebisa da kritikis s agani g axldaT, dRes gaTvaliswinebulia

aSS-is JNC-7-is klasifikaciis struqturaSi. iseve, rogorc JNC-7-

Si, mixeil winamZRvriSvilic 60 wlis win amtkicebda am

mdgomareobis mqone pacientebis xangrZlivi meTvalyureobis

aucileblobas. dRes ukve cnobilia, rom dawyebuli 115/75

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mm.vwy.sv.-dan arteriuli wnevis mateba yoveli 20/10 mm. vwy.sv.-iT,

aormagebs kardiovaskuluri garTulebebis ganviTarebis risks.

ZiriTadi principi, romliTac unda ixelmZRvanelos

praqtikosma eqimma, mdgomareobs momatebuli arteriuli wnevis

daqveiTebaSi optimalur samizne donemde. swored am strategiam

Zireulad unda gamoasworos hipertenziis kontrolTan

dakavSirebuli situacia.

gansakuTrebul mniSvnelobas iZens eqimsa da pacients Soris

partnioruli urTierTobis damyarebis aucilebloba, i gi ar unda

darCes mxolod mcdelobad. idealuri daniSnulebebic ki,

pacientebis mier Sesruldeba mxolod im SemTxvevaSi, Tu eqimi

SeZlebs aa maRlos pacientis motivacia mkurnalobisadmi. es erT-

erTi mTavari faqtori gaxlavT hi pertenziis efeqturi

kontrolisa.

winamdebare gaidlaini warmoadgens hi pertenziis sferoSi

dReisaTvis y velaze a vtoritetuli saerTaSoriso organizaciebis

rekomendaciebis adaptirebul versias (JNC 7, ESH-ESC-2003 da ESH

updates) . man mniSvnelovnad unda Seuwyos xeli arteriuli

hipertenziis kontrolis sistemis Seqmnas da gaaumjobesos

pirveladi jandacvis rgolebis, s aswrafo daxmarebis samsaxuris,

sadazRvevo medicinis da Sromis eqspertizis sa medicino

momsaxurebis xarisxi.

profesori beJan winamZRvriSvili

akad. m.

winamZRvriSvilis sax.

kardiologiis institutis direqtori

saqarTvelos hipertenziis Se mswavleli sazogadoebis

prezidenti

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meTodologia

winamdebare gaidlaini warmoadgens adaptirebul gaidlains.“gaidlainebis miRebis xerxi/wyaro” aris “s xvada sxva gaidlainebis

Sejereba da adaptacia”. ZiriTad wyaros warmoadgens “aSS maR ali arteriuli wnevis

prevenciis, gamovlenis, Sefasebisa da mkurnalobis gaerTianebuli nacionaluri komitetis me-7 mox seneba”. gamoyenebulia aseve:

“aSS maR ali arteriuli wnevis prevenciis, gamovlenis, Sefasebisa da mkurnalobis gaerTianebuli nacionaluri komitet is me-6 mox seneba”;

ESH-ESC-2003 da ESH updates Manual of Cardiovascular Medicine (second Edition) editors BRIAN P.

GRIFFIN.ERIC J. TOPOL. HEART DISEASE (A textbook of cardiovascular medicine) BRAUNWALD ZIPES LIBBY. 6th Edition.

definicia, sinonimebi, terminologia

arteriul hipertenz iad iTv leba sistoluri wneva 140 mm .vwy .s v. da meti an diastoluri wneva 90 mm.v wy.s v. da meti.

arteriuli hipertenz iis SemTx vevaTa umetesobaSi (90-95%-ze meti) ver vlindeba hipertenzi is gamomwvevi mizezi da ama s pirveladi, esenciuri an idiopaTiuri hipertenzia ewodeba. adre CvenSi ma s hipertoniul daavadebas uwodebdnen. rodesac arteriuli hiperten zia viTa rdeba raime specifiuri gamomwvevi mizezis Sedegad, mas meoradi anu sim ptomuri hipertenzia ewodeba.

epidemiologia

arter iuli hipert enzia warmoadge ns yvelaz e farTod gavrcel ebul gul-sisxlZarRv Ta daavadebas da amav e dros, igi sxva gul- sisxlZarRv Ta daavadeb eb is ganvi Tar eb is umTa vre si riskis faqtoria . arteri ul wne vasa da kardio vask uluri Sem Txv ev eb is ganviTa re bis risks Soris damokid ebuleb a aris mkafio , uwyve ti da sxva riskis faqtore bi sagan damou kid eb eli .

ekon om ikurad ganviTa re buli qvey ne bis mozrdil mosaxleo baSi misi gamovle nis sixSir e daaxloe biT 20%- ia . hiperte nz ia aris yvelaz e xSiri pirvelad i diagnoz i msofl ios bevr i qvey nisaT vi s. janmrT elobis msoflio organizac iis Sefase biT (WHO 2002), mTe li msofli os masStabi T arteri uli hiperte nz ia daaxloeb iT 1 miliard adamians aReni Sn eba da yov elwliurad masTan dakavSire bulia daaxloe biT 7 mili on sikvdil ze met i [252 ].

saqarTv eloSi ukanask neli 20 wlis ganmav loba Si Catareb uli epidem iologi uri kvle ve bis monace me bi adastur eb en , rom arte riu li hiperte nz ia warmoadg ens yv elaz e metad gavrcel ebul daavadebas qarTu l populaciaS i.

akad. m. winamZRv riS vil is sax. kardiologi is institu ts gaaCnia unika luri SesaZle blo ba arter iuli hiperte nz iis gavrce lebis 60 wliani dinam ikis Sefase bisa moz rdili mosaxle ob is (18 wlis ze moT) repr eze nta tul jguf ebS i (1950w. araor ga nizeb uli populacia 7,2%, organiz ebuli populacia 10,5%; 1980w. 16,6% da 25,1%; 1999w . 37,2% da 32,7% ; 2005 w. 43,2 % da 45,7%).

jandacvis msofl io organizac iis 2005w. raportSi (The European Health Raport. 2005), 2002 wlis mona ce me biT, saqarTv eloSi arter iuli hiperte nz iis xvedriT i wili sikvdilo bis mize zTa Soris aris 48,8%. qvey nis oficia luri

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statisti kur i monac em eb iT , hipert onuli daavadebis gavrce lebis dinamika 1998-2004 ww. negatiu ria (daavadeb iano ba Sesaba misad 1628,8 da 3108,2; avadoba 446,3 – 801,9 ; janmr Telobis dacva 2003,20 04).

1996w. hipert enzi is respu bli kuri cen trisa da aSS daavadeba Ta kont rol is centr is erT obl iv i kvle viT aWaraSi (xel mZRvan eli b. winamZR vri Svi li da s. miuz ik i) arteri uli hipert enzi is gavrcel eb a mozrdi l mosaxle obaS i (18 wlis zem oT ) – baT um i, qeda , xulo – 26,9% . 2001 w. 5 wliani dinamika igiv e kontig entSi (kardio logi is instit utis profilaq ti kur i kardiol ogiis ganyofil eba) – 49,8% . (epid em iol ogiu ri biul etini 1996w. noe mb er- deke mb er i; 2004).

arteri uli hiperte nz iis gavrcel eb is Seswavl is miz niT, viskons in is samedic ino kol ejis (aSS), milu ok is janmr Telobis trei ni ngis saerTaS oris o centr isa (aSS) da eqspe rim entuli da klinik uri Terap iis samecn iero- kvle viTi institu tis (xelmZRvan eli akad. n. yifSiZ e) mi er 1996 wels Catare buli erTob li vi kvl ev iT qalaqis populacia Si (q. Tbi lis is didubis raioni) , arteri uli hiper te nzi is gavrcel eba 40- 70w. asakis individ ebS i 59,9% (qaleb i 59,1% da mama kace bi 62,0%) da soflis populaciaS i (duSeT is raioni) 40,5% (qaleb i 42,0% da mamaka ce bi 37,5%) iyo.

The Republic of Georgia High Blood Pressure Control Program. Ethnicity and Disease, 2006; 16[suppl 2]:S2-62–66). Barbakadze V., Koblianidze L., Kipshidze N., Grim CE, Grim CM, Tavill F.

saqarTveloSi amJamad hipertenziis gavrcelebis sxva monacemebi ar arsebobs.

bolo wle bSi saerTaS oris o standarteb iT Catare buli kvl ev eb is

safuZv elz e SesaZloa vivaraud oT , rom qvey nis masStabi T arteri uli

hipert enzia aReniS ne ba 600 000 pirze mets .

etiopaTogeneziesenciuri hiperte nziis etiopaTog enez i multifaqtorulia da ma s

safuZvlad udevs arteriuli wnevis regulaciis darR veva, romelSic CarTulia erTmaneTTan daka vSirebuli neirohumoraluri da ujredul-moleku luri faqtorebi. fiziolo giurad arteriuli wnevis sidides ganapirobebs ori faqtori, guli s wuTmoculoba da sis xlZarRv Ta periferiuli winaaRmdegoba (upiratesad rezistiul doneze) , cxri l 1-Si mocemulia im dar RvevaTa erToblioba, romlebic gavlenas axdens am ZiriTad komponenteb ze da erTmaneTTan urTierTqmedebiT iwvev s hipertenz ias. calkeuli pacienteb isaTvis am darRvevaTa tipi da simZime gans xvavebulia .

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ნატრიუმის ჭარბი მიღება

სიმსუქნენეფრონების რიცხვის შემცირება

სტრესი გენეტიკური ალტერაცია

ენდოთელური ფაქტორები

ნატრიუმის შეკავება თირკმელებში

ფილტრაციის ზედაპირის შემცირება

სიმპათიკური სისტემის ჰიპერტონუსი

-რენინანგიოტენზინის სიჭარბე

უჯრედის მემბრანული ცვლილებები

-ჰიპერინსულინემია

სტრუქტურული ჰიპერტროფია

ფუნქციურიკონსტრიქცია

კუმშვადობაპრედატვირთვა

-ვენოკონსტრიქცია

სითხის მოცულობა

ავტორეგულაცია

= / ჰიპერტენზია გულის გაზრდილი წუთმოცულობა და ან გაზრდილი პერიფერიული წინააღმდეგობა

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klinikuri simtomatikauxSiresad gaurT uleb eli hiperte nz ia mimdi nar eobs asimpt omurad .paci ents ara aqvs gaTvi Tcnob iere buli mosalodn eli kardio vasku luri riskis Sesaxeb .si mpt om eb i roml eb ic Tan axlavs hiper te nz ias Semd egia : Tavis tkivi li , xmauri yur ebS i, Tavb rusx ve va , saerTo sisuste ,g ulis friali .magram zemo T aRniSnu li simpt om eb i SeiZl eb a Segvxdes igive sixSiri T normo te nz iul populaciaS ic. ufro met ic bev ri simt om i, rom elic Tan axlavs hipert enzias Tavis warmoSo biT aris fsiqoge nuri .Tav is tkivi lic ki , rome lic didi xnis ganmavl obaS i ganixile boda rogorc hiperte nz iis yve laze xSiri simptom i, sust korelac iaSia arteri uli wnev is sidides Tan .

arteriuli wnevis klasifikacia

ganixileba arteriuli wnevis 3 kategoria: normuli, prehiperte nzia da hiperten zia, xolo hipertenz iis sul ori stadia gamoiyofa (I stadia da II stadia).

antihiperte nziuli mkurna lobis daniSvnis sabaziso kriteriumad wnevi s matebis xaris xi ganixileba da mowodebulia yvela hipertenziuli piris (I da II stadiis) mkurnaloba.

unda aRiniSnos, rom prehiperten zia ar aris daavadebis kategor ia. is moicavs im individebs, romlebic arian arteriuli hipertenz iis ganviTarebis maR ali riskis qveS da Sesabamisad saWiroeben cxovrebis wesi s Secvlas . metic, Tu prehiperte nzi is mqone pirebs aqvT diabeti an Tirkm lis qronikuli daav adebebi da cxovrebis wesis warmatebuli Secvla ver uzrunvelyofs wnevis 130/80 mm .vwy .s v.-ze qvemoT daqveiTebas, unda Catardes medikamenturi mkurnaloba. wnevis am kategor iis mqone pirebSi cxovrebis jansaRi wesis adreul danergvas SeuZlia wnevis Semcireba, asakTan erTad wnevi s hiperten ziul donemde progresirebis Seneleba an hiperten ziis Tavidan acileba.

arteriuli wnevis klasifikacia 18 wlis da ufrosi asakis mozrdilebisaTvis:

arteriuli wnevis kategoria

sistoluri wneva

(mm .vwy.sv.)da/ an

diastoluriwneva

(mm. vwy.sv.)

normaluri < 120 da < 80prehipertenzia 120-139 an 80-89

hipertenzia:

hipertenziis I stadia 140-159 an 90-99hipertenziis II stadia ≥ 160 an ≥ 100

** damyarebulia ofisSi ori an meti vizitis dros dadasturebul wnevi s maRal cifreb ze. TiTo vizitis dros mxedvelobaSi miiReba ori an meti gazomvis s aSualo.*** rodesac sistoluri da diastoluri wnevebi sx vada sxva kategorieb Si xvdeba, mxedvelobaSi miiReba ufro maRali kategoria (mag, Tu arteriuli

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wnevi s cifrebi aris 162/94 mm .vwy .sv ., am SemTxvev aSi piri miekuTvneba hipertenz iis II stadias) . *** * mdgomareoba , roca si stoluri wneva 140 mm.v wy. sv. da metia, xolo diastoluri wneva naklebia 90 mm. vwy. sv .-ze, iTv leba izolirebul sistolur hipertenziad. izolirebuli si stoluri hipertenz iis dros stadiis mikuTvneba xdeba sistoluri wnevis donis mixedviT. mag, arteriuli wnevis cifrebis 170/82 mm .vwy .sv . SemTxvevaSi, piri miekuT vneba hipertenz iis II stadias .

Mmeoradi hi pertenziis mizezebi. (identificirebadi mizezebi)

hipert enzi is gamom wv ev i mize ze bis dasadgenad SesaZloa saWiro gaxdes damateb iTisadiagnostik o RonisZi eb eb i. im Sem Txv ev ebSi rodesac;

1. pacient is asaki, fizi kal uri gamokv le va, hiper te nzi is simZim e da/an sawyisi

laborato riuli monac em eb i migva niS ne bs hiperte nz iis miz ez ebze .

2. arteri uli hiperte nz ia cudad eqv emde bar eba medi kam entur mkur nalo bas

3. kargad kontr oli rebuli hiperte nz iis Sem Txv ev aSi arteri uli wneva gaurkve veli miz eziT izrde ba.

4. hiperte nz ia uecrad iwye ba.

cxrili #8meoradi hipertenziis sadiagnostiko testebi.

diagnozi Ddiagnostikuri testebiTir kmlis qroni kuli daavadeba GFR-is Sefase baAaortis koarq tacia CT angiografiakuSi ngis sindrom i da sxva mdgomar eobe biT gamowv euli gluko kor ti koid eb is siWarbe , qron ikuli stero idu li Terap ia

anamne zi , deqsame taz on is supres iis testi

medi kam enturi (ix.cxri li#18) anamne zi , medika me nturi skrini ngifeoq romoc ito ma 24sT- ian SardSi metan efrin isa da

norme tan efrin is gansazRvrapirv eladi aldoster oni zm i da sxva miz eziT gamowv euli min era lok ort iko ide bis siWarb e

24sT- ian SardSi aldostero nis donis an sxva min eral okort iko ide bis donis gansazRvra.

ren ovask ula ruli hipert enzia Ddopler eqokardi ografia , magnito rezona nsu li angiografia

Zilis apnea Zilis dros saturaci is gansazRvraTir oidu li /paraT iroidu li daavadeba TSH da Sratis PTH-is gansazRvra

GFR-glom erular uli f iltracii s s iCqareCT- kompiuter uli t omografiaTSH-Tiroidma stimulireb eli h ormoniPTH-para Tiroidu li h ormoni

feoqr omoci tom a unda vivaraudo T im pacie nt ebS i, visac aReniSn eb a labilu ri , an paroqsi zmuli saxis hipert enzia , rasac Tan axlavs Tavis tkivi li , gulisce mis SegrZn eba , siferm krTal e, ofliano ba.

11

Aaortis koarqtac ias axasiaT ebs arter iuli wnev is Semci re ba qvem o kidure bz e, dagvian ebuli pulsacia barZayis arte riaz e. sims uq ne torsis midamoS i, tolera nto ba gluko zis mi marT da strieb i miu TiTebs kuSi ngis sindromz e. labora tor iuli kvle ve bida n sayuradReb oa araprovo cir eb adi hipokale mi a- (pirve ladi aldoste ron iz mi) ; hiperka lce mi a- (hiperparaT ir eoidiz mi) , maRali krea ti nin i an Sardis Secv lili analizi- (Tirk mlis paren qi muli daziane ba). Tir kmlis paren qi muli dazian eba , asocir ebuli hipert enzias Tan ume tes wilad gamowv eulia , qroni kuli glome rulon efrit eb iT , polik isto ziT da hiper te nz iuli nefr oskl eroziT . es mize ze bi SeiZl eba dadgindes klini kuri da damate biTi laborator iuli kvlev eb iT . magaliTad : Tir kmlis eqosk opiu ri kvle viT SesaZle belia polik isto zis dadgena . Tirkm lis arteri eb is sten ozi da Sesaba misad renovas kularu li hiperte nz ia unda vivaraud oT Semd eg SemTx ve ve bS i:

1. hiperte nz iis gamovl ena 30 wlis asakamde , gansakuT rebiT im Se mTx ve ve bS i, rodesac pacien ts ar aReniS ne ba datvirT uli ojaxuri anamne zi an mniSv nelovani hipert enzia viTa rde ba 55 wlis Semdgo m.

2. abdomin uri Suili .3. mzardi hiperte nz ia

4. warsulSi kontro lir ebuli hiper te nzia , magram amJamad rezis te ntuli hiperte nz ia.

5. ganmeo re biTi filtv eb is SeSup eba .6. gaurkve veli etio logi is Tirk mlis ukmar iso ba, gansakuT rebiT im

SemTx ve vaS i Tu ar aris protei nuria an SardSi ar aRiniS ne ba paTologi uri nale qi .

7. Tirk mlis mwva ve uk maris oba , ganvi Tar ebuli agf inhib ito rebiT da a.r . bloke re biT mkurna lob iT , Tirkm lis arteri is ormxri vi sten ozis an hipovol em iis pirob ebS i.

pacien te bS i, rom elT ac SesaZle belia hqonde T, renovas kularu li gene zis hiperte nz ia, arainvaz iuri gamokv le vis meT ode bi moicavs agf inhi bit ore biT gaZliere bul Tirk mlis skanire bas, dopler ul kvle vas, magni tur -rezo nans ul angiografias. miux edavad imisa rom Tirk mlis arteri eb is angiografia aRiare bulia , rogorc oqros standarti Tirk mlis arteri eb is anatomi is Seswa vlisa Tv is, diagnostik isaT vis mainc ar aris reko me ndir ebuli mxolod misi gamoy en eb a, procedu rasTa n asocire buli didi riskis gamo . int erv enci is dros angiografia unda ganxorcie lde s kont rastis SezRud uli raodenob iT , raTa dadgindes steno zis arsebo ba da Tirk mlis arter ie bi s anato mia .

mkacri Cvenebebi hipert enzia SesaZle belia sxvadasxva klin ikur mdgomare ob ebTa n iyos asocire buli .ase Ti mdgomare ob eb ia : gulis ukma riso ba, Tir kmlis qroni kuli ukmar iso ba, ganme ore biTi insu lteb i, gulisn iSe miuri daavadeba , diabet i.as eT SemTx ve ve bS i mkurna loba warma te buli unda iyos orive mimar TulebiT:rogorc sisxlis wnevis daqvei Tebi s, aseve asocir ebuli klini kuri mdgomare ob is mimar TulebiT.Progress (perindopr iliT dacva ganmeo re biTi insu lteb isagan) kvle vis mixedv iT ganme ore biTi insult is sixSire Semci re bul iqna Tiaz idis damateb iT agf inhibi tor eb iT bazalur Terap iaze .

cxrili #1.arteriuli wnevis klasifikacia da menejmenti mozrdilebSi.

12

arteri uli wnev is (BP) klasifika cia .

sistolu riarteri uliwneva (SBP)(mm/v wy .sv )

diastolur i arteri uliwneva (DBP) (mm/ vw y/sv )

cxovre bisstilis modifi ka- cia

sawyisi medika me nturi mkur nalo ba

mkacriCven eb is gareSe

mkacri Cven eb iT

Nnorma luri <120 D<80 mizanS ewo-nilia

prehipe rte nz ia 120—139 Aan 80-89 diax

ar saWiro ebs antihipe rt enziul mkur nalo bas

Aar saWiroe bs

saWiroe bs mkur nalo -bas

hiperte nz iis I stadia

140-159Aan 90-99 diax ume tesad

Tiazid uri diure tik eb i an agf.i. ,a.r .b . ,b.b., k.a .b . Aan maTi komb inac iaN

Hhipert enzi is II stadia

≥160 ≥100 diax ori medika me nt is komb inac ia(Tiazid uri diure tik i da agfi,arb ,b b, kab.

medika me nt ebi mkacr i Cven eb eb isas sxva antihipe rt enziul i wamle bi :(diure tik ebi,

Aagfi,arb ,b b,kab.saWiroe bis SemTx ve vaS i

cxrili #12 .

klini kur kvl ev ebze da gaidlain ebze damyar ebuli sxvadasxva jgufis medika me nt eb is gamoye ne ba mkacr i/ Cven eb eb isas damyare bulia gaidlainz e da klini kur kvl ev ebze .

mkacri Cvenebebi

rekomendebuli medikamentebi

diur eti ki

bb agfi

arb kab Aaldos.a nt

ag

klinikuri kvlevebi

gulis uk maris oba + + + + +

ACC/AHA gulis ukmar iso bis gaidlaini.

mio kardi um is infarqt is Semdgo mi period i

+ +

+

ACC/AHA – Post MI gaidlaini

13

koro naru li daavadeb is arseb ob is maRali riski

+

+ + +

ALLHAT,HOPE, ANBP, LIFE CONVINCE

diabe ti + + + + +NKF-ADA gaidlaini

Tir kmlis qron ikuli daavadeba +

+

NFK gaidlaini ,RENAAL,IDNT,REIN,AASK

ganme or eb iTi insul tis prev encia

+ + PPROGRESS

arteriuli wnevis gazomva

arteriuli wnevis gazomvis oqros standarts warmoadgens kaTeteris saSualebiT pirdapiri intraarteriuli gazomva, romelic klinikur praqtikaSi iSviaTad gamoiyeneba. arteriuli wnevis kontrolis ZiriTad meTods wnevi s gazomvis arapirdapiri, au skultaciuri meTodi warmoadgens. igi advilad Sesru lebadobis gamo farTod gamoiyeneba rogorc s amedicin o personalis, aseve mosax leobis mier.

arteriuli wnevis gazomva medicinaS i yvelaze xSirad gamoyenebuli proceduraa. sakmari sia aRiniSnos, rom eqims Tavisi samedicino karieris manZilze ramdenime aTa sjer mouwevs arteriuli wnevis gazomva da ami s safuZvelze gadawyvetilebis miReba. wnevis mxolod zusti da sar wmuno gazomva warmoadgens arteriuli wnevi s saTanado kontrolis s afuZvels. pacients da mTlianad sazogadoebas mxolod maSin SeuZlia miiRos s argebeli da mniSvnelovnad Semcirdes arteriuli hiperten ziiT gamowveuli avadoba da si kvdiloba, Tu arteriuli wnevis gazomva klinikur praqtikaSi maqsima luri sizu stiT moxdeba.

arteriuli wnevis gazomva ausku ltaciuri meTodiT unda moxdes teqnikurad gamarTuli instrumentiT, sul cota orjer TiTo vizitisas. pacienti gazomvamde aranak leb 5 wT-i s ganmavlobaSi unda iyos mos venebul mdgomareobaS i. sistoluri arteriuli wneva Seesabameba korotkovis I fazas da ganisazRvreba rogorc ori regularu li dartymidan pirveli. diastolur arteriul wneva s Seesabameba korotkovis V fazis dasawyisi, roca aRiniSneba tonebis sruli gaqroba. arteriuli wnevi s dafiqsireba xdeba 2 mm.v wy. sv. intervalebiT da Canaweric Sesabamisi keTdeba. eqimma pacients sityvierad unda acnobos da dau weros kidevac gazomili wnevis cifrebi da s amizne wneva .

periodulad naCvenebia pacientis wnevis gazomva fexze mdgom mdgomareobaSi , gansaku TrebiT im SemTx vevebSi, roca pacients aqv s orTostatikuri hipote nziis ganviTarebis riski (xanSi Sesuli pirebi, axali medikamentis daniSvna an wamli s dozis cvlilebebi, pacientis mier fexze adgomisas Sesabamisi simptomebis aRniSvna).

daw vrilebiT arteriuli wnevis sworad gazomvis Sesa xeb ixileT protokolSi.

14

arteriuli wnevis ambulatoriuli monitoringi

arteriuli wnevis ambulatoriuli monitorin gi (ABPM) gvaZlev s informacias arteriuli wnevis cva lebadobis Sesaxeb Zilis dro s da dRis ganmavlobaSi. igi mniSvnelovania:

samizne organoebis dazianebis ararsebobisas “TeTri xalaTis hipertenz iis” gamovlenis mizniT;

sxv adasx va medikament is mimarT rezistent obis ganviTarebis aRmoCenis mizniT;

antihiperte nziuli medikament ebiT ganpirobebuli hipoten ziis sim ptomebis, epizoduri hipote nzi isa da avtonomiuri disfunqciebis aRmoCenis mizniT.

Cveulebriv arteriuli wneva Ramis ganmavlobaSi mcirdeba 10-20%-iT . im pirebs, romelTac wnevis es fiziolo giuri Semcireba ar aReniSnebaT, kardiovaskulu ri daavadebebis ganviTarebis ufro maRa li riski aReniSnebaT.

arteriuli wnevis ambulatoriuli monitori ngiT miRebuli monacemebiT, arahiperten ziulad ari s miCneuli wnevis done sifxizleSi nak lebi 13 5/85 mm .vwy .sv .-ze da Zilis dros naklebi 120/75 mm.v wy.s v.-ze.

arteriuli wnevis TviTkontroli

arteriuli wnevis TviTkontrols (pacientis an misi axloblebis mier arteriuli wnevis sa xlSi an sam sa xurSi gazomvas) aq vs mTeli rigi dadebiTi momentebi :

Ta visufalia situaciuri matebisgan - e.w . “TeTri xalaTis hipertenz ia”, anu roca pacientis wneva maRalia mxolod maSin, rodesac is samedicino personali s mier an maTi Tandas wrebiT izomeba;

pacients warmodgenas uqmnis antihiper ten ziuli medikamentis adeqvaturi moqmedebis Sesa xeb;

cvli s pacientis ganwyobas mkurnalobis mimarT, kerZod aumjobesebs pacientis mkurnalobisadmi erTgulebas (pacienteb i nak lebad anebeben Ta vs mkurnaloba s);

potenciurad amcirebs mkurnalobis Rirebulebas .Tumca, pacientisTvis, an misi ojaxis we vrebisTvis metad

mniSvnelovania arteriuli wnevis zustad da sworad gazomvis sw avleba, sazomi aparatebis sizu stis regularulad Semowmeba da eqimtan mudmivi kontaqtis SenarCuneba.

saxlSi gazomvis pirobebSi wnevis cifrebi meti an toli 135/85 mm .vwy .sv .-ze miCneulia hiperte nziad.

15

pacientTa Sefaseba.

hiperte nz iul pacient Ta Sefase bas aqvs 3 miza ni:

1. Sefasdes cxovre bis wesi da gamovli ndes sxva kardiovask uluri risk-faqtore bi da Tan mxle bi darRvev eb i, romel Tac SeuZ lia T daamZimo n prognozi da Secva lon mku rnal obis taqti ka (cxrili #3).

2. maRali arter iuli wne vis gamomw ve vi mize ze bi s iden tif ici re ba.

3. samizn e organoe bis daziane bis da sxva kardiovask uluri daavadeb eb is arsebo bis albaT ob is gansazRvra .

Ppacien tis Sefase ba xdeba Semdeg i monace me biT: samedi cin o anamne zi , fizikal uri gamok vlev eb i, rut inu li laborat ori ul kvl ev eb i da sxva diagnostik ur proced ure bi . fizika luri gamokvl eva unda moicavd es arteri uli wnevis saTanado kontro ls orive zem o kidurze , Tval is fskeris Sem owm eb as, sxeul is masis indeqs is gamo Tvlas (BMI) (agreT ve sasurve lia welis garSem owe rilobis gansazRvra), karotid eb is, muc lis aortis da barZayis arteriis ausk ultac ias, farise br i jirkv lis palpacias; filtve bisa da gulis srul gamok vlevas ; abdomin ur gasinjvas, Tirk melebi s gadidebis da aortis paTolog iur i pulsaciis aRmoCe nis mizn iT . qvem o kidure bi s palpacias SeSupe bisa da pulsaci is Sefase bis mizn iT , agreTv e nevr ologi ur Sefas ebas .

cxrili #3. kardiovask ula ruli riskis faqtore bi .

mize ze bi

mTa vari /didi riskfaq tor eb i

hiperte nz ia

sigaretis mow eva

simsuq ne (sxeu lis masis inde qsi ≥30kg/m2

fizik uri aqtiv oba

dislipide mia

Saqriani diabe ti

mikroa lbum inuria an glom eru -

luri filtraci is siCqare <60 ml/w T

asaki ( >55 mamakac i, > 65 qali)

ojaxuri istor ia, anamn ezS i kardiovask uluri daavadeba (mamaka ci <55 welz e da qali <65

samiz ne organo eb is dazian eba .

guli

• marcxena parkuW is hipertro fia

• steno kardia an gadatanil i miokardi um is infarqt i.

• gadatanil i koronar uli revas kulari zacia

• gulis uk maris oba

Tavis tvini

• insult i an Tav is tvin Si sisxlis mim oqc ev is gardamavali moSla

• deme ncia

16

Tirk mlis qron ikuli uk maris oba

perife riuli arte rie bi s daavadeba

retin opaT ia

cxrili #4meorad i hiper te nzi is mize ze bi :

Zilis apnoe

medika me nt iT gamow veuli sruli an nawil obr iv i mize ze bi .

qroni kuli Tirk mlis uk maris oba

pirvelad i aldost ero niz mi

Tirk mlis sisxlZarRvo van i paTol ogia

qroni kuli steroid uli Te rapia da kuSi ngis sindrom i

feoqr omoci tom a

aortis koarq tacia

fariseb ri da paraTiro idu li daavadebe bi .

Oobstr uqc iuli uropaT ia

laboratoriuli analizebi da sxva diagnostikuri procedurebi

antihipe rt enziuli mk urna lob is dawye bamd e, rekom ende bulia ruti nuli laborato riuli analiz eb is Catareba , rome lic moica vs e.k. g- s, Sardis saerTo analizs , sisxlSi gluko zisa da hemat okr itis , Sratis kali um i, kreati ni nis (an Sesabam isi glome rularu li filtrac iis sixSiris (GFR)), kalciu mis lipidu ri speqtris (kve bida n 9- 12sT- is Semdgo m), rom eli c moicavs m.s. l., d.s. l., trigliceridebis gansazRvras. damate biTi analiz eb i moicavs SardSi albu mi nisa da albu mi ni /kr eat in inis Sefard eb is gansazRvras.damateb iTi teste bis gamoy en eba ar aris naCven eb i Tu wnev is kont rol i miRwe ulia.teste bi Cven eb iT rekom ende bulia im SemTx ve vaSi , Tu wnev is kontro lis miRwe va ver xerxde ba da rutin uli test eb i migvani Sn ebs meo rad hiperte nz iaz e.

mkurnaloba s am izne wn ev a

antih iper te nz iuli mkur nal obis miza nia kardiovask uluri da Tirk mlis daavadebe biT gamowve uli avadobisa da sikvdil obis Sem cir eb a. hiperte nz iul pirebS i gansaku Treb iT 50 wels zevi T, pirv eli rigis amocanaa sistolu ri wnev is kontrol is miRwe va. samiz ne arter iuli wne vad miCn euli a <140/ 90 mm. vwy .sv -ze , rad gan am SemTx ve vaS i mci rde ba kardio vask uluri daavadeb eb is ganvi Tar eb is albaTo ba. pacie nt ebS i rome lTa c aqvT Saqrian i diabeti an Tirk mlis qronik uli ukmar iso ba samiz ne wne vaa<13 0/80 mm. vw y/sv .- ze.

cxovrebis wesis Secvla.

17

jansaRi cxovr eb is wesi yve la adamian isT vis aris hipert enzi is mniSv nelovani prev encia, mas asev e gansakuT rebuli mniS vn elo ba eniW eb a hiperte nz iul pirebis mk urna loba Si. cxovreb is jansaRi wesi moica vs: 1. wonis Semci re bas maTSi visac Warb i wona aqvs 2. regu lar uli fizi kur i varjiSs (swrafi siaruli sufTa haerz e min imum 30 wu Ti kviris um et es dRee bS i) 3. dietur i kvebas anu kali um iT da kalciu miT mdidar(xili , bostne uli,dabal cxim ian i rZis produqte bi ) da natriu miT Rarib sakve bs. Nnatri um is dRiur i miR eba unda Semc ird es 100 mmo lamd e (2,4 grami natriu mi rac Seesaba me ba 4 gram sufris marils). 4. alkoholis moxmar eb is Semc ire bas 30 mil ilitra mde dReSi eTan olz e gadaangariSeb iT mama kace bS i da 15 milil itra mde qalebsa da dabali wonis pire bSi . Ddie tis princip eb i moc emulia #5 cxrilSi romel ic Seiq mna kvle va DASH-is (diet is principe bi hipert enzi is preve nci is da mkur nalo bis Tv is) jansaRi cxovr eb is wesi amcire bs arteri ul wnevas ,axd ens hiperte nz iis preve ncias an anel ebs mis ganvi Tar ebas ,as ev e aZlier ebs antihip ert enziuli medika me nt eb is ef eqt urobas da amcir ebs kardiovas kular uli daavadeb eb is ganviTar eb is risks: magali Tad DASH-is mixedv iT garkve l pire bSi ,sak ve bS i natriu mis SezR udvas 1600 mg- mde (66 mm oli rac Seesa bam eb a 4g sufris marils) aqvs igive efe qti , rac erTi antihip erte nz iuli medika me nt iT mkur nalo bas. jansaRi cxovr eb is wesis ori an meti RonisZi eb is komb inac iiT SesaZle belia sauke Teso Sedeg eb is miRw eva .

medikamenturi mkurnaloba hiper te nz iis samkur nalod gamoiy en eb a sxvadasxva jgufis med ikam ente bi . cxrili # 6 da 7 moica vs yvelaz e xSirad gamoye ne bad antihip ert enziuli medika me nt eb s. hipert enziul pirTa daa xloe biT or mesam edSi samizne arteri uli wne vis miRwe va xerxdeba ori an meti antihip erte nzi uli preparatis saSuale biT,pa ci entTa mxolod erT mesa medSia SesaZle beli ef eqt uri mkur nalo ba erT i medi kam entis saSuale biT. magal iTad kvle va (ALLHAT)-is mixedv iT pacient eb is mxolod 30% hqondaT arte riu li wneva kargad gakontro lebuli erTi antihipe rte nz iuli prepatatiT . danarCen pacie nt ebs Wirdeb odaT ori an meti medika me nt i. 1967 wlidan kvl ev eb iT aRiareb ulia Tiazid uri diur eti ke bi rogorc antihipe rt enziuli mkurna lob is bazisi. diure tik eb i mniSv nelovnad amcire be n hipert enzi iT gamowv eul kardiovask ulur garTu lebe bi s sixSires. . diur etike bi mrava l med ika me ntTan komb inac iaSi aZliere be n antih iper te nz iul efe qts da gamoirC ev ian siiafi T sxva antihipe rt enziul med ika me nt ebTa n Sedare biT. miux edavad am monace me bi sa bisa maT jer kidev ver hpoves jerova ni gamoye ne ba . Bbevri kvleviT Ddadasturebulia rom maRali wnevis mkurnaloba (agf inhib ito rebiT, a.r. bloke re biT, beta bloke re biT, kalciu mis arxeb is antagon iste biT) -iT aseve amcirebs hipertenziis garTulebebis sixSires . hiperte nz iul pacient Ta umrav les obaS i Tiazid uri tipis diur eti ke bi unda iqnas gamoye ne buli mkurna lobis sawyis stadiaz e marto an kom bi nacia Si sxva ((agf inhib ito rebiT, a.r. bloke re biT, beta bloke re biT, kalciu mis arxeb is antagon iste biT ) medi kam ente bTan er Tad. sxva antihipe rt enziuli preparat eb is gamoye ne bis Cve ne ba moce mulia me- 12 cxrilSi. medika me nt is autanlo bis an ukuCv en eb is Sem Txv eva Si sxva jgufis preparate bi .

cxrili #5. cxovre bis wesis sruly ofa hiperte nz iis mkur nalo bis miz niT .

modifikacia rekomendaciebisistoluri arteriuli wnevis maCveneblebi

wonis Semc ir ebaNsxeul is masis norma liza cia (sxeul is masis ine qsi 18,5-24,5 kg/ m)

5-20 mm /vwy .sv wonis Sem cir eb isas

18

Kkve ba DASH-is dietis mixed viT

gulisx mobs xiliT , bostn euliT mdidar da najeri cxime biT Rarib dietas

8-14 mm /vwysv .

sakve bSi sufris maril is raodeno bis SezR udva

100 mmola mde dReSi , rac Seesa bam eb a 6 gram sufris marils

2-8 mm /vwysv .

F fizik uri aqtiv oba

regu laru li aerob ikuli fizi kur i aqtiur oba , rogoric aris swrafi siaruli (30wT main c dReSi , kvir is ume tes dReeb Si)

4-6 mm /vwysv.

alkoho lis miReb is SezR udva

alkoho lis SezRudva araum et es 2- jer miReb isa (1 oz an 30 ml eTan oli, 24 oz ludi , 10 oz Rvino , 3 oz viski ). yove l dRe mamaka cTa umra vle sobaSi da arau metes erT i miReb isa qale bSi da mcir e wonis pirebS i.

2-4 mm /vwysv.

DASH – d ieturi mi dgoma h ip ertoniis mkurna lobi saT vis.OZ – 37 mililitri

cxrili #6. peroral uri antihip erte nz iuli medika me nt eb i

jgufi Mmedi kam ente bidozireba mg/dReSi

dRiur i jeradoba

Tiazid uri Sardmde ne bi qlorT iaz idiqlortal idon ihidroqlor Tiazid ipoliTia zidiindapamidimeto lazo ni

125-50012,5- 2512,5- 502-41,25- 2,50,5- 1.0

1-211111

maryu Jz e moqm edi Sardmden i bum eta nidifurose mid itorsem idi

0,5- 220- 802,5- 10

221

kaliu mSe mn axv eli Sardmden i

amilor iditriamt er en i

5-1050-100

1-21-2

aldostero nis rec eptor is bloke re bi

Eeple re nonispironola qto ni

50-10025-50

11

beta- bloke re bi atenol oli bisoprol olimetapr ololinadololipropranolo ligaxangrZli ve buli moqm ede bi s propranolo liTimo lol i

25-1002,5- 1050-10040-12040-16060-180

20- 40

111-2121

2

beta- blokato rebi +si mpa-tomi meti ke bi

acebu tol olipindolol i

200- 80010-40

22

komb in eruli alfa da beta bloke re bi

karvedi lol ilabeta lol i

12,5- 50200- 800

22

19

Aagf inhi bit oreb i benaz epr ilikaptopril ienalapri lifozinopr ililizin opril iperindopr ilimoeqs ipri liqvinapr iliramipri litrandolapri li

10-4025-1005-4010-4010-404-87,5- 3010-802,5- 201-4

111-21111111

angiote nz in recep tor eb is bloke re bi

kanvesa rtan ieprosarta niirbesar tan ilosartaniolmesa rtan itelm isarta nivalsartani

8-32400- 800150-30025-10020- 4020- 8080-320

11-211-2111-2

Kkalci um i arxebis bloke re bi (aradihid ripi ridi nis jgufis)

dilTiaz em i(xang rZli vi moqmad eb is)verapam ili(xa nmokl e moqm ede bi s)verapam ili(xa ngrZl ivimoqm ede bi s)verapm ili

180-420

80-320

120- 480

120- 360

1

2

1-2

1

Kkalci um is rxebis bloke re bi (dihidr ipir idin is jgufis )

amlodip iniFfelodip in i isradipin i nikardip in i nifed ipin i(xangrZl iv i moq med eb is) nisoldip in i

2,5- 102,5- 202,5- 1060-12030-60

10-40

11221

1

alfa1 bloke re bi doqsazozi niprazozin iterazo zin i

1-162-201-20

12-31-2

centra luri moqm ede bi s alfa 2- is agoniste bi da sxva centra luri moqm ede bi s med ika me nete bi

klonidi niklonidi nis plastiri

meT ildo fareze rpin iguanfacin i

0,1- 0,80,1- 0,3

250-1000,1- 0,250,5- 2,0

21- xel kviraSi

211

Ppirdapiri moqm ede bis vazodilata tor eb i

hidralazin imino qsidi li

25-1002,5- 80

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cxrili #7. hipert enzi is samkur nalo komb in ire buli med ika me nt eb i.

kombinaciis tipebi Sereuli dozebis kombinacia, mg-Si

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agfi da kab amlodipi ni- benaz epr ili enalapri li- fenodipi ni trandolapri li- verapam ili

????

agfi da Sardmden i

Bbena zep ril i- hidroql orTia zidi kaptopril- hidroqlor Tiazid i enalapri l- hidroql orT iaz idi fosinopri l- hidroql orTia zidi lizinop ril- hidroqlo rTiaz idi moeqs ipri l- hidroql orT iaz idi qvinapri l- hidroql orTia zidi

arb da Sardmde ni kanderza tan- hidroqlor Tiazid i eprosartan -hidroqlo rTiaz idi irbesar tan- hidroqlor Tiazid i losartan- hidroq lor Tia zidi olmesar tan- hidroqlo rTiazid i telm isarta n- hidroql orT iaz idi valsartan- hidroqlor Tia zidi

bb da Sardmde ni atenol ol- qlortal idon i bisoprol ol- hidroqlor Tia zidi metopr olol- hidroql ort iaz idi propranolo l(xangrZl ivi moq med eb is)- hidroqlor Tia zidi Timo lol- hidroqlo rTiaz idi

centra luri moqm ede bi s medika me nt eb i da Sardmden eb i

meT ildopa- hidroqlor Tiazid i rezerp in- qlortal idon i rezerp in- qlorT iaz idi reze rpin -hidroqlo rTiaz idi

Sardmden i da Sardmden i

amil oridi -hidroql orT iaz idi spironola qto ni- hidroqlor Tiazxidi triamt er en- hidroqlo rTiaz idi

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arteriuli wnevis kontrolis miRweva pacientebSi.

hiperte nz iul pacien tTa umrav les obas esaWiro eb a ori an met i antihipe rt enziuli medika me nt i samiz ne arteri uli wnev is misaRwe vad. rodesac erTi prepare tis adeqvat uri dozis miReb is Sedegad ver xerxdeba wnev is kontr oli , maSin saWiroa sxva jgufis medika me nt is damate ba. Tu arteri uli wneva samizn es aRemat eb a 20/10m m/ vwy .s v. –iT, maSin sasurve lia mkur nalo bis gagrZele ba erTdro ulad ori preparat iT , romli Tac miiRw ev a arteri uli wnev is uk eTesi kontro li . Ggarkv eul Sem Txv ev ebSi saWiroa sifrTxil is gamoCena xandazmu l, diabe tiT daavadeb ul pacie nte bS i, rome lTa c aReniSn eb aT autono miuri disfun qcia - SesaZlo orTosta tiuli hipoten zi is ganviTa re bis gamo . gener uli medi kam ente bi s an maT i komb inac ie bis gamoy en eba mkv eTrad amcire bs mkur nalo bis Rireb uleb as.

Semdgomi monitoringi da meTvalyureoba

pacien tTa umra vleso bam antihip erte nzi uli mkur nalo bis dawyeb idan , erT i Tvis int erva liT an samiz ne arteri uli wnev is miRw evamd e unda gaiaros Semdgom i Sem ow me ba. meo re stadiis hiper te nz iisa da Tanmxl eb i daavadeb is

cxov re bi s we sis Secvl a

sam iz ne art eriu li wn ev a ar aris miRwe uli < 14 0/9 0 (diab etisa da Tirkmlis qr oni ruli uk mar isob is dros < 1 30 /80 m m/v wy/ sv)

saw yisi m edikam entu ri Terapia

mkac ri Cve ne bis gare Se mkac ri Cv en eb iT

hi per te nzi is II st adia(SBP ≥160 an DBP≥100 mm vw y/ sv )ori medik ame ntis kom bi naci a (u xSir esadTiaz idu ri diure tike bi da agfi ,ar b, bb ,k ab ).

medikam ent eb i mkac ri Cve ne bissam kurn alod(i x. cxril i 8)sxv a antihi perte nz iuli saSu ale beb i(di ureti ke bi ,agfi, arb, bb,kab ) saWi roe bi s mixe dvi T

sam iz ne w ne va m iuRwe velia

hi per te nzi isI st adia(SBP 140-159; an DBP 90-99m mvw y/sv )Se mTxvevaT a umravl eso baSi Tiaz idu ri diure tike bi, ase ve Agfi, arb, bb, kab an maT i k om bi naci ebi

medikam enturi Terapii s Se cvla( medik ame nte bi s damat eb a an doz ebis Secvl a art eriuli wn ev is dar egu lire bam de). hi per te nzi is spec iali stis ko nsu ltac ia.

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mqon e pacient eb isaT vi s saWiroa ufro xSiri vizi te bi . plazmis kaliu mis da kreati ni nis kont rol i unda ganxorcie ldes aranakle b orjer weliwadS i. samizn e wnev is miRw ev is Semdeg momd evn o vizit eb i SeiZle ba ganxorcie ldes 3 – 6 Tvis int er vali T. Tanmx lebi daavadeb eb is , magali Tad gulis ukmar iso bis da diabet is dros aucile beli vizi te bis sixSir e izrd eba . paralelu rad unda mimdina reobd es sxva kardiovas kuluri risk faqtor eb is kor eqc ia. aspirinis dabali dozi T mkurna loba naCv ene bi a samiz ne wne vis miRw evis Semdeg ., radganac arakon tro lir eb adi hipert enzi is dros arseb obs hemorag iuli insult is ganviTar eb is riski .

hi pertenziis marTva gansakuTrebul SemTxvevebSi.

gulis iSemiuri daavadeba

Ppaci ent eb i arteri uli hiperte nz iiT, imy ofe bi an mzardi riskis jgufSi miokard iu mis infarq tis an sxva koro naru li paTologi is ganviTar eb is Tvalsazr isi T. aseve ufro maRali riskis qveS mioka rdiu mi s infar qti T gamowve uli sikvdil is Tvalsa zris iT . hipert enzi iT daavadeb ulebSi miokard iu mis Jangbadi T momarag eba SeiZ leba SezRudu li iyos Tan mxle bi k.a.d .- is gamo, maSin roca Jangbadz e moTxov nileba gazrdilia, erTis mxriv gazrdili perife riu li winaaRmd ego ba da meor es mxriv marcxena parkuW is hipertr ofi is gamo. . pacien te bSi k.a.d .- iT rogorc sistol uri asev e diastolur i wnev is Sem cir eb iT miokardi um is Jangbadz e mo Txov nil eb a da Sesabam isad kardiovas kuluri garTul eb eb is riski qvei Tde baa m jgufis pacient ebSi antihip ert enziuli mkurna lobis erT erTi mniS vn elovan i aspeqti aris koronar uli riskis zrda dabali diastolur i wne vis pirob ebS i. magaliTad : SHEP kvle viT diastolur i wnevis Sem cir eba 55-60 mm/v wy .sv -is qvev iT asocir ebuli iyo mzard kardio vask ulur garTul eb ebTa n, maT Soris miokard iu mis mwva ve infarq tTa n, Tu mcaRa igive kavSir i ar iyo dadgenil i sistolu ri wnev is agresi uli daqve iT eb is Sem Txv eva Si. da bolos hipert enzi is agresiu li mkur nalo biT, gacil eb iT met i garT ule be bi s Tavidan acile ba SeiZle ba , vidre warmoq mna .

stabiluri stenokardia da munji iSemia.

am pacien te bSi mkur nalo bis mizania miokardi um is infarqtis da sikvdi lis preve ncia , aseve sten okardi is simptom eb is Semc ir eba . beta bloke re bi , rogorc sawyisi Terapia gamoiy en eb a yve la SemT xve vaS i Tu ar aris ukuC ve ne ba . betab lok er eb i amcire be n arter iul wne vas, sten okard iis simptom eb s, sikvdil iano bas, gulis wuT moc ulobasa da gulis Sek umSva Ta sixSires . Semci re buli inotr opiz mi da Seku mSva Ta sixSire amcir ebs miokard iu mis moTx ovn ilebas Jangbadz e. mkurna loba asev e moicavs : glukoz is kontro ls, lipide bis donis daqve iT eb as, antiagr egacias , varjiSs, wonis Semc ire bas Warbwo nian pacie nte bS i da Tamba qos mowe vis Sewy vetas. Tu ki arter iuli wnevisa da sten okard iis simpt om eb is kont rol i ver xerxdeba mxolod beta blo keriT , an Tu beta bloke ri uku naCv en eb ia , magaliTad ise T Sem Txv ev ebSi , rogoric aris sasun Tqi gzebis mZi me obstru qci uli paTolog ia, perif eriuli arteri eb is daavadeba, maRali xarisxis atrio ve ntr ikular uli blokada , sinus is kvanZis sisust is sindrom i mizanS ewon ilia xangrZliv mo qm edi dihidropir idin eb is an aradihidropir idin is tipis kalciu mi s arxebis bloke re bi s gamoye ne ba . kalciu mis arxebis blok er eb i amcir eb en perif eriul winaaRmd egobas , rac Tavis mxriv amcire bs marcx ena parkuW is kedlis daWimu lobas . kalciu mis arxebis blok er eb i asev e amcir eb en winaar mdego bas korona rul arter ie bSi da Sesabam isad aumjob ese be n postste noz ur korona rul perf uzias . aradihidropir idin uli kalci um is arxebis bloke re bi aseve amci re be n gulis Seku mS vaTa sixSires , beta blo kere bTan komb inac iaSi SeuZlia T gamoiwv io n mZim e bradikardia an maRali xarisxis blokada , im Sem Txv eva Si Tu steno kardia an arteri uli wneva ver kontro lird eb a am orko mpo ne ntia ni reJi miT, SesaZl eb elia daematos nitrat i, magram aucil eb elia didi

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sifrTxil is gamoCena im pacient ebSi , romle bic iReb en fosfodi esT erazas 5-is inhib ito rebs (sildena fils - viagra). A pacie nte bS i arter iuli hiperte nz iiT da stabil uri steno kardii T ar gamoi ye ne ba xanmo kle moqm ede bi s kalciu mi s arxebis bloke re bi( mag. Nnifed ipin i), radgan isini zrdian sikvdi lia nobas .

gulis ukmarisoba

gulis ukma riso bis sindrom i, vlind eb a im SemTx ve vaS i, rodesac guli ver uzru nv elyofs perife riuli qsovile bi s perf uzias da metab olu ri moTxo vni lebe bi s dasakmayof ileblad adeqvat uri sisxlis nakadis miwode bas. gulis uk maris ob iT pacien te bis 40- 50%-s SeiZle ba hqonde T SenarC un ebuli sistolu ri fun qcia . aseT pacient ebs metad savaraudoa hqondeT hipert enzia, marcxena parkuW is hipertro fia da izoli rebuli diastol uri disfunq cia , am jgufs ufro xSirad ganek uTvn eb ian qale bi . sxvadasxva neiroh umuraluri sistem eb i, gansakuT rebiT renin -angiot enz in-aldostero nisa da simpa Tik uri nerv uli siste ma SeiZl eb a gaaqtiurd es marcxena parkuW is disfunqc iisas , magram aseT aqtiva cias SeiZl eba mohyv es paTologi uri re mode lir eb a, Semdgo mS i marcx ena parkuWis dilatacia da daqvei Tebuli ku mSvadi funq cia . marcxena parkuW is disfunqc iis progresir eb a SeiZl eba Sene lebul iqnas agfi,b b- iT da diure ti ke biT . hiperte nz ia win uswr ebs gulis ukmar isob is ganvi Tar ebas daaxloeb iT 90% pacient ebSi da 2- 3-jer zrdis gulis ukmaris ob is ganviTa re bis risks. ameri kis SeerT ebul State bSi , Se mTx ve vaTa 2/3- Si gulis uk maris ob is mize zs warmoadge ns koronar uli arter ie bis daavadeba . ukanask neli 50 wlis ganmavlo baSi gulis ukmar iso bis sixSir e ar Secvl ila mamakac ebS i, xolo qalebS i Sei mCn eva kleb is tend enc ia, gulis ukmar isob iT hospitaliza ci is sixSire TiTq mis gaormagda bolo 20 weli wadSi. amis mize zs warmoadg ens mkur nalo bis gaumjob es eba da sicocxl is xangrZli vob is gazrda. gulis ukmar iso bis gamo hospitalisa zaci is Se mTx ve ve bi savaraudod gaizrdeba Cven Tanac momava lSi c da es tend enc ia dakavSir ebulia sicocxlisxangrZ li vob is zrdasTan. ACC/AHA gaidlain eb i xelsayre lia gulis ukmaris ob is marTv isT vis . A stadiis jgufSi, es aris I (NYHA), maT Tv is visac aqvT gulis ukmaris ob is ganviTar eb is maRali riski , magram marcxena parkuWis kumSvad ob is daqvei Teba ar aReniS ne baT, mkurna loba gulisx mobs risk- faqtor eb is marT vas: arteri uli wnevis , hiperqo leste ri ne mi is, hipergl ik em ii s kont rols . Aam stadiaze maRali kardiovask uluri riskis mqo ne pacien te bS i mizanS ewon ilia agf inhi bit oreb is gamoye ne ba . ALHHAT-is safuZv elz e gamoiT qva varaud i, Tiazidu ri jgufis diur eti ke bis mizanS ewon ilo baz e daavadebis progresis SesaCe re blad .B stadia gulis uk maris oba (NYHA) - I; marcx ena parkuWis kum Svadi funq ciis daqvei Teba EF<40%-ze, sxvamxri v usimp tom o pacien te bS i, maTT vis reko me ndir ebulia agf inhib itore bi da be ta blok er eb i .C stadia gulis ukmar iso ba II- II I (NYHA); marcxena parkuWis disfunqc iis Tanaarse boba da manife sti re buli simpto me bi . aseT i pacie nt eb isaT vis naCven eb ia agf inhibi tor is beta bloke re bis gamoye ne ba, aldoster onis antagonist eb ic , SeiZle ba Rireb uli iyos am situac iaSi , maryu Jova ni Sardmden eb i aucile beli a zed meti moc ulo bis sakontr olod , Tumca ar arsebo bs imis mtk ice ba , rom diur eti ke bs SeuZ lia T daavadeb is progresis preve ncia da amasTa n Warbi gamoy en eb isas iwve ve n kreati ni nis donis mat ebas . D stadia, gulis uk maris oba IV (NYHA); pacient eb i saWiro eb en igive mkur nalo bas rasac C stadiis dros plus mkurna lobas inotrop eb iT , implant ir ebuli defibri lato riT, biv entri kuluri peism ek er iT , meqa ni kur i “asist- devais iT ” an gulis transplan taci iT . pacient ebSi , roml ebSic agf inhi bit ore bi s gamoy en eba ver xerxdeba SesaZle belia a.r. b. -is gamoy en eb a, gulis ukmar iso bis dros beta- blok er eb is gamoye ne bac rek om end ebulia, radganac klin ikurma kvl ev eb ma aCve na maTi gamoye ne bis SemTx ve vaS i avadobis da sikvdil iano bis Semci re ba, agreTv e gulis uk maris ob is simpt om eb is gaumjob ese ba . (ix. cxrili #12). marcxe na parkuWo vani mZim e disfunq ci is dros stadia C –ze (NYHA III-IV) mkur nalo baSi aldoste ron is antagonist eb is damateba efe qturia . kvle va (RALES)-is mixedvi T spirono laq ton i dabali doziT (12,5- 25mg/dReS i) damateb uli standartul Terap iaz e amcire bs sikvdil iano bas 34%- iT,m aTSi

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visac EF≤40%-ze da 90%- s aReniS ne baT gulis ukma riso bis simptoma ti ka. aldostero nis antagonist is gamoye ne bi sas hiperkal em ii s(radganac pacient eb is umra vleso ba Rebu lobs agf inhibi tors an a.r. blo kers) Tavidan acile bis miz niT maTi miReba unda SeizRudos im pacient ebSi rom elTac kreati ni ni >2,5mg /dl. maTi xmareb is paralelu rad unda xdeb odes sisxlSi kaliu mis donis kont rol i. pacient ebSi gulis ukmar isob iT arter iuli wne vis sasurve li done ar aris mkacrad gansaRvru li , Tum ca sistol uri arte riu li wne vis Semc ire ba yove lTvis dadebiT ad moq med ebs am situa ci ebS i, aris kvl ev eb i rome lTa mixedv iT pacient ebSi arte riu li hiperte nz iiT da gulis ukma riso biT sistolu ri wnev is Semci re ba sasurve lia <100 mmvcx /sv- isa. miux edavad dabalsarwm uno klinik uri kvlev eb isa digoqsin i kvlav gamoiye ne ba pacie nt ebSi gulis uk maris ob iT . kvl evaS i Dig digoqsini ar amcire bda sikvdil iano bas NYHA II-III pacient ebSi , romle bic iRebdne n agf inhibi tor ebs da diuret ik ebs , magram Seamci ra gulis ukma riso bis simptom eb i da hospitali zaci is sixSir e.

diabeti da hi pertenzia

pacient eb s arte riu li hipert enzi iT da diabe tiT aqvT maRali riski ganuvi Tard eT kardiovas kuluri garTul eb eb i, insult i, Tir kmlis qroni kuli

ukmar iso ba,dia beturi nefr opaT ia. Kkvl eva (UKPDS ) aCve na , rom sistol uri wnev is yov eli 10- iT Sem cir eb a iwv evs diabetda mo kid ebuli garTu lebe bi s 13%-iT, mioka rdiu mi s infar qtis 11%- iT, nefropa Ti is retin opaT iis mikro vask ular uli garTul eb eb is 13%- iT Semc ir ebas . Semdeg ma kvle ve bm a: (UKPDS, HOT, SHEP, LIFE, ALLHAT ,HOPE study cxada d aCvena , rom wne vis adeqvat uri kontro li aumjob es ebs kardiovas kuluri garTul eb eb is gamosavals , gansakuT rebiT insul tis gamosavals. Ddiab et ian pacient ebSi Tirk mlis qroni kuli paTologia iTvl eb a diagnostire bulad Tu pacie nts aReniSn eb a mZim e album inuria( > 300mg/dRe Si an kreati ni ni SardSi >200 mg/gr.) an Tirk mlis uk maris oba (glume ruli filtrac iis siCqar e < 60ml/ wuTSi rac Seesaba me ba plazmaS i krea tin ins >1.5mg /dl kacebS i da >1.3 mg/dl qaleb Si) JNC7-is rekom enda ci eb i Seesaba me ba , ameri kis diabet is asociaciis gaidlains, romlis mixed viT ac arteri uli wneva diabet ian pacient ebSi ar unda aRemate bod es 130/80 mm/Hg-s.kli nik uri kvlev eb iT dadgeni lia , rom pacient ebSi I an II tipis diabet iT da arter iuli hipert enzi iT efe qturia Semdeg i jgufis medika me nt eb i : Tiaz idur i tipis Sardmden eb i, beta bloke re bi , kalci antagonist eb i , agf inhib itore bi , a.r. blo kere bi pacient ebSi diabet iT da arteri uli hipert enzi iT samiz ne wne vis misaRwe vad rogorc wesi saWiroa ori an met i medika me nt is kombi nacia . pacien te bS i diabe tiT da arteri uli hiperte nz iiT efeq turia Tiazid uri tipis Sardmde ne bis gamoye ne ba marto an komb inac iaSi . kvl eva m ALHAT aCvena , rom am pacie nte bS i dawye bulma mk urna lobam qlor talido niT, gulis koronar uli daavadeb is da miokard iu mis infarq tis fatalur i gamosava li Seamc ira imave xarisxiT , rogorc mk urna loba m lizin opri liT a da amlodipi niT. yuradR eb is sagans warmoadge ns is tend encia , rom Sardmde ne bi auarese be n hipergl ik em ias, magram es efe qt i mcir ea da ar iwve vs ufro met kardiovask ula rul garTu lebe bs vidre sxva klasis antihipe rte nz iuli medika me nt eb i. agf inhibi tor eb i aseve mniS vn elovan kompo ne nts warmoadg ens diabet iT da arteri uli hiperte nz iiT daavadeb uli pacient eb is mkur nalo bis sqema Si . Ees jgufi SeiZl eb a gamoy en ebuli iqnas marto, magram ufro efeq tur ia Tiazid ebTan kom bi naciaS i. ADA reko me ndacias uwe vs agf inhib ito rebs diabet is mqo ne >55 wel ze asakis maRali kardiovask uluri riskis pacient ebSi da beta blok er ebs diagnosti re buli korona ruli arteri eb is daavadebe bis Sem Txv eva Si. Bbeta blok er eb i gansakuT rebiT beta- 1 sele qti uri efeq tur ia diabet iT daavadebu l pacie nt ebS i rogorc nawil i multi ko mpo ne nturi Terap iis , magram maTi gamoye ne ba rogorc monoT erapia dRemd e davis sagans warmoadg ens . kvle va LIFE-is mixedvi T beta bloke re bi a.r . bloke re bTan Sedare biT nakle b efeq turia insul tis preve nci is mizni T. Bbeta blok er eb ma SeiZl eba gamoiwv ios insu lin isadm i mgrZnob elo bis gauares eba da hipogli ke mi is epine fri ngam owv euli simptom eb is SeniR bva , es proble me bi Cve ulebri v

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advilad koregi rde ba da ar aris Bbe ta bloke re bis daniSvn is absolut uri ukuC ve ne ba . kalci um is arxebis blok er eb i aseve SeiZl eb a gamoy en ebul iyos diabet ian pacient ebSi , rogorc kombi nire buli Terap iis nawili . kvl ev eb iT dadginda, rom isin i amcir eb en kardiovask ulur garTul eb eb s diabeti T daavadebu l pacient ebSi . kvle va ALHAT- is mixedv iT amlodip in i iyo iseT iv e efeq turi rogorc qlor Tal idon i, garda gulis ukma riso bis qvejgu fisa sadac qlortal idon is upirates oba iyo aSkara.

Tirkmlis qronikuli daavadeba sicocxlis mesam e - meoTx e dekadidan Tirk mlis eqs kre tor uli funqc ia iwye bs gauar ese bas da mee qvs e dekadisT vis glum eruli filtra ciis siCqar e mcirde ba 1-2ml- iT/wT yovel wli urad .. E asakdamok ide buli Tirk mlis funqc iis gauarese ba pirdapirpropor ciul kavSirS ia arteri uli wnevis sididesTa n. magali Tad cudad gakontr olebuli arteri uli wne vis SemTx ve vaS i gauares eb a mimdina reobs oTxjer ufro swrafad.gaua res eb is temp ma SeiZ leba gamoiwv ios iseT i xarisxis Tirkm lis uk maris oba , rom aucile beli gaxdes dializi an transplanta cia Tir kmlis qroni kuli daavadeba gulisxmo bs:

1. eqskr etoruli funqc iis Semc ir ebas – glom eru lifil trac iis siCqare (GFR) <60ml/ wT / yov el 1,73m2 -ze (romel ic daaxloebi T Seesa bam eb a kreti ni ns > 1,5mg/d l kace bSi da >1,3 mg/dl qale bSi . Aan

2. album inurias (>300 mg/dReS i ) kardiovask uluri daavadeb eb i aris sikvdil is uxSir esi miz ezi aseT pacient ebSi ,T avis mxriv Tir kmlis qroni kuli daavadeba aris kardiovask uluri paTol ogiis ganvi Tare bis damou kid eb eli risk faqtori . magaliTad Tu glomer uli filtraci is siCqare aris <60 ml/wT -Si kardiovask uluri sikvdilia nobis riski aris 16%- iT meti .Tu glum eruli filtraci is siCqare <30 ml/w T- Si sikvdil iano ba aris 30%- iT met i. pacient ebSi arter iuli hiperte nz iiT da Tirk mlis qronik uli daavadeb iT samizn e arteri uli wne vaa <130/80 mm /vw ysv .am miznis misaRw evad rogorc wesi saWiroa ori an meti antihip ert enziuli medi kam enti . mkur nalo baSi arCev is preparate bia agf nhibito rebi da a.r .bl ok er eb i Sardmden ebTa n kom bi naciaS i . ume tes wilad upirat eso ba eZleva mary uJze moq med Sardmde ne bs. Aagf inhibi tor eb iT da a.r. blo kere biT mkur nalo bisas dasaSveb ia sawyisi kreati ni nis donis mat eba 35%- iT da es ar warmoadge ns am preparate bis Sewyv et is Cvene bas .

pacientebi cerebrovaskuluri daavadebebiT

mwva ve insu lte bi s dros arter iuli wnev is mkve Tri daqve iT eb iT riski da gamosavali aris cudi, arter iuliwne vi s kont rol i saSualo fargle bSi (daa xloe biT 160/110mm /vw y. sv .) miza nSe wonil ia manam sanam mdgomar eobis stabili zacia da gaumjo bes eb a ar moxdeba . ganme ore biTi insu lteb is sixSire mcirde ba agf inhib ito rebisa da Tiaz idu ri tipis Sardmde ne bis gamoye ne biT. kli nik uri garT ule be bi s riski cer ebrovas kular uli daavadeb eb isas, moicavs : iSem iur insults , hemorag iul insu lts da dem enc ias. yve laze xSirad iSem iur i insult i viTarde ba prehipe rte nz iul an hiper te nz iis pirvel i stadiis pacien te bSi . iSem iuri da hemo ragiu li insu ltis sixSire mkve Trad kle bulobs arter iuli wne vis kargi kontr olis Sem Txv eva Si . dResdReo biT ar aris gamov lenili rome li me medi kam entis mkafi o upirate soba insu ltis prev enc iis Tv is. kvl eva LIFE-is mixedv iT losarta ni ufro efeqt uria vidre atnolol i insu ltis prev enciis Tv is . kvleva ALLHAT-is mixedvi T Tiazid uri tipis Sardmde ne bi da dihidropi ridi nuli tipis kalciu mis arxeb is blok er eb i ufro efeq turia vidre agf inhib ito rebi insult is preve nci isT vis . amave kvl evis mixed viT qlortal idon i da amlodipi ni gacileb iT ef eqt urad amcir ebd ne n arteri ul wnevas vidre lozartan i. Kkvl eva PPROGRESS-is mixedvi T indapamidis da peri ndopri lis komb inac iam gamoiw via insul tis sixSiris 43%- iT Sem cir eba .

26

arteri uli wnevis marT va mwvave insult is dros dRemde kama Tis sagans warmoadge ns. Mmw vave insult is dros xSiria mkve Trad moma te buli arteri uli wneva, rac rigi avtore bis azriT fiziolog iuri kompe nsato ruli pasuxia Tavis tvinS i iSemi uri ubne bis perfu zi is gasaumjob ese blad . klini kuri mdgomar eobis stabili zacia mde ar aris reko me nde buli arter iuli wnev is swrafi daqvei Teba . amer ikis insu ltis asociaciis mixed viT; pacient ebs insu lti T da sistol uri wne viT >220m m/ vws an diastolur i wne viT 120- 140 mm /vws , wnev is daqve iT eb a unda ganxorcie ldes frTxilad araume te s 10- 15 %- iT. pacient ebSi insul tiT da diastolu ri wnev iT >140- mm /vw y.s vz e unda dawyeb ul iqnas natriu mis nitr oprus idis infuz ia wnevis 10- 15 %-iT Sesamc ire blad . iSe miuri insult is dros Tro mboli zisis Catare bis ukuC ve ne baa - sistolu ri arteri uli wneva > 18 5 mm/v wy .sv -ze an diastol uri arter iuli wneva > 110 mm /vw y. sv- ze. Tro mbo lizur i Terapi is dawye bis Semd eg saWiroa arteri uli wnevis mkacr i monit ori ngi gansakuT rebiT pirvel i 24 saaTis ganmavlo baSi . sistolu ri arter iuli wneva >180 mm/ vwys v. -ze da diastolu ri > 105 mm/ vwy .s v. -ze saWiroe bs agresiu l intra ve nur mkur nalo bas intrace re bruli sisxldene bis Tavida n acil eb is miz niT.

simsuqne da metaboluri sindromi.

Mmeta bolur i sindro mi warmoadg ens Semdeg kardio vask ulur riskfaq tor Ta erTo bliobas : hiperte nz ia, abdomina luri sims uqn e, dislipid em ia da insul inis mima rT rez iste ntoba .m et abolu ri sindrom is diagnostir eb isT vis aucile beli a sami an meti qve moT CamoT vli li riskfaq tor eb is Tanxvedra :

1. cximova ni qsovi lis Warbi ganviTa re ba muc lis midam oSi (garSemo weril oba >102sm mamaka ce bSi ; an > 88sm qale bSi

2. arteri uli wneva ≥130/85mm /vw y.s v

3. glukoza uzm od ≥110mg/dl 4. trigl ice rid eb i ≥150 mg/dl 5. maRali simkvr iv is lipopro te in i <40 mg/dl kace bSi da <50 mg/dl qalebS i.Mmamaka ce bSi metabo luri sindrom iT riski fatalur i koronar uli paTologi is izrd eba oTxjer , riski kardio vask uluri garTu lebe bis da zogadad sikvdil is izrdeba orjer da riski diabet is ganviTa re bis izrdeba 5-9 jer.Mmku rnal oba moicavs Se mdeg Ziri Tad mome nt eb s: wonis Semc ir eba , arter iuli hiperte nz iis kargi kont rol i, lipiduri speqtris gamoswore ba , cxovr ebis wesis Secvla- jansaRi kveba da fizi kuri varjiSi.

simsuq ne (BMI≥30kg/m2 sxeul is masis indeqs i BMI =wona [kilogra me bS i] / (simaRl e [metre bS i])²) aris risk- faqtori hipert enzi isa da kardiovask uluri daavadeb eb is ganviTar eb is . sxeulis masis inde qsis Secvla (dabrune ba normaSi) unda moxdes Se mdegi RonisZie be biT: maqsi mal urad Canacvldes cxovr eb is jdomi Ti wesi fizik uri aqtivob iT (siaru li , velos ipedi T seirno ba, te nis i, fexbur Ti da sxva). unda Semc ird es: sakveb i uluf eb is zoma, maRalkalo riuli sasme lis moxmar eba .

marcxena parkuWis hi pertrofia. (LVH) .

Mmarcxe na parkuW is masis zrda damaxasiaT eb elia marcx ena parkuW is hipertr ofi is yve la tipisTv is. aTl etebS i ganviTar ebuli marcxena parkuW is hipertr ofi isT vis (LVH) damaxasiaTe beli a norma lur i an gazrdili sistolu ri fun qcia , gazrdili sabolo o distolu ri moc ulo ba da elongi re buli miof ibr ileb i. Hhipe rtro fiis am tips uwod eb en eqsc entru l

27

hipertr ofias . Aarte riuli hiperte nz iis Sedegad viTarde ba konc entruli hipertr ofia , romlis Tv isac damaxasiaT eb elia miofi bri lebis cirku mf er encial uri hiper trof ia normal uri an gazrdili kontraq tiloba , kedlis sisqis gazrda, norma luri an Semci re buli saboloo diastol uri mocu loba da gauares ebuli rela qsacia .u mkurnal eb el an cudad namku rnal eb pacient ebSi marcx ena parkuWis hipert rof ia aris mTa vari riskfaq tor i dilataciu ri kardiomi opaT iis da gulis uk maris obis ganviTar eb is .ma rcxe na parkuWis hipertro fiis diagnostir eb is yve laze sensit iuri meTod eb ia: e.k .g . da eqoka rdios kopia . gansakuT rebiT sensit iuri meT odia eqoka rdios kopia , radgan ekg krite rium eb is mixedv iT xSiria cru dadebi Ti diagnozi . pacient eb s marcx ena parkuW is hiper trof iiT aqvT orjer maRali riski kardiovask uluri garT ule be bi s da sikvdil is. Kkvl ev eb iT dadastur ebulia rom marcx ena parkuWis hipert rof iis regres i amci re bs kardiovask uluri garTul eb eb is risks. Mmarcx ena parkuWis hipert rof iis regres i miiR we va Semdeg i RonisZie be biT: wonis Semci re ba,s ufris marilis moxmar eb is Semc ire ba , arter iuli wne vis kargi kontr oli. am mizn iT gamoiy en eb a yvela ZiriTadi jgufis antih iper te nz iuli preparati .

periferiuli arteriebis daavadeba

arter iuli hipert enzia , diabe ti da Tam baqo arian mTavar i riskfaqt ore bi perife riuli arte rie bi s daavadeb is ganvi Tar eb isT vis . simpto muri perife riuli arte rie bi s daavadeba asocir ebulia kardio vasku luri garTul eb eb is maRal riskTa n. Aam jgufis pacie nt ebS i arter iuli hiperte nz iis samkur nalod SeiZ leba gamoye ne bul iqnas yvela Ziri Tadi antihipe rt enziuli jgufis preparate bi maT Soris beta blok er eb ic , radgan kvle ve bm a aCve na rom isini mcir edi T auarese be n xangamoSv eb iT koWlobas , Sesabam isad maTi gamoy en eb a SesaZl eb elia im pacient ebSi , visac aqvT perife riuli arteri eb is daavadeba , gansaku Treb iT , Tu maT aReniS ne baT koronar uli arteri eb is daavadeba da/an gulis ukmar iso ba. unda aRiniS nos, rom mxolod antihip ert enziuli mkurna loba ar aris sakmaris i perife riu li arteri eb is daavadebi T gamow veuli simptom eb is gasaqrobad. Auci lebeli a semdeg i RonisZi eb eb i: Tamba qos mowe vis sewyv et a, ideal uri wonis miRwe va, datvirT vis specia luri programis gamoye ne ba, samizn e arter iuli wnevis miRwe va, lipiduri profilis gamoswo re ba (d.s.l . <100 mg/dl),d iab et is preve ncia an kontr oli , antiagregac iuli mku rnal oba ( aspirini ,klop irog eli an oriv e),ga nixi le cilosta zol is gamoy en eb is aucile bloba Tu mxolod datvir Tv a ar aris sakmaris i.

izolirebuli sistoluri h ip ertenzia

JNC-VI- isa da WHO/ISH mixedviT, izolirebuli sistoluri

hipertenzia gansazRvreba, rogorc: sistoluri sisxlis wneva ≥ 140 mm vwy sv da diastoluri sisxlis wneva < 90 mm vwy sv.

izolirebuli sistoluri hipertenziis (ISH) sxvadasxva xarisxebi gansazRvreba Semdegnairad:

I xarisxi:

jgufSida mosazRvre

II xarisxi:

III xarisxi

sistoluri arteriuli wneva < 160 mm vwy sv.

sistoluri arteriuli wneva < 150 mm vwy sv.

sistoluri arteriuli wneva < 180 mm vwy sv.

sistoluri arteriuli wneva ≥

28

180 mm vwy sv.

asakTan dakavSire buli sisxlZarRvo vani da neiroh umoruli cvlile be bi

mniSv nelovani faqtor eb ia, rom elTac miv yavar T hiperte nz iis da kerZ od,

izolir ebuli sistolu ri hipert enziis ganvi Tare ba mde . asakTan erTad

izrdeba kolage nis , ujredgare matri qsis cile bis , ZiriTadi niv Ti er eb is da

elasti nis raodeno ba, rac kavSirS ia sisxlZarRvTa struqt urul da

funqc iur cvli lebe bTan , Sesabam isad uar esde ba arteri uli damyol obac . es

cvlil eb eb i iwve vs sisxlZarRv Ta intim isa da mediis struq turul da

meqa nik ur cvli lebe bs . kalciu mi ukavS ird eba elasti ns, Sedegad mediis

aradifere ncireb uli kunT ova ni ujrede bi ganicdian prolif erac ias da

elasti kur i mem bran is gavliT migrir eb en inti maS i. Sema erTebeli qsovil is

prolife racia iwv evs intim is gasqele basa da fibrozs , izrde ba

sisxlZarRvTa rigidul oba kumS vadob is mniSv nelovani Semc ir eb iT .

Sesabam isad mci rde ba arte riu li damyol oba da ikl ebs msxvili arter ie bis

e.w . “windkessel function”. sistol uri arter iuli wnev is araproporciu li zrda

iwve vs puls uri wnev isa da pulsu ri talRis siCqaris zrdas, rac

ganpirobe bulia perif eriaz e wnev iTi talRis adreul i arek vliT .

Sesabam isad, 60 wels gadaSoreb ul pire bSi sisxlis sistol uri wne va

imate bs, maSi n, roca diastol uri wne va ucv lelia an Semci re buli .

izolir ebuli sistolu ri hipert enziis dros aRiniSn eba gulis

wuT moc ulobis, dartymi Ti moc ulobis , sisxlZarRvSida mocu lob is,

Tirk mlis sisxlis mimo qce visa da plazmis reni nis aqtivo bis Semc ir eba ,

marcxena parkuW is masis, mocir kulir e kateq olamin eb is (kerZod ,

noradre nali nis) , da saerTo perif eriuli sisxlZar Rvovani rezis te nto bis

zrdis fonze . aseve mcird eba baror ecepto rebis mgrZno beloba sisxlis

wnev is cvli lebe bi s mi marT , rac ganpiro be bulia sisxlis wne vis maRali

variabe lobiT.

izolir ebuli sistolu ri hipert enziis ukanas kn el gansazRvre baz e

dayrdnobi T (≥140/ <90 mm vwy sv), arseb obs mwiri infor mac ia izolir ebuli

sistolu ri hipert enziis gavrce lebis Sesaxe b. asakTan erTad aRiniSn eba

izolir ebuli sistolu ri hipert enziis (Zvel i gansazRvr eba) gavrc ele bi s

29

zrda (tabula 2). is warmoadge ns hiperte nziis yve laz e metad gavrc ele bul

tips asakovanT a Soris . 60 wels gadaSore bul, aranam kurnal eb i hipert enziis

mqon e pirebs Soris, izoli rebuli sistol uri hipert enzia warmoadg ens

hiperte nz iis yve laze me tad gavrce lebul formas.

tabula 2

izolir ebuli sistolu ri hipert enziis gavrce leba (Zveli gansazRvre ba, ≥

160/ <90 mm. vwy .s v)

asaki (%)

50

60

70

80+

0.8

5.0

8-12.6

23- 25

Framingham Study –is (asev e Zvel i gansazRvr eb is gamoye ne biT) 24- wlian

kum ulac iur mona ce me bz e dayrdnob iT , izoli rebuli sistol uri hipert enzi is

arsebo ba maRalia rogorc 65 wels gadaSore bul qale bS i (533/1000) , ise

mamakac ebSi (418/1000). 65 wels gadaSoreb ulTa Soris, izolir ebuli

sistolu ri hipert enzia diagnostirda , rogorc hiper te nzi is yvelaz e metad

gavrcel ebuli tipi (57.4%- kacebS i, 65.1%- qale bSi) . zogier Tm a kvleva m

gamoavli na kardio- an cer ebr ovask uluri daavadeb eb is ganviTa re bisa da

sikvdilo bis gazrdili riski pacient ebSi izoli rebuli sistol uri

hiperte nz iiT. izolir ebuli sistolu ri hiperte nz ia orjer da metad zrdis

kardiovask ulur avadobasa da yvela mize ziT ganpirob ebul sikvdi lobas ,

xolo kardiovas kulur sikvdi lobas – samjer . MRFIT kvlev eaS i, rom elS ic

CarTul i iyo 316 099 mamakac i, gamovl inda sistolu ri wnev is uk eTes i

prediqt oru li mniS vn elo ba diastolur Ta n Sedar eb iT . izoli rebuli

sistolu ri hipert enziis mqo ne aranamk urna leb pacient ebSi gamovl inda

konce ntra ciuli re mode lir eb is tipis marcx ena parkuWis hipert rof iis

farTo gavrc ele ba , rac cudi kardiovas kuluri prognozis mima niS ne belia .

30

Catareb uli randomiz ebuli klini kuri kvle ve bi avle ns izol irebuli

sistolu ri hipert enziis mku rnal obis mniSv nelova n sargeblia nobas . Systolic

Hypertension in the Elderly Program (SHEP) kvle va iyo pirve li, rom elS ic 4716 pacie nt is

magaliT ze gamovl inda qlortal idoniT (saWiro eb is SemTx ve vaS i

atenol olis da rezerp in is damate biT) antihip ert enziuli mk urna lobis

dadeb iTi gavle na kardi ovas kulur avadobasa da sikvdil obaz e.

Aarafatalu ri insul tis SemTx ve vaTa raode noba Sem cirda 37%- iT,

arafatalur i miokardi um is infarqt is – 33%- iT da marcx ena parkuWis

ukmar iso bis – 54%- iT. AaRiniSna mkv eTri tend enc ia tranzit oruli iSe miuri

Sete ve bis (25%- iT), saer To sikvdilo bis (13%- iT), kardiovas kuluri (20%- iT),

cere bro vas kul uri (29%- iT) da koro naru li (20%- iT) sikvdilo bis Sem cir eb is

mxriv. kvl ev is farglebSi asev e gamov linda SardmJavas damou kid ebeli

prediqt oru li mniS vn elo ba izolir ebuli sistolu ri hipert enziis mqo ne

pacient eb isa Tv is. pacien te bS i SardmJa vas maRali Semc velobiT, diur etik ebze

damyare buli mkur nal oba iseT iv e efeq turi iyo, rogorc pacie nt ebSi

SardmJavas dabali doni T. The Systolic Hypertension in Europe (Syst-Eur) iyo pirve li

udidesi kvle va (rome lSic CarT uli iyo izolir ebuli sistolu ri

hiperte nz iis mqon e 4695 pacient i), rom eli c mieZRv na gaxangrZliv ebuli

moqm ede bi s kalci um is antagonis tis, nitr end ipi nis (saWiroe bis Sem Txv eva Si

enalapri lis da/an hidroqlo rTiaz idis damat eb iT) efe qturo bis Seswav las

avadobasa da sikvdi lobis riskze . Syst- Eur kvle vaSi gamovl inda

insult eb is saerT o raoden ob is 42%- iani da sisxlZarRvovan i demen ci is

ganviTar eb is 50%- iani Semc ir eba , rac ar aRiniSna qlorta lido nis miRe baz e

damyare buli SHEP kvl ev is dros, Tum ca gamo Tqm uli iqna mosaz re ba

dihidropirid inuli jgufis kalciu mis antagonis tis , nitre ndipi nis

neirop rot eqtor uli efeq tis arsebo bis Sesaxeb . Syst- China kvl eva m

ganamtki ca Sexed uleb a izol ire bul i sistolur i hiperte nz iis mqon e

pacient ebze nitre ndipi nis dadebiT i gavlenis arseb ob is Sesaxe b, ram eTu

kvle vis procesSi gamovl inda insul tis saerTo raoden ob is 38%- iani,

insult iT avadobis 58%- iani, yvela saxis sikvdilo bis 39%- iani ,

kardiovask uluri sikvdilo bis 39%- iani, fatalu ri da arafatalur i

kardiovask uluri movle ne bi s 37%- iani Semc ire ba . INSIGHT kvlev is jgufSida

analizma gamoavl ina , rom izol ire buli sistol uri hiper te nz iis mqon e

31

pacient eb i Cveu lebriv hipert enzias Tan Sedar ebi T uke T eqv emd eb are bod ne n

gaxangrZli ve buli moq med eb is nifedi pi niT mku rnal obas da mniS vn elov nad

nakle bi raodeno biT pacient i saWiroe bda meor e preparatis damatebas .

Staessen-is meta- analizm a aCve na, rom aqtiur i mkur nalo ba amcire bs saerTo

sikvdilo bas 13%- iT, kardiovask ulur sikvdil obas 18%-iT , yvela saxis

kardiovask uluri garT ule be bi s ganvi Tar ebas 26%- iT, insu lte bi s

ganviTar eb as 30%- iT da korona ruli movl en eb is ganviTar eb as 23%- iT.

absolut uri sargebe li gamovli nda upirat esad mamakac ebSi , 70 wels

gadaSore bul pacient ebSi , gadatanil i kardiovas kuluri garTu lebe bi sa da

farTo pulsuri wne vis mqon e individ ebS i. aRniSn uli mk urna lobis

preve nci uli efeq ti koronar ul movl en ebTa n Sedare biT ufro Zlie rad

insult Ta n mi marT eb aS i gamovl inda .

sisxlis wne vis Semc ire bisa da kardio vask uluri garTu lebe bi s prev enciis

Tvalsazr isi T Catareb ulma, med ika me ntTa efeq turob is Sesa fase belm a

kvle ve bm a gamoavl ina beta- bloke re bTan Seda re biT Tiazid- damokide buli

mkur nalo bis upirat eso ba. izol ire buli sistol uri hiperte nz iis mqon e

pacient ebze Catare bulma bolo drois kvl ev eb ma , romel ic moicavda agf-

inhibi tor ebsa da angiote nzi n AT1 rec epto rebis antagonis te bs, asev e

gamoavli na arteri uli wne vis uke Tesi kontr olis saSual eba .

izolir ebuli sistolu ri hipert enziis mqo ne pacien te bi saTvis pirve li

donis mku rnal oba aris cxovre bis stilis Secvla (fizik uri aqtivo ba,

marilis moxmar eb is SezRudva , Warbi wonis mqon e pacient ebSi sxeulis masis

Semc ire ba , mwev elobis Sew yve ta) . rekom endir ebuli sisto luri wnev is

SenarC un eba samiz ne donez e, ker Zod ≤ 140 mm vwy sv (garkveu li period is

ganmavlo baSi SesaZl eb elia 160 mm vwy sv- ze nakle bi cifre bis SenarC un eb ac).

Tu cxovreb is stilis Sec vla ar iZle va sisto luri wnev is samiz ne donis

miRwe vis saSuale bas, sisxlis wnev is kont rol is misaRwevad

reko me ndir ebulia medika ment uri mkur nalo ba. izol ire buli sistol uri

hiperte nz iis mqon e pacien te bisa Tv is, diur etike bi da gaxangrZliv ebuli

moqm ede bi s dihidropi ridi nuli tipis kalci um is antagonist eb i miCn eulia

mkur nalo bis pirve li rigis medi kam ente bad . garda aRniSnu li

medika me nt eb isa , izolir ebuli sisto luri hiperte nz iis samku rnal od

32

aranakle b efeq tur med ikam ente bad iTvl eb a agf- inhibi tor eb i da angiote nz in

AT1 rec epto rebis antago nist eb i. zogie rTi mimdi nare kvl eva iZleva im eds,

rom gamovl ind es medika me nt eb is SesaZlo axali damateb iTi efeq te bi da

axali medika me nt eb i proble mi s gadaWris mizni T.

orTostatikuri hi potenzia

normaS i fexz e dgomisas sistolu ri arter iuli wneva mcir edi T kleb ulobs da diastol uri wneva mcired iT matul obs . orTos tati kuri hipoten zia diagnostird eba Tu wamodgom isas sistolur i arteri uli wne va qvei Tde ba > 20 mm/ vw y.s v. an diastol uri wneva qve iTd eb a > 10 mm /vw y.s v. orTosta ti kuri hipoten zia gansaku Treb iT xSiria xanSiSes ul , diabe tiT daavadebu l pacient ebSi . Aarsebo bs pirdapiri korelac ia orTostat ikur hipote nzi is simZim esa da sikvdi lobas Soris. orT ostat ikuri hipoten zi is mize ze bi a: hipovol em ia, barore cep tor eb is disfun qcia , avton om iuri disfun qc ia, sxvadasxva ve nodila tato rebi (alfa blok er eb i, beta -alfa bloke re bi ) nitrat eb ma da diure ti ke bma SeiZl eb a gaaZlie ron orTos tati kuri hipoten zia . xanSiSes ul pacient Ta mku rnal obisas klin ic iste bs yove lTvis unda axsovdeT orTos tat iku ri hipote nz iis ganviTar eb is riskis Sesaxeb da ar gamoeparo T misi simpto me bi( wamodgom isas Tavbr usxv eva , wonasw oro bis kargva, sisust e). Sesabam isad aucil eb elia peri odulad wnevis gazomva wolisas da dgomisas yve la pacie ntS i 50 wlis zem oT .

hi pertenzia qalebSi

araorsul qalebSi.

arsebo bs arteri uli wnevis seqs ualu ri dimorf izm i, romel ic gamoixate ba dabal arteri ul wne vaSi mozardi asakis qale bSi , Sedare biT mamakac ebTa n da piriqi T sicocxlis mee qvs e dekadidan qale bs ufro maRali sistolu ri arteri uli wneva aReniSn eb aT vidr e mama kace bs . diastolur i arteri uli wneva qale bSi ufro dabalia vidre mamaka ce bSi mi uxedavad asakisa. Sesabam isad adreu l mozard asakSi hiperte nz ia nakle bad xSiria qalebS i, vidre mamakac ebSi . Tum ca sicocxlis mexu Te dekadidan qale bS i arter iuli hiperte nz ia gvxvdeba igive an ufro me ti sixSiriT vidr e mama kace bS i

me nopauza da arteriuli wne va .

menopa uzis gavle na arteri ul wneva ze davis sagans warmoadge ns. er Tma nawilma kvl ev eb isa ver daa dastura axdens Tu ara gavle nas menopa uza arteri ul wne vaze , maSin rodesac kvle ve bis meo re nawil ma aCvena arteri uli wnev is mni Svn elova ni zrda postme nopau zur qalebS i.

33

oraluri kontracefcia da arteriuli wneva.

qaleb is umravl eso bas, rom lebic iye ne be n oralur kontra cefcias aReniSn eb aT arter iuli wnev is mcire d, magram SesamCn ev ad mat eba , xolo maT mcire proce nts ki ewy eba T mniS vn elo van i hiperte nz ia. erT erTi kvl ev is mixedv iT qale bi , romle bic xSirad iye ne be n kontra cep tiv eb s imy ofe bi an ufro maRal riskjgufSi arter iuli hipert enziis ganvi Tare bi s, vidre qaleb i, roml eb ic oralur kontra cep ti ve bs ar xmarob en . sxvadasxva kvle ve bm a aCve na, rom oralu ri kontrac ept iv eb is moxmar eb is Sewyv et is me re arteri uli wneva 3 Tv eSi ubr und eba sawyis dones. kontra cep tiv eb iT Terapi isas rekom end ir ebulia arteri uli wne vis regular uli monit ori ngi. kontrac ept iv is miR eb is xangrZliv oba unda SeizRud os eq vs Tv emd e, raTa moxdes mdgomare ob is xelaxali Sefas eba . kontrac ept iv eb iT gamowv euli hiper te nz iis dros unda Sewyde s am preparate bis miRe ba. gamonakl is SemTx ve ve bS i (Tu sxva kontrac ept iuli meT ode bi ar aris xelsayre li) kom bi nir ebuli unda iyos antihipe rte nz iul Terapias Ta n.

.

ant ihipertenziuli mkurnalobis SerCevi s principebi qalebSi.

antih iper te nz iuli mkur nal obis daniSvn isas qalebS i unda gaviTval isw ino T, ramoden im e specifi kuri sakiTxi . ACEI, ARB ukuna Cv en eb ia im pireb Si , vinc SeiZ leba iyvne n an ukve fexmZi med arian, nayofis anomal ie bis ganviTa re bis Tavida n asacil eblad . ramden im e antihep ert enziuli medika me nt i specifi uria sqesis mima rT . magaliTad : kvle va TOMHS-is, mixedv iT , qalebs orjer met i gverdi Ti ef eqt eb i aReniSn eb aT , vidre mamakac eb s. qale bs ufro xSirad aReniS ne baT diuret ik eb iT gamowve uli hiponatr em ia, xolo mamakac ebs podagra. hipokal em ia ufro xSiria qale bSi , romle bic mkur nalo be n diure tik eb iT . Aagf inhi bit oreb iT gamowve uli xvela orjer ufro xSiria qale bS i, vidre mamaka ce bSi . qaleb Si ufro xSiria kalciu mi s arxeb is bloke re biT gamowve uli perife riuli SeSup eba da min oqsid ili T gamowv euli hirsut izm i.

orsulTa hi pertenzia

orsulT a hiper te nz ia dedis, nayofis da neo nata lur i avadobisa da

sikvdilo bis mniSv nelovani mize zia , rogorc ganvi Tare bad , aseve

ganviTar ebul qv eyn ebSi . orsulo bis meor e trim est rSi aRiniSn eba arter iuli

wnev is fizi olog iur i daqvei Teba da Sesaba misad , arter iuli wne va

daa xloe biT 15 mm .vw y. sv .- iT (saSualod) nakle bia orsulo bamd el dones Tan

Sedare biT . mesa me tri mes trS i arter iuli wne va ubr und eba orsul oba mde l

dones da SeiZle ba gadaaWarbos mas.

dReisaT vis ar arsebobs orsul Ta hipert enziis unif ic ire buli gansazrvr eb a. Zvel i gansazRvr eba eyrdn oboda meo re trim est rSi arter iuli wnev is mateb is sidides pirv eli trim est ris sabaziso maCv en eblTan an orsuloba mde l donesTa n Sedareb iT ; dReisaT vis upirat eso ba arteri uli wnevis absol utu r doneze (sistol uri arte riu li

wne va (saw) > 140 mm vwy sv an/da diastolur i arteri uli wne va (daw) ≥90 mm vwy sv) damyar ebul gansazRvr ebas eniW eb a.

34

orsul Ta hipert enziis klasif ikac ia:

orsulT a hiper te nz ia moi cavs Semdeg form ebs :

• orsulo bamd e arsebu li hipert enzia arTul ebs orsuloba Ta 1-5%- s da

ganisazRvre ba , rogorc arter iuli wneva ≥140/90 mm vwy sv, rom eli c win

uswre bs orsulo bas an viTard eb a orsul obis meoc e kviramd e;

Cveu lebriv rCeba mSobia rob is Semd eg 42 dRez e met xans da SeiZl eb a

Tan axldes prote inuria.

• gestaciu ri hipert enzia ganisazRvre ba , rogorc orsul obiT

gamowve uli hipert enzia protei nuriis gareS e. gestaci ur hipert enzias

mniSv nelovan protei nurias Tan erTad (>300 mg/l an >500 mg/24 sT an +2

da meti test is Cxirze) preek lamfs ia ewod eba . gestaci uri hipert enzia

viTard eba oci kvir is orsul obis Semdeg da xasiaTde ba organo eb is

perfuz iis gauares eb iT .

• gestaciu ri hipert enzia da prote inuri iT garTu lebuli orsul oba mde

arsebu li hiperte nz ia. aRniSnul i Seesa bam eb a adre arsebu l ter mins -

“pree kla mfs iiT garTul ebuli qron ikuli hipert enzia ”. igi xasiaTde ba

orsulo bis meoc e kviris Semd eg protei nur iiT Tanxle buli arter iuli

wnev is mkve Tri zrdi T (cilis eqskr eciasT an ≥3 g/dReSi 24 saaTian

SardSi).

• antena talu rad araklasifi cir ebuli hiper te nzia ganisazRvre ba ,

rogorc orsul obis meoc e kviris Semdeg pirve ladad gamovl en ili

hiperte nz ia siste muri gamov lin eb eb iT an maT gareSe . ganme or eb iTi

Sefase ba aucil eb elia mSob iaro bida n 42 dRis Semd eg. Tu am

droisaTv is hipert enzia aRar aRiniS ne ba, mdgomare oba Sefasdeba

rogorc gestaciu ri hiperte nz ia (prote inu ri iT an mis gareSe) . Tu

hiperte nz ia rCeba, mdgomar eoba Sefasde ba rogorc orsulo bamd e

arsebu li hipert enzia .

rek om end ire buli labora tor iuli gamokvl ev eb i:

orsul obisas ganvi Tar ebulma hiperte nz iam da masTan asocire bulma

darRvev eb ma , kerZod gestaciu rma hipert enzia m protei nurii T an mis

gareS e, SeiZl eba gamoiw vios hema tol ogiu ri , Tirk mlisa da RviZlis

funq ciuri maCv en eblebis cvli lebe bi da uary ofi Ti gavlena moaxdin os

dedisa da nayofis gamosavalz e. orsu lob isas hiperte nz iuli pacien te bis

mon ito ring isaT vis reko me ndi re buli ZiriTad i laborator iuli

gamokv le ve bi moc emulia cxrili 1-Si.

cxrili 1. orsulT a hipert enziis mqon e pacien te bis monit ori ngisa Tv is reko me ndir ebuli ZiriTadi labora tor iuli gamokvl ev eb i.

hem oglo bin i da

hema tok rit i

hem oko nce ntracia gestaci uri hiper te nz iis diagnozis (prote inuriiT an mis gareSe) safuZvlia da miuTiTebs mdgomar eobis simZim ez e. Zalian mZi me SemTx vav ev ebSi aRniSn uli maCv en eb eli SeiZle ba dabali iyos , rac hem oli ziTaa ganpirob ebuli.

35

Tro mboci te bi

aRiniSn eb a Trom boc itop en ia < 100.000 X 10 99 /l, rac SesaZl eb elia/l, rac SesaZl eb elia mcir e sisxlZarRv ebS i mis moxmar eb aze miu TiTebd es . maCv en eb elimcir e sisxlZarRv ebS i mis moxmar eb aze miu TiTebd es . maCv en eb eli kor eli re bs simZi me sTa n da gansazRvravs mSob iaro bis Se mdgomkor eli re bs simZi me sTa n da gansazRvravs mSob iaro bis Se mdgom periodS i gamojanmr TeperiodS i gamojanmr Teleb is temps.leb is temps.

ast da alt sisxlSi

moma te buli maCv en eb eli miu TiTebs procesS i RviZlis CarTva ze . Semdgo mS i maT i mateba mdgomar eobis damZim eba ze mi uTiTebs.

ldh sisxlSi

moma te buli done procesS i RviZlis CarTvasa da hemo lizze miuTiTebs. SeiZle ba asa xavdes mdgomar eobis simZim es da gansazRvravd es mSobia rob is Semdgom gamojanm rTeleb is pote ncia ls.

prote inuria (24 saaTiani

Sardis Segro ve biT)

prote inuriis Sesafase beli standartu li meT odia . Tu prote inuriis done metia 2 g/dReSi, aucil eb elia inte nsiu ri mon ito ring is ganxorcie leba . im Sem Txv eva Si, Tu is aRema te ba 3 g/dReSi , unda daisvas mSobia rob is daCqareb is sakiTx i.

Sardis analiz i

test is CxiriT protei nur iis gansazRvra xasiaTd eba cru-pozit iur i da cru- negati uri Sedege bis mniS vne lovan i sixSiri T.

dadebi Ti Sedegis Sem Txv eva Si (≥1), protei nuriis dasadasture blad saWiroa 24 saaTiani Sardis kvle va. uary ofi Ti

Sedeg i ar gamoricxavs protei nurias , gansakuT rebiT daw ≥ 90 mm vwy sv SemTx ve vaSi .

SardmJa va sisxlSi

moma te buli done gvexmar eba gestaci uri hiperte nz iis difer encial ur diagnozSi da SeiZ leba asa xavdes mdgomare ob is simZi me s.

kreati ni ni sisxlSi

done qv eiT de ba orsul obisas . momat ebuli done hipert enzi is simZi mis xarisxis zdaze miuTiTebs; mizanS ewon ilia kreati ni nis 24 saaTian i klire nsis gansazRvra.

HELLP ast – aspart amin otra nsfe raza ; alt - alanin amino trans feraza; ldhHELLP ast – aspart amin otra nsfe raza ; alt - alanin amino trans feraza; ldh – laqtatdeh idrog ena za, daw – diastolur i arteri uli wne va.– laqtatdeh idrog ena za, daw – diastolur i arteri uli wne va.

orsul Ta hipert enziis mk urna loba :

pacie nte bs , romel Tac orsul oba mde aReniS ne boda T msub uq i an saSualo simZi mis arter iuli hipert enzia(140 -179/90- 109 mm vwy sv) da ar gaaCniaT Tir kmlis funqc iis darRveve bi , ar saWiroe be n medika me ntur Carevas , radgan ar arsebobs imis mtki ce buleba , rom farmak ologi uri mkur nalo ba neo natal uri gamosav lis gaumjob ese bas iwve vs. Sefard eb iTi riski pacie ntT a am kont ige ntS i Sedareb iT dabalia .

B

orsulT a hiper te nz iis aramedi kam enturi mkur nal oba da profilaq ti ka:

aramed ika me nturi mar Tvis sakiTx i unda daisvas im Sem Txv eva Si, roca orsul ebs aReni Sne baT saw 140- 149 mm. vwy .sv . an daw 90- 99 mm. vwy .s v, an orive erTad. mkur nal obis tipi ganisazRvre ba arteri uli wnevis doniT , gestaci uri asakiT, dedisa da nayof is mdgomare ob iT ; da moica vs mWid ro zedamx edv elobas , aqtivo bis SezRudvas da xSirSe mTxv evaS i, woli T reJi ms marcx ena lateral ur poziciaS i.

aseTi pacien te bisa Tv is rekom ende bulia dieta marilis SezRud viT.

kalciu mis preparate bis (2 g/dReSi), Tevz is qonisa da dabali doziT

acetilsa lic ilis mJavas miRe bam ver dadasturda efe qturo ba gestaci uri

hiperte nz iis , gansakuT rebiT preek lam fsiis riskis Semc ir eb is Tvalsazr isi T.

im qalebS i, romle bsac anamne zSi aReniSn eba T adre uli preek lamfs ia (<28

kvira), aspirin is dabali dozeb iT profilaq ti kuri daniSvna mizanS ewon ilia .

orsulo bis periodS i arter iuli wne vis daqvei Tebi saT vis wonis dakleba

reko me ndir ebuli ar aris, rame Tu wonis dakle bam SeiZl eb a gamoi wvi os

axalSobil is dabali wona da Seaf erxos bavSvis zrda (dedis dietaz e

yofnis SemT xve vaS i).

sakama To rCeba qroni kuli hiperte nz iis mqon e orsul qaleb Si

antihipe rt enziuli medi kam ente bi s mudmi vi miRe bis saWiroe bis sakiTx i.

arsebo bs erTia ni azri imis Sesaxeb , rom orsulob isas mZime hiperte nz iis

medika me nturi mkur nalo ba aucile beli , efe qtu ri da sasargebl oa.

36

hiperte nz iis Sedareb iT msub uq i form eb is mkur nal obis Sesaxeb ki

gansxvaveb uli mosazre be bi arsebobs . marTal ia, artri uli wne vis daqvei Teba

dedisTv is SeiZle ba sasargeblo iyos, magram aman SeiZ leba gaauaresos

uter oplac enturi perfuz ia da Sesabam isad nayof is ganvi Tar eba .

orsul Ta hipert enziis farmak olog iur i mkur nalo ba:

miuxedavad imisa , rom orsul Ta hiperte nz iis mku rnal obis miza ni dedismxr iv i riskis Sem cir eb aa, SerC euli preparate bi misaRe bi unda iyos nayof isT visac .

orsul ebs, rom elT ac aReniSn eb aT : gestaciu ri hipert enzia prote inu ri is gareS e an arseb uli hiper te nzia 28 kviris orsul oba mde , gestaciu ri hipert enzia da prote inuria an simpto me biT mi mdinar e orsulo bis neb ism ieri period i, arseb uli hiper te nzia da samiz ne organos daziane ba, gestaci uri hiperte nz ia garTu lebuli arseb uli hiperte nz iiT, - mkurna lob is dawye bis zRurb lia saw - 140 mm .vw y. sv . da daw – 90 mm .v wy. sv . sxva SemT xve vaS i Carevis zRurbl i saw - 150 mm .v wy .sv da daw – 95 mm .v wy .sv .- aa.

• orsul qalebS i saw ≥170 mm vwy sv an daw ≥110 mm vwy sv unda

CaiTval os gadaudeb el mdgomar eobad da aucil eb elia hospitalizac ia.

SesaZle belia farmako logi uri mkurna loba intra ve nuri labe talo liT ,

peroral uri meT ildo faT i an nif edipi niT . intrav enuri hidralazin i

aRar ganixile ba arCev is preparatad, ramdenadac misi gamoye ne ba sxva

medika me nt ebTa n Sedare biT ufro met peri natal ur gverdi T

movl en ebTa n asocird eba .

• hiperte nz iis nakl ebad mZime formisas arCevis medi kam ente bia

meT ildo fa, labeta lol i, kalci um is antagonist eb i da beta-

blokat ore bi . amasTan , kalciu mi s antagon isti ar unda dainiSn os

magniu mis sulfatTa n erTad (hipoten ziis riski; potenc iuri

sinergi zm is gamo) .

• orsulo bisas ar SeiZle ba angiote nz inis gardamqn eli fer me nt is (a gf)

inhibi tor eb is da angiot enz i II antagon iste bi s gamoy en eb a.

• preek lam fsiis Sem Txv eva Si Semc ire bulia plazm is moc ulo ba. aqedan

gamomdina re , Tu saxeze ar aris oligur ia, Sardmdene biT mkur nalo ba

araadeqvat uria.

• eklam fsiis prev enciisa da kru nCxv eb is mkurna lobaSi efe qtu ria

magniu mis sulfat is intra ve nuri ine qcia .

• naadrevi mSobia rob is gamowv eva saWiroa im SemT xve ve bS i, Tu aRiniSn eb a

protei nuriisa da gestac iur i hipert enzi is iseT i garTu lebe bi ,

rogoricaa mxedve lobis gauarese ba , koagulaci uri darRve ve bi an

nayofis distresi .

cxrili 2: hipote nz iur i preparate bi orsul ebSi .

orsule bs , romel Tac aReniS ne boda T orsulo bamd eli periodis hiperte nz ia, unda ganagrZon daniSn uli hipote nzi uri medi kam ente bis miReba ; garda agf-inhibi tor eb isa da angiot enz in II antagonist eb isa. arseb uli hiperte nz iis

mqon e qaleb ma, rom elTa daw ≥100 mm .v wy .sv .(a n daw <100 mm .vw y. sv. da aReniSn eb aT samizn e organoe bis daziane ba an/da Tirk mlis paTol ogiis

arsebo ba) da mwvave hipert enzi isas (daw ≥105 mm .v wy, sv .) reko me ndi re bulia miiRon Semd egi preparate bi :

37

cen tral uri alfa agoniste bi

meTildofa arCevis preparat ia

beta- blokato rebi aten ololi da metapr ololi uvn eb eli da efeq turia orsul obis mogv ian eb iT periodS i.

alfa/b eta-blokat ore bi

labe talo ls aqvs meT ildofas msgavsi moqm ed eba ; mZim ed mi mdinar e hipert enzi is Sem Txv ev aSi unda dainiSn os intra ve nurad

kalciu mis arxeb is blokat ore bi

arter iuli hipert enzi is dros, gadaude bel situaci ebSi unda dainiSn os peroralu rad nifedipi ni , an intra ve nurad isradipin i. am jgufis preparate bis daniSvna m magniu mis sulfat Tan , potenc iurad sin ergist uli moqm ede bis gamo SeiZl eb a gamoi wvi os hipotonia .

agf-inhib ito rebi , angiot enzin II antagonist eb i

preparat eb is miReba m SeiZl eba gamoiw vios nayofis dazian eba da sikvdi li , ris gamoc isini uku naCv en eb ia orsul ebSi

diure tik eb i

diur eti ke bi rek om end ebulia qroni kuli hiperte nz iis mqon e qale bSi Tu isini daniSnu li iyo gestac iamd e, an pacien te bSi , rom elTac aReniSn eb aT gaZlier ebuli mgrZnob eloba maril is mi marT . am jgufis preparat eb i ar aris rek om end ire buli pre-ekla mfs iis dros.

pirdapiri vazodilata tor eb

i

hidralazi ni iniSn eb a upira tesad parent eral urad mavn e peri natal uri ef eqt is gamo .

hiperte nz ia laqtaciis dros:

ZuZuT i kve ba ar zrdis dedis arte riu l wne vas. meZuZ uri dedis mier

miReb uli yvela antihip ert enziuli preparat i xvdeba rZeSi . maTi

umrav les ob is konc entrac ia Zalian dabalia, garda proprano lol isa da

nifedip inisa , rom elTa konc entrac ia dedis rZeSi plazm uri konce ntrac iis

sidides uto lde ba.

hi pertenzia bavSvebsa da mozardebSi

bavSve bsa da mozard ebS i arter iuli hiper te nzia ganisazRvre ba rogorc ramode nim e ganmeor eb iTi gazom viT miRe buli maRali arteri uli wnev is cifre bi - asakis, sqesis da simaRli T gaTvalis win ebulis 95(persin tili an meti) . bavSv ebS i hiperte nz iis Sem Txv evaS i eqim ma aucil eblad unda ifiqros meorad hiper te nz iaze da klini kur i monac em eb is safuZve lze daiwyos Sesabam isi gamokv le ve bi . mozard ebS i arteri uli hipert enzia xSirad asocire bulia simsu qn esT an , mjdomare cxovr ebis wes Tan , hiperte nz iis da sxva kardio vasku luri garTul eb eb is ojaxur anamn ezTa n.a rt eri uli hiperte nz iis mku rnal obisas farmak olog iuri Terapia aucile beli xdeba , roca misi marTva ver xerxdeba mxolod cxovre bis wesis Secvli T. antihipe rt enziuli medika me nt eb i igivea, rac mozrd ili asakis pacient TaTv is, mxolod doza aris mcire da amavdrou lad unda dainiS nos didi sifrTxi liT. Aagf inhib itore bi da a.r. bloke re bi ar gamoiy en eba orsul da seqsua lurad aqtiur gogonebS i, romel Tac dafexmZim eb is riski aqvT. gaurT uleb eli hipert enzi is pirob ebSi , bavSve bi ar unda SeizR udon fizik uri aqtivo bis mxriv , radganac xangrZlivi varjiSi aqvei Te bs arteri ul wnevas . bavSve bS i mkac rad ikrZal eba anabol uri ster oid eb is gamoy en eb a.

hip ertenziis gad audebeli da saswrafo Se mTxvevebis mkurnaloba

38

hiperte nz iis gadaudeb eli Sem Txv ev eb i ganisazRvr eba , rogorc arte riu li wnev is (aw) Zlier i mateba samiz ne organo ebis mwva ve daziane bis arseb obisas . mwvav e koronar uli sindro mi , aortis ganSre ve badi anevr iz ma, filt ve bis mwvav e SeSupe ba , hiperte nz iuli ence falopa Ti a, Tavis tvinis mwva ve infarq ti an intrace re bra lur i sisxlCaqce va da eklam fsia aris is klini kur i mdgoma -reob eb i, rodesac saWiroa aw dauyo vn eb eli daqv eiT eb a, raTa Tavidan iqnes acile buli samizn e organoe bis daziane bis progresir eb a (cx. 1).

hipert enzi is saswrafo Sem Txv ev eb i aris aw Zlie ri mate ba (>180/120 mm . vwy .sv) samizn e organoe bis mwvav e daziane bis gareSe . hiperte nz iis saswrafo SemTx ve ve bi s dros aw Cveu lebriv unda daqvei Tdes oralurad misaRe bi medi kam ente biT, ambu lator iuli me Tvaly ure ob is qveS.

pirvelad i Sefas eba : pirv eladi Sefase bis kriti kuli nawilia pacie nte bi saT vis damaxasi aTeb eli triada: anamn ez is dawvri lebiTi Segro ve ba (gansaku Trebuli yuradRe ba unda mieq ces hipert enzi is da samizne organoeb is dazianeb is arsebo bas), zust i fizi kalu ri gasinjva (moi cavs ofTalm osk opiasac) da SerC ev iTi labora tor iuli gamokvl ev eb i, rogoricaa Sardis analizi , kreati nin i, Sardovana , eleq tro lit eb i da sisxlis saer To analizi .

Tu saeWvoa simpto muri hipert enzi is arseboba , saWiroa sisxlSi gamok -vle ul iqnas renin is, aldoste ron is da kateq olam in eb is Semc veloba. yve la avadmyofs mizanS ewoni lia Cautard es el eqt roka rdiogra fia da gulm kerdis rentg eno logi uri gamok vle va (cx. 2).

arseb uli gaidlain eb is mixedv iT , arteri uli wneva unda gaizom os mjdo -mare da ver ti kalu r pozicie bS i. Tu aRiniSn eba xele bs Soris aw mniSv ne -lovan i sxvaoba , eWvi unda iqnas mitan ili aortis ganSrev eba ze . gadaudeb eli daxmare bis ganyofi lebe bS i unda Catardes aw zusti mon ito rir eba .

hiperte nz iis gadaudeb eli Sem Txv ev eb is mku rnal oba : avadmyo fe bi unda mo Tavsdn en int ens iur i Terapi is palataSi klin iku ri meTvaly ure ob isa da aw xangrZli vi monit ori re bis miz niT . umra vles Sem -Txv eveb Si upirate soba eni We ba parent eral uri medika me nt eb iT agresi ul mkurna lobas , risi miza nic aris aw nawilo bri vi daqvei Teba (da ara norma -lizac ia), pirve li wuT eb idan erT i an ori saaTis ganmavlo baS i 20- 25%- iT, Semd eg saWiroa aw frTxil i daqve iT eb a. aw swrafi daqv eiT eb a misaReb ia hipert enzi is gadaude beli SemT xve ve bi s ume tes ob isas, cer ebr ovask uluri Sem Txv ev eb is garda, rodesac mizanS ewoni lia ufro frTxili midgo ma. aw mkv eTri daqve iT eb a pote nci urad saSiSia ise Ti SesaZlo iSe miu ri garTu lebe bi s gamo, rogoricaa mio kardi um is mwvave infarqti da Tav is tvin is insult i. hipert enzi is gadaude beli SemT xve ve bi s dros gamoi ye ne ba parent era luri medi kam ente bi (cx. 3). pirvel i rigis antihipe rt enziu li medi ka me nte bi s SerC eva unda moxdes pacie ntis sruli klini kuri mdgomar eobis gaTvalis wi ne biT.

hiperte nz iis gansakuT rebuli specif ikuri Se mTx ve ve bi : avadmyo fe bSi mwva ve korona ruli sindrom iT aw mniS vn elo van i mateba ar aris iSvia Ti . im pacie nte bS i, roml ebsac hemodi nam ikurad dadastur ebuli ara aqvT koronar uli arteri eb is daavadeb eb i, aw mniS vn elovan ma mate bam SesaZloa Tavis mxriv gamoiw vios mioka rdiu mi s iSemia marcx ena parkuWis ked lis daWim ulobis da mio kardi um is Jangbadze mo Txov nil eb is mniSv ne -lovan i zrdis Sedegad. aseT SemTx ve ve bS i sawyisi medika me nt eb ia nitr ogli cerini da nitropr usid i beta -blok er ebTa n kom bi nacia Si (labe talo li , meta prolol i, esmo lol i an aten ololi) , rac daaqve iT ebs aw da gulis ce mis sixSires da Sesabam isad ikle bs mio kadiu mi s mier Jangbadis moxmar eb ac.

marcx ena parkuWis mwva ve ukma riso bis dros aw unda gakontro ldes swra -fad. arCev is preparate bia intrav enuri nitrogl ice ri ni an nitropr usidi mary uJovan Sardmde ne bTan komb inac iaSi , mocu lob iTi gadaZabvis kont rol isaT vis .

pacie nte bS i aortis ganSre ve biT da hipert enzii T aw kontro li gadam -wyv etia . mku rnal oba unda daiwyos dauyovn ebli v da sistolu ri aw daqve iTd es swrafad 100 mm .v wy .sv- ze qve viT. idealu rma medi kam entm a unda daaqve iTos aramar to wneva , aramed Seam cir os gulisc em is sixSire , Seku m-

39

Svadoba da aortis kedlis daWimu loba . es SeiZle ba ganxorcie lde s beta -blo ker is da vazodilatat oris , rogoricaa nitropr usid i an nitogl icerinis kom binaci is intrave nuri Seyva niT .

feoq romoc ito mis dros krizis marT va xdeba intrav enuri alfa-blok eriT , rogoricaa fent ola mi ni , Semdgom beta- bloke ris Tan mxle bi gadasxmiT ; SesaZloa daemat os nitr opru sidi .

pacie nte bS i feoqro mocit om iT beta -blok er eb i yovel Tvis unda SeuRld es alfa- blok er ebTan . beta- recep tor eb is inhibi re ba iwvevs vazodila tir eb is stim ulire bas , rac Tav idan aicile bs aw mat ebas alfa- adren erg uli vazo -konst riq ciis pirob ebSi . monoT erapia labeta lol iT axdens alfa da beta blo kadas. Tavis tvinSi mwvav e sisxlCaqce vis mqo ne avadmyo fe bSi antihip ertenz iuli mkur nalo ba jer kidev sakamaT oa. Tavis tvin is iSe miuri ubn ebSi iTrg une ba sisxlis nakadis autoreg ula cia da aw daqve iT eb a amci re bs sisxlis miwod ebas iSe miur ubne bS i, rasac mosde vs infarq tis zom eb is zrda.

amgvarad, iSe miuri insul tis dros antihipe rte nz iuli mkurna loba reko me ndir ebulia mxolod Tu aw cifre bi aris 220/12 0 mm. vw y.s v- ze maRali (an saSualo aw >140 mm .vw y. sv) da aw unda daqvei Tde s sawyis monac em ebTa n Sedare biT 10-15%-iT . mkur nalo ba unda daiwyos intra ve nuri labe talo liT da Tu saWiroa nitr ogli cerin iT an nitrop rus idiT . pacien te bS i mwva ve sisxlCaqce viT, rom elT ac utard eba T Tro mbo lizisi , aw unda Senar Cu ndes 185/110 mm .v wy .sv -ze qv evi T.

pirv eladi intrac er ebralu ri sisxlCaqc ev is dros mku rnal oba unda daiwyos , Tu aw cifre bi aris 180/105 mm. vw y.s v- ze met i.

mwva ve postope raci uli hiper te nz ia ar aris iSviaT i, gansaku Treb iT kardio Tora kal uri , vaskul uri, Tavis , kisris da neiro qir urg iuli ope -racie bis Semd eg. arakardi uli qiru rgiis um et es SemTx ve ve bS i ar aris SeTa nxme ba im zRurbl ze , rodesac unda daiwyos mk urna loba da am Sem Txv evSi mxed velobaS i unda iqnes miRe ebuli avadmyofe bi s Ziri Tadi aw, qir urgi uli proced uris tipi da asocire buli klin ikuri mdgomar eobe bi .

misaRe bia aw cifre bis SenarC un eb a operac iamd eli monace me bi s 20%- is fargle bSi . kardioT oraka luri qirurg iis SemTx ve ve bS i riski matulo bs aw cifr eb is postope raci uli mateb is SemTx ve vaSi aw unda iyos 140/90 mm .v wy .sv- ze qve viT. arteri uli wne vis kontr olis mizn iT gamoy en ebuli unda iqnas labe talo li (da sxva beta- blok er eb i) , nitropru sidi , nitr ogli cerin i an fen ildopa mi intrav enurad .

hiperte nz iis saswrafo SemTx ve ve bis mk urna loba : mZi me hipert enzi iT avadmyo fTa umra vle sobaSi samizn e organoe bis dazian ebis niSn eb i Cveu lebri v ar aris. aseT avadmyof ebSi aw unda daqve iTdes TandaTan ob iT 24- 48 saaTis ganmavlo baS i. es xSirad xorci elde ba oralur i med ika me nt eb iT , staciona rSi moTa vse bis gareSe da amb ulat ori uli meT valy ureobis qveS . klini kuri gaumjob es eba SesaZl eb elia wamle bis miRe bidan pirve l ramdeni me saaTSi, aw unda daqve iTd es TandaTan ob iT . asimpto mur pacient ebSi , romle bsac ara aqvT samiz ne organo eb is aSkara mwvave dazian eba , aw swrafi daqvei Teba ar aris miza nSe wonil i da piriqi T aw mkv eTrm a daweva m SeiZl eba ufro met i zian i miay enos. cxrili 4- Si moce mulia hipert enzi is saswrafo Sem Txv ev eb is dros reko me ndi re buli oralur i medika me nt eb i. Tavidanv e antihip erte nz iuli medika me nt eb is komb ina ciis gamoy en eba zrdis aw daqve iT eb is efeq turobis albaTo bas.

subl ing ualu ri nifed ipin iT aw daqvei Tebi s xarisxi inducird eb a, risi arc winaswar mety veleba da arc kontr oli ar aris SesaZle beli da amit omac es preparat i ar aris reko me ndi re buli .

daskvne bi : aw mZim e ele vaci is dos samizn e organoe bis mwvav e daziane bis iden tif icir eb isa Tv is gadamwy vetia dauyovn eb eli, da zusti moqm ed eb is dawye ba.

pirv eladi gamokvl ev is Sedege bz e dayrdnobi T, mkur nalo ba unda daiwyos gadaudeb eli daxmare bis ganyofi lebaSi parent eruli an oralu ri medi kam ente biT. aw unda daqvei Tde s swrafad, magram Tavidan unda avici loT mkve Tri daqve iT eb a, vina idan SemTx ve vaT a um ravl eso baSi aw daqve iT eb a da ara norma liza cia aris mkur nal obis miza ni .

40

cxrili 1hiperte nz iis gadaudeb eli Sem Txv ev eb i

hipert enziuli encefa lopa TiaZlie ri hiperte nz ia asocirde ba samiz ne organo eb is mwva ve dazian ebas Tan- mwva ve korona ruli sindrom i- filtv eb is SeSup eba- aortis mwvav e ganSrev eba- intrac er ebral uri sisxlCaqc ev a, subaraq no idul i sisxlCaqce va- Tavis tvin is mwvave infar qti- mwva ve an swrafad progresir eb adi Tirk mlis uk maris obaZlie ri hipert enzia ganviTar ebuli iSe miuri insul tis dros Catareb uli Tro mboli zis is Semd egkriz i feo qro moc itom is drosGui llia n- Barre -s sindro mizurgis tvin is dazian ebamedi kam ente bi , romle bsac ukavSird eb a hipert enzia (simpa Tom im eturi saSual eb eb i, fen tik lidi ni , fenilpr opon ola mi ni , dieTi lam ini ,c iklospor in i)ekla mfs iapostope raci uli sisxldenagvirgvi no vani arter ie bis Sunt ire bi s Se mdgom i hiper te nz ia

cxrili 2diagnostik uri gamok vle ve bi

sisxlis wnevis ganme or eb iTi gazomve bi (pirv eli gazomva oriv e mxarze)klin ikuri istor ia da saeqim o gasinjva- karsio vask uluri- cns- Tval is fskerisel eqc iuri laborato riuli kvl ev eb i- Sardis analizi , kreat in in i, Sardovana, eleqtrol iteb i da sisxlis

saer To analizi- Tu simpto mur hiperte nz iaz ea eWvi , plazmaSi reni nis, aldost ero nis da

kate qola mi ne bi s aqtiv ob is dadgenaeleqt roka rdiogra magulm kerdis rentg eno logi uri gamok vle vaSemdgo mi kvl ev eb i (ukavSird eb a klin ikur suraTs)

- eqo kardi ografia (TTE, TE)- Tavis tvin is C T an MRI- abdom inal uri ult rason ografia

- Tora ko, abdom inal uri C T an MRI- vasku luri ultrabg eriTi gamok vleva

cxrili 3hiperte nz iis gadaudeb eli mdgomar eobisa Tv is saWiro medika me nt eb i

medi kam enti doza sawyisi xangrZliv oba

gverdi Ti mov lene bi

Sodium Nitroprussiate

0,25 – 10mg/kg/wT

dauyov ne beli

1 - 2 wT. hipot enz ia, Rebin eba , cianat uri toqsi uroba

Labetalol20 – 80 mg . nakadi T;1 – 2 mg /wT wve Tovnad

5 – 10 wT. 2 – 6 sT. gulisr eva , Rebin eb a, gulis blokada, bron qospaz mi

Glyceryl trinitrato

5 – 100 μg/wT

1 - 3 wT. 5 – 15 wT. Tavis tkiv ili , Rebi ne ba

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Enalaprilat1,25 – 5,0 mg. nakadurad

15 wT. 4 – 6 sT. hipot enz ia, Tirk mlis uk maris oba , angio ede ma

Furosemde40 – 60 mg 5 wT. 2sT . hipot enz ia

Fenoldopam0,1 – 0,6 μg/kg/wT

5 – 10 wT. 10 – 15 wT. hipot enz ia, Tavis tkiv ili

Nicardipine2 – 10 mg/sT 5 – 10 wT. 2 – 4 sT. refl eqs uri

taqika rdia, saxis siwi Tle

Hydralazine10 20 mg. nakadurad

10 wT. 2 – 6 sT. refl eqs uri taqika rdia

Phentolamine5 – 10 mg/w T 1 – 2 wT . 3 – 5 wT. refl eqs uri

taqika rdia

Urapidil 25 – 50 mg.nakadurad

3 – 4 wT . 8 – 12 sT. sedacia

cxrili 4hiperte nz iis saswrafo SemTx ve ve bis samk urna lo medika me nt eb i

medi kam enti doza pikis dro naxevardaSlis period i

gverdi Ti mov lene bi

Captopril12,5 – 25 mg.p/o

15 - 60 wT . 1,5 sT. pacie nte bS i Tir kmlis arter iis sten ozi T Tir kmlis uk maris oba

labetalol 200 – 400 mg. p/o

20 – 120 wT . 2,5 – 8 sT bron qospaz mi , mio kardi um is Sek umSvado bis daqve iT eb a, AV blokada , gulis da RviZlis enzim eb is elevac ia

furosemide 25 – 50 mg.p/o

1 –2 sT. 0,5 – 1,1 sT. moc ulo bis daqve iT eb a

Amlodipine5 – 10 mg.p/o

1 – 6 sT. 30 – 50 sT. Tavis tkiv ili , taqika rdia, saxis siwi Tle, perif eriuli SeS upe be bi

Felodipine5 – 10 mg.p/o

2 – 5 sT. 11 – 16 sT. Tavis tkiv ili , taqika rdia, saxis siwi Tle, perif eriuli SeS upe be bi

Isradipine5 – 10 mg.p/o

1 – 1,5 sT. 8 – 16 sT. Tavis tkiv ili , taqika rdia, saxis siwi Tle, perif eriuli SeS upe be bi

Prazosin1 – 2 mg.p/o

1 – 2 sT. 2 – 4 sT. sinkop e (pirv eli doza), TrTol va, taqika rdia, orTos tat uli hipot enz ia

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damatebiTi mosazrebebi antihi pertenziuli medikamentebis arCevis Sesaxeb.

antihipe rt enziul med ikam ente bs aqvT sasargebl o da gverdiT i efe qt eb i sxva Tan mxle bi paTol ogie bis arseb ob isas. sasargebl o efeq te biTiazid uri tipis diuret ik eb i sasargebloa Tanmx lebi osteop oroz is dros. Bbeta bloke re bis gamoye ne ba sasargebl oa winagul ovan i taqikardi is/f ibrila ciis , Sakikis , Tire oto qsi koz is, tre mor is sawyisi stadiis an winasaope raci o hipert ernzi is mku rnal obis dros. kalci um is arxebis blok er eb is gamoy en eb a mizanS ewon ilia reinos sindrom isa da zogier Ti ariT mi is Tanaars ebob isas. alfabl ok er eb i ki prostatis adeno mi s dros. gverdi Ti ef eqt eb iTiazid uri tipis diuret ik eb i, sifrTx ili T gamoiy en eb a, im pacie nt ebSi visac aqvT podagra, visac anamn ezSi aReniSn eb a hiponat re mia . Beta bloke re bi ukuna Cv en eb ia im pacien te bS i, visac aqvT asTma, sasunT qi gzebis daavadeb eb i, meor e da mesa me xarisxis blokada . agfi da a.r. b. winaaRmdeg naCv en eb ia fexmZim e qalebS i. agfi agreT ve ar gamoiy en eb a im pacient ebSi visac anamn ezSi aReniSn eb aT angioede ma . aldoste ron is antagonis te bm a da kalium is Semnax velma diur eti ke bm a SeiZ leba gamoiwv ion hiperka le mi a da ukunaC ve ne bi a im pacien te bS i visac plazmaSi kaliu mis done aqvT > 5,0ml. eq /l- ze.

rezistentuli hipertenzia

hiperte nz ia jer kidev rCeba janmrT elobis udides probl em ad, rom eli c moicavs 60 wels gadaSore buli mosaxleo bis daa xloe biT 30%- s. hiperte nz iul pacien tTa 10% rez iste ntulia mku rnal obis mimar T. rezist entuli hipert enzia ganisazRvr eba , rogorc ne bism ier asakobri v jgufSi sami an met i gansxvave buli antihip erte nz iuli agent is erTdr ouli gamoye ne bis miuxeda vad arteri uli wne vis 140/90 mm. vwy .sv .- ze metad daqvei Tebi s SeuZ lebloba .

refraqt eruli hiperte nz iis siste mat uri Sefas eba klini kis pirob ebSi aucile beli a procesSi CarTu li faqtore bi sa da meqan iz me bis identi fic ire bi s miz niT. Yakovlevitch-ma da Black-ma gamoav lin es subopt ima luri medika me nturi reJi mi , rogorc yve laze gavrc eleb uli faqtori (43%), rome lic mohyv eb a medika me nturi mk urna lobis mimar T tolera ntobis darRvevas (22%), damyolo bis arar sebobasa (10%) da me oradi hipert enzias (11%). me oradi hipert enziis gavrce lebis done msgavsia Ande rson- is (10%) da Desforg es- is (11%) raporte bSi . meorad i hiper te nz iis mize ze bis moZi eba mde , rome lic moica vs ZviradRi rebu l kvlev is meT ode bs, unda moxdes medika me nturi reJi mis Sesabam iso bis , medika ment eb is SesaZlo urTi erTq mede bis , alkohol is da medika me nt eb is erTdr ouli miReb is, medika me nturi reJi mis darRvevis , fsevdohip erte nzi is, Te Tri xalaTis /of isis hiperte nziis, siTxis Sekave bi s, simsu qn is an Zilis apnoes sindro mis gulmodgi ne gamokv le va- Sefaseba . am faqtore bi s eli mi nac iis Semdeg , WeSma ritad refraq teruli hiperte nz ia aRiniSne ba mxolod hiperte nz iis mqon e saerTo populaci is 5%-Si. metad gavrcel ebuli egzogen uri substanc ie bi /m ed ika me nt eb i, roml eb ic xels uSl ian hiperte nz iis kontr ols , aris NSAIDS, alkoho li, malx eni medi kam ente bi , oralur i kontrac ept iveb i da fsiqotr opuli medi kam ente bi .Aa mas Tan , arsebo bs farTo indiv idSida variabe loba medika me nt eb is efeq turobis mxriv, rac xSirad SeuZl eb els xdis sisxlis wnevis kontr ols . pacient is damyo loba udavod didi kompon entia sisxlis wne vis warmat ebuli kontro lis misaRw evad. sisxlis wnev is kont rol is SeuZl ebloba Sem Txv ev aTa 50%- Si Tan axlavs medika me nturi reJi mis darRvevas, e. w. fsevdo refraq teroba .

fsevdohip ert enzia ganisazRvr eba rogorc mdgomare ob a, roml is drosac manJe tSida wne va Seusa bam od maRalia sisxlZarRvSida wnevas Ta n Sedar eb iT ,

43

rac ganpiro be bulia sisxlZarRv Ta sixisti T. iTvl eba , rom fsevdohip ert enzia metad gavrcel ebulia asakovan Ta Soris.

miux edavad imisa, rom “Te Tri xalaTis hiperte nz ia” (izoli re buli ofisis an klin ikur i hiper te nzia) da “T eTri xalaTis efe qti” ganisazRvra oTxmocdaa Tia ni wle bis dasawyisSi, rez iste ntuli hipert enziis mqo ne pacient ebSi am movl en is irgvliv SezR udul i raodeno biT kvlev eb ia Catareb uli. cota xnis win gamoqv ey ne bul Brown et al. kvl evaS i, arter iuli wnev is 24- saaTian i ambula tor iuli moni tor ire bis monac em eb is mix edvi T, gamoxatul i rezist entuli hipert enziis mqo ne yov eli 10 pacient idan 2-3- s aReniSn eb a kont rol ire buli sisxlis wneva .

plazmis mocu lob is siWarbe , rome lic SesaZl eb elia gazom il iqnas L125 radioaqti urad moniS nuli albu mi niT , damaxasiaT eb elia pacient eb isa Tv is rezist entuli hipert enzi iT . es paci entebi kargad eqve md eba re bia n diure tik eb s. populac iur i kvle ve bi avlen en xazovan kavSi rs mari lis moxmar ebasa da sisxlis wnevas Soris. Warb natriu ms SeuZl ia Seasus tos agf-inhib ito rebis da diu retik eb is ef eqt i, amdenad sakve bi maril is moxmar eb is Sez Rud va aucil eb elia rezist entuli hipert enzi is mqo ne yve la pacient isaT vis.

frem inge mi s kvl ev is Sedege bi aCven eb en sxeul is masis indeqs is (>25- 30 kg/m 2) da rezist entuli hipert enzi is kavSi rs. sxeul is masis yove li 10%- iT mate ba asocird eba sistol uri wne vis 6,5 mm- ian mate basT an . sxeulis masis Semc ire ba reko me ndir ebuli unda iyos yvela hipert enziis mqo ne pacient ist vis. aseve gamovli nda mni Svn elova ni kavSiri Zilis apnoesa da hiperte nz ias Soris. bolo drois naSrom eb i aCven eb en , rom rezist entuli hiperte nz iis mqon e pacien te bis Tv is damaxa si aTeb elia Zilis apnoes sindrom i da Tum ca meqan iz mi ucno bia , naCven eb ia mkur nalo ba haeris nazal uri mud miv i dadeb iTi wnevi T, rome lic iwv evs sisxlis wne vis Semc ir ebas .

am mavne faqtor eb is elim ina ciis da Seq ce vadob is Semdeg , SeiZle ba ganxilul iqnas meoradi miz ez eb i . bolo wlebis kvl ev eb i aCvene ben , rom hiperaldost eron izm i aris metad damaxasiaTe beli me oradi mize zi (8-32%), rome lsac mivya varT Tir kmlis ukmar isobisa da Tir kmlis arteri is stenoz is ganviTar eb amd e . pacient ebSi dabali ren in- rezist entuli hipert enzi iT , aldoste roniz mis skrin ingi aucil eb elia . pirveladi hiperald oste ro nizm i kargad eq ve mde bar eb a Sesaba mis mku rnal obas (qiru rgiu ls an med ika me nturs) . renovas kuluri daavadebisas revask ula rizacia aRadgens Tir kmlis funqc ias, magram sisxlis wnev is kontro li limi tir ebulia. Tir kmlis ukma riso bis mkur nalo ba tardeba etiol ogiis mixed viT .

“We Sma riT ad rez iste ntuli hiperte nz ia” SesaZl eb elia diag nos tir des, mxolod ze mo aRniSnu li xelSe mSl eli faqtore bis eli mi naci is Semdeg . gaTvalisw in ebul unda iqnas, rom me orad hiperte nz ias SeiZ leba Tan axldes mravali egzog enu ri faqtor i. rezis tent uli hiper te nzi is mkur nalo ba moicavs egzog enu ri faqtor eb is elim inac iasa da mravali medi kam entis maqsima luri tolera ntuli (asatani) dozeb is, xangrZliv mo mq med i diure tik eb is CaTvli T, gamoye ne bas. Ouzan et al. kvl evam aCve na, rom sam- an oTxkom po nent ian medika me ntur kom bi nacia ze spirono laqt on is damat eba rezist entuli hipert enziis mqo ne pacien te bS i, usafrTx oa da mniSv nelov nad amcire bs gamosaye ne beli med ika me nteb is raodeno bas. es Sedegi moi Txo vs Semdgom farTo mas Stabian randomi zir ebul kvl ev eb s.

hi pertenziis kontrolis gaumjobeseba

qce viTi modele bi adasture be n, rom yvela ze frTxil i klini cist is mie r gamow eri li ef eqt uri mku rnal obac ki gaakontr ole bs hiperte nz ias mxo -lod im SemTx ve vaSi , Tu pacient i mot iv ire bulia medi kam entis

44

daniSn uleb is mixedv iT misaRe bad da janmr TelobisaT vis xelSe mw yob i cxovr eb is wesis dasacavad. moti vacia umjob esd eba , roca pacients aqvs rwm ena misi mkur nal i eqi mi s mi marT . uk eTesi kom un ikac ia aumjob ese bs gamosavals .

risi gakeTeba SeuZlia eqims?

eqi msa da pacien ts Soris partnior uli urT ierToba , rom elic emya re ba rwm enas , pativisc em asa da pacient is ganaTl eb is dones kavSir Sia pozit iur gamosaval Ta n. pacient eb i eqi mis kompe te ncias xSirad afaseb en pacie ntTan mopyr ob is xelov ne biT da ara eqi mis klinik uri codni T. pacient is momsax ureba moicavs Zaldautane bel mopy robas , lodin is mini mal ur drosa da momsax ure personal is yuradRe bia n da Tavazia n damo kide bulebas; yve la aRniSn uli cnobil ia, rogorc pacient is kmayof ile basa da rwm enaz e zegavl en is mqon e faqtori . klini cist eb ma unda ganaxorci elon momsaxu re persona lis “trei ni ngi” , raTa Sei qm nas poziti uri, intera qt iuli da TanagrZn ob isu naria ni gare mo. es gazrdis pacien tis kom forts da surv ils miiRos mona wil eoba sakuTar i janmr Telobis marT vaSi .

klinikuri inertuloba/umoqmedoba

arseb obs kli nic istT a farTo wre , roml eb ic axorci eleb en hipert enziis optima lur Terapias . medika me ntTa titrac iisa da komb inac iis ukma riso ba da cxovr eb is stilis arasakmar isi modifi kac ia, avlens klin ikur ine rtu lobas, rome lic daZlevas moiTx ovs . gadawyve til eb is mxardaW eris siste ma erT- erTi yve laze efeqt uri gzaa, rome lic mou wode bs eqim s gaaumjo bes os mkurna loba maSi n, roca samiz ne wne va ar aris miRw euli.

pacient ze ori ent ire buli qce viTi Carev eb i, ise Ti rogoricaa rCev is

mice ma/ re ko mendac ia, aumjo bes eb s sisxlis wnev is kont rols . medde bma ,

klini cist eb ma da farmac evte bma daadastures Tavis i efeq tur i roli

sisxlis samizn e wnev is miRwe vis procesSi . klin icis te bma period ulad

unda gadaamowm on sakuTar i pacient eb is mona cem eb i, Seafason xarisxi,

medika me nturi Carevisa da dasaxuli miznis miRw ev is warmat ebuloba.

janmr Telobis dacvis sxva specialis te bis roli

eqi me bm a unda iTanam Sro mlon jandacvis sxva specia list ebTa n, raTa zegavl en a moax dinon an gaaZlier on swavl eba /i nstr uqtaJi pacient is cxovr eb is stilisa da sisxlis wnev is kont rol is gasaumjo bese blad .

hiperte nz iis kontro lis gaumjo bes eb is proces Si CarT uli arian: hiperte nz iis centr eb i, profesio nal uri jandacviT i departam ente bi da organizac ie bi , farmace vt eb i da sazogadoeb is araprof esio nali muSa ke bi . sazogadoebr iv i jandacvis muSak eb i, medde bi da Te mis muSak eb i , aseve saWiroa maRali riskis populaci ebSi skrini ngis , vizitis TariRis Setyo bi ne bis da pacie ntT a ganaTle bis mizn iT . jandacvis sfero Si momu Sav e yve la special isti unda gaer Tiand es sisxlis wne vis kont rol is donis gasaumjob es eblad; yuradRe ba unda gamaxvilde s hiper te nzi is riskze , sistolu ri da diastol uri sisxlis wne vis marT vis mniS vne lobaz e da samizn e arteri uli wnevis miRw ev is auci leblobaz e. aseve aucil eb elia cxovre bis stilis modifika ci is swavle ba, medika me nturi mku rnal oba da rwme na mkurna lobis mimar T.

pacie ntT an dakavSire buli faqtor eb i

kult uruli gansxvaveba ni , rwm ena da damokid ebuleb a sakuTa ri janmrT elobis mi marT did zegavl enas axdens pacien tTa pozic iaze . eqi mm a unda auxsnas mis pacients , rom ter mi ne bi “hipe rt enzia” da “maRali sisxlis wneva ” urT ierTSe mc vle li term in eb ia da arc erT i maTgan i ar miu TiTebs SemaSfo Tebel, ui med o mdgomare ob aze . pacients sWirdeba rogorc mot iva ciis gazrda, ise specifi kuri ganaTle ba , romel ic mas

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daexmare ba cxovre bis stilis Secvlasa da medi kam entTa daniSn uleb is mixedv iT miReba Si, rac aucil eb elia TviT SegrZ ne bis gaumjob ese bi sa da riskis Semci re bis Tv is.

miz nis miRwe va da qcev is cvli lebe bi

eqi mi da pacie nti unda SeTanx mdne n samiz ne arteri uli wnev is donez e da daad gino n mizn is misaRwe vad saWiro dro. es yove liv e unda aisaxos sqe matu rad. eqi mm a unda daarwmun os pacient i, rom qcevi Ti cvli lebe bi pacie ntis pasuxismge blo bis sakiTxia. Tu pacie nte bi ganaxorcie lebe n qce viT cvlile be bs , maT aReniSn eb aT mniS vn elova ni xaris xiT winsvla .

Tu Sedegi arasakmar isia , eqim ma motiva ci is gaZlier eb is mizn iT unda gamoark vios xelSe mSl eli faqtor eb i e.w “bari er eb i” . Tu vizit is dros arter iuli wneva aRemat eb a samiz ne dones , mkur nalo bis grafikis darRvev eb i unda dafiqsird es dokum enturad. saxlis pirob ebS i arter iuli wne vis gasazom i mowyo bilobe bis gamoy en eb a mizan Sewon ilia . eqim i valde bulia Seamo wmos aRniSn uli mow yobil ob eb i (sazomi aparatebi) . es advilad ganxorcie lebadia ; pacie ntm a wneva unda gaizo mos eqi mis meTva lyureobis qveS . saxlSi gazomil i arte riu li wne vis done 5 mm. vw y.s v. -Ti ufro nakleb ia e.w . “ofisis ” wnevas Tan Sedare biT. am faqtis gaTval iswi ne ba aucile beli a im Sem Txv ev ebSi , roca arteri uli wne vis done samizn esTan axlosaa. pacient is keTilganw yoba jandacvis samsaxuris warmo madge nlis mi marT , mku rnal obisadm i misi damyol obis predi qtor ia. yve la eqi mma unda gamoiC inos dadebiT i, pacien tze orie nti re buli mzr un veloba , raTa daakmayo fil os pacien ti da daiTanxm os mku rnal oba ze . zogie rT pacient ze orien tirebu lma qcev iTma Careva m, iseT ma , rogoricaa rCeva /r ekom endac ia, gamoavl ina sisxlis wne vis kontr olis gaumjo bes eb a.

eko no mi kur i sirTu leeb i

efeq turi mkur nalo bis xelS emS leli SesaZloa iyos med ika me nt is fasi. pacient eb i xSirad amtkic eb en , rom cxovre bis stilis modifika cia DASH kveb iTi gegmis mixedvi T Zviria, Tumca misi ganxorcie leba mwiri biuje tiTac ki SesaZl eb elia. dietu ri kve biTi mkur nalo ba aumjo bes eb s janmrT elobas pacien te bSi maRali qolest erin iT , diabet iT , simsu qni T, da sxva qroni kul daavadebaT a risk- faqtor eb iT . pacients unda mi ece s reko me ndacia , rom cxovr eb is stilis modif ikac iaT a umra vleso ba ufasoa da SesaZloa fulis dazogvac ki (mag. mwe velob is Sewyv eta da alkoho lis miReb is Semci re ba). amasTan, cxovr eb is stilis Secv las SeuZlia misaRe bi medika me nt eb is ricxvis da Sesaba misad fasis da dazRvevis Rireb uleb is Semc ire ba . pacien ti , rom eli c imyof eb a DASH kveb iT gegmaze , saWiroe bs nakle b medi kam ents da Sesabam isad zogavs fuls. pacie nt ma unda gaacnobi eros mniS vn elovan i gansxvaveba medi kam entis fassa da reko me n-daciis dacvis fass Soris. medi kam entis fasi aris fulis raodeno ba, rome lic aucile beli a medika me nt is SesaZ enad, xolo rek om enda ci eb is ugule belyofis SemTx ve vaS i uaresd eba sicocxlis xarisxi, viTarde ba garTul eb eb i, romel Ta marT vac pacients gacile biT Zviri ujde ba.

saqarTv elos pirobe bS i arteri uli hipert enzi is kontr olis optimi zaci is SesaZle blo be bis gansazRvris mizn iT , 2000- 2003 wle bSi mcxeT a- mTiane TSi/ miluok is pirve ladi jandacvis partnio ruli program is farglebS i, rome lic ganxorci elda ameri kis saer TaSor iso jandacvis kavSiris (AIHA) egidiT da aSS ganviTar eb is saagentos (USAID) mxardaWe riT, moxerxda programaSi monawi le pacient eb is hiper te nz iis kont rol is maCve ne blis 59%-mde gazrda. saqarT veloS i arseb ul pirv eladi jandacvis qselz e dayrdnobi T da hipert enziul pirTa aqtiur i, Tanam edr ove sqemaz e dafuZne buli anihipe rte nz iuli mku rnal obiT (hidroql orT iaz idi da atenol oli), martivad da SezRud uli resurs eb iT SesaZle beli gaxda hiperte nz iis kontr olis maCv en eblebis swrafi da mkve Tri gaumjob es eba programaSi CarTu l pire bSi .

The Republic of Georgia High Blood Pressure Control Program. Ethnicity and Disease, 2006; 16[suppl 2]:S2-62–66). Barbakadze V., Koblianidze L., Kipshidze N., Grim CE, Grim CM, Tavill F.

saqarTv elos hipert enziis Semswa vle li sazogadoeb is mier bolo 3 wlis gan mav lobaSi gadaidga pirv eli nabij ebi qve yanaS i arteri uli hiperte nz iis aradamakmay ofilebe li kontro lis miz ez eb is dasadgenad. farmako epid emiologi uri kvle ve biT, am etapz e gamovl en ilia hipert enzi is

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marTva Si zogie rTi mniS vn elovan i xarvez eb i. ZiriTadad es gaxlavT, antihipe rt enziuli medika me nt eb is xSiri cvla da wyve til oba mkur nalo baSi . aRniSnu li ganpirob ebulia eqimsa dapacien ts Soris partnior uli urT ierTob is defici tiT , mkur nalo bis mimar T pacien tis dabali moti vac iiT a da Sesabam isad dabali damyolo biT mkur nalo baz e, mkur nalo bis procesSi titraci uli reJi mis darRve ve biTa da sabolood preparatis samizn e dozis miuR we velobiT (klini kur i medic ina 2004; Кардиология СНГ 2004).

populaciaS i hiperte nz iis kontro lis gaumjob es eb is Tvalsazr isi T mniSv nelovania farmace vtuli kompan ie bis aqtivoba . msoflioS i arseb ul mraval farmace vtul kompan ias gaaCnia specialu ri programa am mimar TulebiT.

avtorTa jgufi itovebs uflebas msoflioSi mimdinare kvlevebis Sedegebis Sesabamisad, periodulad gamosces zemo aRniSnuli gaidlainis calkeuli Tavebis ganaxlebuli versiebi.

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