فشار خون مقاوم به درمان


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پرفشاری خون، هنگامی مقاوم است که علی رغم استفاده صحیح از رژیم دارویی که یکی از آنها را داروی دیورتیک (مدر) تشکیل می دهد، نتوان به فشار خون هدف دست یافت.

علل فشار خون مقاوم به درمان

علل متعددی موجب پاسخ ناکافی یا ضعیف به درمان فشار خون می شوند که مصرف بیش از حد نمک یا ناکافی بودن مقدار داروی مدر برای درمان فشار خون محتمل ترین این علل را تشکیل می دهند. علل فشار خون مقاوم به درمان دیگر عبارتند از: عدم استفاده صحیح از داروها، استفاده از داروهای دیگر (به جز داورهای ضد فشار خون) که موجب افزایش فشار خون می شوند، فشار خون ثانویه تشخیص داده نشده، فشار خون کاذب، یا موارد همراه، نظیر چاقی و مصرف الکل. در موارد فشار خون مقاوم به درمان ، رژیم درمانی باید شامل یک داروی مدر (دیورتیک) به اضافه دوزهای نزدیک به حداکثر دو گروه از داروهای زیر باشند: - بتابلاکرها – داروی دارای اثر مستقیم گشاد کننده رگ ها- مسدودکننده های کانال کلسیم- بازدارنده ACE – داروهای مسدود کننده گیرنده آنژیوتانسین

علل مختلفی می توانند موجب فشار خون مقاوم به  درمان شوند: - اندازه گیری ناصحیح فشار خون (مانند باد کردن بیش از اندازه بازو بند دستگاه فشار خون یا استفاده از بازوبندهایی که خیلی کوچکتر از بازوی بیمار هستند). – کلسیفیه بودن شدید یا اسکلروز شدید سرخرگ های بازویی موجب می شود این سرخرگ ها به طور کامل در اثر فشار بادکنک بازوبند تحت فشار قرار نگیرند و فشار خون به اشتباه بالا نشان داده شود (پرفشاری خون کاذب). – وجود فشار خون روپوش سفید – عدم مصرف صحیح داروهای درمان فشار خون بالا به وسیله ی بیمار یا صحیح نبودن نحوه تجویز داروها- ناکافی بودن داروی مدر – وجود تداخل های دارویی

نکته: در صورتی که فشار خون بالا با استفاده از دو دارو کنترل نشده است یا احتمال فشار خون ثانویه وجود دارد با پزشک مشورت کنید.

چه هنگام می توان مقدار یا تعداد داروهای ضدپرفشاری خون را ضمن رعایت محدودیت های شیوه زندگی کاهش داد؟ وقتی فشار خون بالا به خوبی کنترل شده و فشار خون بالا با عوارض همراه نیست. وقتی فشار خون بیمار تثبیت شده و حداقل از یک سال قبل تحت کنترل درآمده است.

درمان فشار خون مقاوم

داشتن فشار خون بالا مقاوم به درمان بدین معنا نیست که هیچ گاه نمی توانید آن را کاهش دهید . در حقیقت چنانچه شما و پزشکتان بتوانید تعیین کنید چه چیزی در پشت فشار خون بالا مقاوم شما وجود دارد این شانس وجود دارد که بتوانید موثرتر به درمان فشار خون مقاوم بپردازید . این امکان وجود دارد که شرایط دیگری که از آن مطلع نیستید علت فشار خون بالا شما هستند ، شرایطی مانند مشکلات کلیوی و یا نارسایی تنفس هنگام خواب . در این شرایط باید با پشتکار بیشتری توصیه های تغییر روش زندگی برای درمان فشار خون مقاوم را دنبال کنید.

پزشک شما نوع داروها و دوز مصرفی آنها را از لحاظ مناسب بودنشان برای درمان فشار خون مقاوم شما ارزیابی می کند .داروهای شما و دوز آنها باید به گونه ای تنظیم شوند که موثرترین ترکیب داروی را برایدرمان فشار خون مقاوم ایجاد کنند . ممکن است که پزشک شما داروهای دیگری را نیز برای درمان فشار خون مقاوم تجویز کند ازجمله یک دیورتیک قوی با طول اثر طولانی . این امکان نیز وجود دارد که پزشک شما داروهای دیورتیک غیر تیازدی را نیز پیشنهاد کند مانند اسپیرونولاکتون که مکانیسم اثر آنها از طریق مهار هورمن آلدوسترون است و باعث تغییر مسیر جذب سدیم و دفع پتاسیم می شوند . معمولاً افرادی که مبتلا به فشار خون مقاوم به درمان هستند، سطوح آلدوسترون بالایی دارند.

چنانچه داروهای خود را دقیقاً طبق دستور دریافت نکنید می تواند به عواقب جبران ناپذیری منتهی شود . هرگز بدون مشورت با پزشک خود درمان دارویی فشار خون خود را تغییر ندهید.

شیوع فشار خون مقاوم به درمان

۲۵ تا ۳۰ درصد کل جمعیت در دنیا و در کشورمان مبتلا به فشار خون بالا هستند که تعداد زیادی از این افراد به دلیل بدون علامت بودن فشارخون از بیماری خود اطلاعی ندارند.

۱۰ درصد جمعیت فشار خونی در آمریکا دارای فشار خون مقاوم به درمان هستند که این رقم در افراد مسن، بیماران کلیوی، بیماران دیابتی، افراد دارای اضافه وزن همراه با وقفه تنفسی، نژاد سیاه و در افراد با مصرف نمک بالا بیشتر است.

فشارخون مقاوم به درمان تعداد قابل ملاحظه‌ای از جمعیت فشار خونی را در بر می‌گیرد. مطالعات جمعیتی که در دو سال گذشته به انجام رسیده است، با توجه به آن که توانسته است تخمین نسبتا دقیقی از شیوع فشار خون مقاوم به درمان دهد در بهبود آگاهی ما از نظر اپیدمیولوژی موثر بوده است.

شیوع فشار خون مقاوم به درمان در جمیت بالغ مبتلا به فشارخون بالا از ۹ تا ۱۲ درصد، بر اساس تعیین فشارخون در کلینیک متغیر است. با توجه به اینکه شرایط زندگی کنونی در کشورمان مانند کشورهای غربی شده است، این امر باعث افزایش فشار خون مقاوم به درمان نیز شده است.

مطالب مرتبط :

استرس و فشار خون بالا

کاهش فشار خون با ترک سیگار

کاهش فشار خون با تغذیه

توصیه های مهم برای کاهش فشار خون

کاهش فشار خون بالا با کنترل وزن

چگونگی کنترل فشار خون

فشار خون و راههای کنترل آن

درمان فشار خون بالا

منبع : راهنمای پزشکی خانواده- فشار خون

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