Il-pressjoni

Il-pressjoni tad-demm hi s-suggett ta' nteress ghal bosta, u fil-fatt parti sostanzjali tax-xoghol tat-tabib tal-familja tinvolvi fil-misurament tal-pressjoni u l-immaniggjar taghha. Pero x'inhi l-importanza tal-pressjoni, u ghala ghandha tinzamm taht kontroll?

Meta pazjent tinqaralu l-pressjoni dan jigi moghti zewg valuri, dik ta' fuq (systolic) u dik ta' taht (diastolic). Il-pressjoni ta' fuq tirreferi ghall-pressjoni fl-arterji waqt li l-qalb tkun qed timbotta d-demm 'il barra, u dik ta' taht ghall-pressjoni fl-arterji waqt li l-qalb tkun qed tirrilassa. Sa xi zmien ilu konna iktar naghmlu enfasi fuq il-pressjoni ta' taht, pero fil-fatt hu important li t-tnejn li huma jkunu taht kontroll.

Pressjoni tad-demm gholja tpoggi lil persuna f'riskju ta kumplikazzjonijiet, fis-sens li jekk din tithalla fuq livell gholi twassal biex l-arterji tad-demm jidjiequ bi process li jissejjah aterosklerosi. Arterji dojoq jikkawzaw "ghatx ta ossignu" fil-partijiet li jissuplixxu, u dan iwassal ghal kumplikazzjonijet bhal attakki tal-qalb jew puplesiji.

Fost il-kawzi tal-pressjoni gholja nsibu bosta, pero f'95% tal-kazi din ma tinstabx u allura nitkellmu fuq "essential hypertension". Fil-5% fejn ikun hemm kawza din tkun wahda jew bosta minn ansjeta, mard fil-kliewi, fit-tirojde, fl-arterji, fil-glandoli adrenali, u anke certu tip ta' kancer rari li jipproducu ormoni.

Fenomenu interessanti ta' ipertensjoni jissejjah "white coat hypertension" fejn il-pazjent toghliehlu l-pressjoni biss fil-presenza tat-tabib. Jien iltqajt ma' kaz bhal dan f'pazjent li meta kienet tehodlu l-pressjoni n-neputija kienet tkun normali, izda meta dan kien jigi l-klinika il-pressjoni kienet toghla sew. Wara li ghadda z-zmien u l-pazjent sar iktar familjari mieghi, il-pressjoni giet ghan-normal.

Barra mard li jikkawza ipertensjoni insibu kundizzjonijiet li huma assocjati ma' pressjoini tad-demm gholja. Hawnjekk irridu nsemmu t-tipjip u l-obesita.

Pressjoni oghla minn 160/85 tista titqies bhala gholja. Madankollu dan il-valur ivarja minn zmien ghal zmien minhabba li r-ricerka dejjem ghaddejja. Perezempju fl-imghoddi kienu jigu accettati valuri hafna oghla, sa anke 190/110.

Fattur iehor li jrid jitqies hu l-istat generali ta sahha tal-individwu. Ghall-ezempju, f'xi hadd li jbati mid-dijabete u x-xaham fid-demm irid isir kontroll strett tal-pressjoni halli din qatt ma taqbez 160/85. Mentri f'xi hadd ta' eta' zghira li ma jbati minn ebda mard valur madwar 160/85 hu accettabli.

Biex wiehed jitqies li jkollu pressjoni gholja, din trid tinstablu gholja ghal tliet darbiet konsekuttivi, u trid tghaddi gimgha bejn kull misurament. Dan ifisser li jekk persuna tinstabilha pressjoni ta 180/100 darba biss, din il-persuna ma titqiesx li tbati bl-ipertensjoni. Fil-prattika difficli li l-affarijiet isiru hekk. Dan ghaliex issib min jinkwieta hafna u jekk tghidlu li ghandu pressjoni gholja pero jkollu jistenna gimghatejn sakemm "tinqatalu", dan iktar jinkwieta u jkompli jgholli l-pressjoni! Hemm ukoll min jitlef l-interess u ma jergax jigi ghal "follow up", biex ma nsemmux dawk li jmorru ghand tabib iehor l-ghada.

Mod tajjeb kif tista' ssir dijanjosi ta' ipertensjoni minghajr ma l-pazjent jallarma ruhu hu l-uzu ta' djarju, fejn l-individwu jzomm rekord tal-pressjoni tieghu matul medda ta' zmien. B'hekk it-tabib ikun jista' jara kif tkun il-pressjoni l-maggor parti tal-hin.

Wara li xi hadd jinstab li jbati minn ipertensjoni dan irid isirulu xi testijiet. Dawn jinkludu ECG, X-Ray tas-sider, u check up komplut tad-demm. Dan isir biex jekk kun hemm xi kawza ghall-pressjoni gholja, din tinstab, kif ukoll biex jigi zvelat jekk il-pressjoni gholja kellhiex effetti negattivi fuq il-gisem.


Dr A. Cordina


Referenzi

• Banegas JR, Segura J, Ruilope LM, Luque M, Garcia-Robles R, Campo C, Rodriguez-Artalejo F, Tamargo J. Blood Pressure Control and Physician Management of Hypertension in Hospital Hypertension Units in Spain. Hypertension April 26, 2004, doi:10.1161/01.HYP.0000127424.59774.84
• Fields LE. Mortality From Stroke and Ischemic Heart Disease Increases Exponentially With Blood Pressure. Hypertension February 23, 2004, doi:10.1161/01.HYP.0000121366.89530.1c
• Muntner P, Gu D, Wu X, Duan X, Wenqi G, Whelton PK, He J. Factors Associated With Hypertension Awareness, Treatment, and Control in a Representative Sample of the Chinese Population. Hypertension January 26, 2004, doi:10.1161/01.HYP.0000116302.08484.14
• Schroeder EB, Liao D, Chambless LE, Prineas RJ, Evans GW, Heiss G. Hypertension, Blood Pressure, and Heart Rate Variability. The Atherosclerosis Risk in Communities (ARIC) Study. Hypertension October 27, 2003, doi:10.1161/01.HYP.0000100444.71069.73
• Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of Weight Reduction on Blood Pressure. A Meta-Analysis of Randomized Controlled Trials. Hypertension published September 15, 2003, doi:10.1161/01.HYP.0000094221.86888.AE
• Sesso HD, Chen RS, L'Italien GJ, Lapuerta P, Chan Lee W, Glynn RJ. Blood Pressure Lowering and Life Expectancy Based on a Markov Model of Cardiovascular Events. Hypertension October 13, 2003, doi:10.1161/01.HYP.0000097602.67134.4D
• Henry P, Thomas F, Benetos A, Guize L. Impaired Fasting Glucose, Blood Pressure and Cardiovascular Disease Mortality. Hypertension published August 26, 2002, doi:10.1161/01.HYP.0000032853.95690.26
• de Gaudemaris R, Lang T, Chatellier G, Larabi L, Lauwers-Cances V, Maitre A, Diene E. Socioeconomic Inequalities in Hypertension Prevalence and Care: The IHPAF Study. Hypertension 2002; 39: 1119-1125, doi:10.1161/01.HYP.0000018912.05345.55