I thisen sang chu damdawiin a control lo em ni? ‘Resistant Hypertension’ chungchang hi han sawi ila!

I hria em, a chang chuan kan thisen sang damdawi ei mah ila, thunun a harsat em em chang a awm thin. Doctor-in damdawi a pek chu pakhat hnu pakhatin i thlak hnuah pawh i thisen sang chu a tlahniam lo niin i hria em? Nangmah chauh i ni lo, hetiang dinhmun hmachhawn mi an awm. Chuvangin vawiin hian he natna ``Resistant Hypertension`` tih hi kan sawi dawn a ni.

Hei hi eng nge ni ‘resistant hypertension’?

A awlsam zawngin, ‘resistant hypertension’ tih chu i thisen sang, a dik zawka sawi chuan, mercury millimeter 140/90 (140/90 mmHg) emaw a aia sang emaw a awm reng a ni - thisen sang damdawi chi thum tal a tam ber i ei pawhin. Heng damdawi chi thumte hi a tlangpuiin:

• Diuretic pakhat (" water pills " kan ti).
• Calcium channel blocker pakhat a ni.
• Angiotensin-converting enzyme (ACE) inhibitor emaw, angiotensin II receptor blocker (ARB) emaw a ni thei.

Thisen sang, a nih loh leh kan hriat vek angin "pressure" hi hriselna lama harsatna lian tak a ni a, chu chuan rilru lam natna (thinlung leh thisen kalna natna) a tipung a ni. I ngaihtuah thei ang em, thla ruk chhung enkawlna mumal tak i neih hnua i thisen sang control a nih loh chuan doctor-te chuan "un controlled high blood pressure" i nei tih an ring tan ta a ni. Nakin lawkah he natna vei te tanpui thei tur enkawlna thar zawng turin clinical study neih mek a ni.

Engtiang chiahin nge ‘thisen sang thunun loh’ hi a hluar?

United States atanga data atanga a lan dan chuan puitling 29% velin thisen sang an nei a ni . Chumi zinga 12% vel chu ‘thisen sang control loh’ category-ah an tla a ni. Sri Lanka ramah pawh hetiang dinhmun hi a pawimawh lo hle niin a lang.

Hei hi eng symptoms nge ni?

Ngaihtuah teh, mi thenkhat chuan kum tam tak chhung chu thisen sang an nei tih pawh an hre lo. Mahse, thisen sang enkawl loh chuan i hriselna atan a hlauhawm hle thei a ni . Symptoms nei reng reng lo mah la, mi thenkhat chuan lu na, rilru na, thawk hahna ang chi thil an tawng tawh a ni . Chuvangin, nang leh i doctor hian i thisen sang hi i fimkhur reng tur a ni a, a bik takin i upat deuh deuh chuan. In lamah pawh electronic blood pressure monitor tha tak, man tlawm tak hmangin i thisen sang i teh thei a ni. Chutiang hmanrua chu damdawi dawrah emaw, online-ah emaw i hmu thei ang.

Engvangin nge he ‘uncontrolled hypertension’ hi a lo awm? A chhan engte nge ni?

‘Thisen sang thunun loh’ a lo awm chhan hi a tam thei hle. Chûngte chu i nun dân aṭangin, damdawi i ei ṭhenkhat aṭangin, a nih loh leh damdawi dang i neih aṭang pawhin a ni thei.

Nunphung leh ei leh in

A hnuaia tarlan te hian thisen sang leh ‘thisen sang thunun loh’ te hi a thlen thei a ni:

• I Body Mass Index (BMI) chu 25 aia tam a ni (chu chu taksa thau tam lutuk i nei tihna a ni).
• Taksa tihchak loh (Exercise neih loh).
• Chi ei tam lutuk (hei hi mi tam tak tan chuan harsatna a ni!).
• Zu in tam lutuk .

Damdawi thenkhat

Damdawi i ei ṭhenkhat, prescription drug leh over-the-counter (OTC) damdawi te hian i thisen sang control a ti harsa thei hle. Entir nan:

• Painkillers , a bik takin ``NSAIDs - Nonsteroidal Anti-inflammatory Drugs)`` an tih te hi a ni. Entirnan ``( Ibuprofen )`` leh ``( Naproxen )`` te hi a ni.
• Hnar tithianghlimtu (nasal decongestants) a ni.
• Naupai venna (birth control pills) ei tur.
• Herbal product thenkhat Ginseng leh Licorice te.

Damdawi lam dinhmun hnuaia awm dangte (Secondary causes) .

A châng chuan, damdawi lam dinhmun hnuaia enkawl theih dangte chu i ‘thisen sang thunun loh’ thlentu a ni thei bawk. Hengte hi secondary cause kan ti a. Entirna tlemte chu hetiang hi a ni:

• Primary hyperaldosteronism: Hei hi i adrenal glands-in hormone thenkhat a siam tam lutuk hi a ni .
• Renal artery stenosis: Hei hi i kal (kidney)-a thisen petu thisen kalna kawng (arteries) te tihtlem a ni.
• Kal natna rei tak ( CKD ).
• Mut theih lohna (sleep apnea) a awm.
• Pheochromocytoma: I adrenal gland-a tumor lo awm (hei hi a tlem deuh).
• Aortic narrowing (hei pawh hi a tlem hle).
• Cushing syndrome: Steroid hormone thenkhat siam tam lutuk (hei pawh hi a awm lo).

Tute nge ‘uncontrolled hypertension’ vei theihna sang zawk?

A hnuaia mite hian ‘uncontrolled high blood pressure’ an nei tam zawk:

• Kidney natna khirh tak nei tan.
• Zunthlum vei tan.
• American mipa hring tan chuan ``(African American)`` (hei hi American zirchiannaah hmuh tur a awm).
• Hmeichhia tan.

Hetiang dinhmun atang hian eng harsatna nge lo awm thei?

Thisen sang nei mahse a control theih tawhte nena khaikhin chuan heng enkawlna hmanga awlsam taka control theih loh ‘uncontrolled high blood pressure’ nei te hi an hlauhawm zawk a ni :

• Thai.
• Kidney natna a awm thei.
• Heart failure a awm thei.

Hei hi hriat reng tur a ni: Hei hian i thisen sang control a pawimawh zia a tilang a ni lawm ni?

He ‘thisen sang thunun loh’ hi engtin nge doctor-te hian an hriat chhuah?

‘Thisen sang control loh’ tih hriat theih nan i doctor chuan i hnen atangin thu tam tak a la khawm ang. A hnuaia mite hi an nemnghet a ngai dawn a ni:

• I thisen sang value te hi a dik em ?
• Nitin damdawi pek dik tak i ei thin em ?
• "White coat syndrome" (doctor i kal hunah chauh i thisen sang a sang tihna) tih natna i nei em.

I medical history chungchang zawh

I doctor chuan hetiang hi a zawt thei ang:

• Engtik lai khan nge thisen sang i neih tan?
• In lama i thisen sang i check hian eng step nge i tih?
• Tunah hian eng damdawi (herbs leh supplement te pawh tel) nge i ei a, i tih angin i ei em?
• I thisen sang thunun theih loh chhan ni thei thil pahnihna chungchanga zawhnate.
• Zu leh zuk leh hmuam hman chungchanga zawhna.

Taksa enfiahna

Taksa enfiahna hian heng thilte hi a zawng thin:

• I mit a inthlak danglam dan pangngai lo (hei hi hypertensive retinopathy an ti).
• Artery lian thenkhat (bruits - vascular murmurs an tih) kaltlangin aw pangngai lo hriat theih. Heng thawmte hian heng thisen kalna kawngte hian thau, plaques an tih chu a awm lo thei tih a tilang a ni.

Lab test neih a ni

Laboratory test-ah hian:

• Zunah hian protein a awm leh awm loh enfiah nan zun test a ni.
• Thisen test hian i thisena creatinine, glucose, leh electrolytes sodium leh potassium ang chi level te a enfiah thin.
• Adrenal gland emaw kidney natna emaw enfiahna atana thisen test.
• Thyroid natna test la, hypothyroidism an tih hian thisen sang a thlen thei a ni.

Imaging test te pawh a awm

I adrenal glands check nan emaw, i renal arteries a tawi em tih hriat nan emaw heng test te hi i ti thei ang:

• X-ray hmanga tih a ni.
• Ultrasound hmanga test a ni.
• CT scan `(Computed tomography - CT scan) hmanga tih a ni.

I doctor pawhin sleep apnea i neih leh neih loh enfiah turin mut zirchianna neih a rawt thei bawk.

He ‘thisen sang thunun loh’ hi engtin nge i thunun? Enkawlnate chu engte nge ni?

Nunphung thlak danglam leh damdawi te hi ‘thisen sang control loh’ enkawlna atan hman theih a ni.

Nunphung a inthlak danglam thin

I tihdanglam theihte chu:

• Salt tihtlem (ni khatah milligram 2,400 aia tlem ei) leh zu tihtlem.
• NSAIDs hi natna tidamtu atana hman khap la, paracetamol (Acetaminophen) ang chi thil hmang zawk rawh.
• Ni khatah minute 30 tal pawnah aerobic activity nei la, kar khatah ni engemaw zat.

Damdawi chi hrang hrang

‘Thisen sang control loh’ enkawl hi a chang chuan i damdawi ei dan tur i zawm tih chian ang maia awlsam a ni thei. Dik tak chuan ‘uncontrolled high blood pressure’ vei zinga 40% vel ah chuan damdawi hi miten an ei tha loh avangin a thawk tha lo . I damdawi aṭanga hlawkna tam ber i hmuh theih nân, ni tin, a dose dik tak, leh ni tin hun dik tak i ei a ngai a ni .

I damdawi ei harsatna i neih chuan i doctor nen inbiakna neihpui ngei ang che . I damdawi ei tur chu a side effect vangin i ei tha thei lo mai thei. Damdawi pakhat avanga side effect i neih chuan i doctor chuan damdawi dang a pe thei che a ni. A nih loh leh, ni khatah vawi khat chauh i ei ngai damdawiah an thlak thei che a ni. Doctor nen inbia lovin i damdawi ei kha bansan ngai suh.

I damdawi i ei dik a, ‘uncontrolled high blood pressure’ i la nei a nih chuan i doctor chuan damdawi dang a dah belh thei bawk. Mi thenkhat chuan thisen sang damdawi chi hrang hrang pali emaw panga emaw an ei a ngai mai thei. Thisen sang damdawi chi hrang hrang hman tlanglawn ber berte chu:

• Diuretics hmanga chaw ei thin.
• Calcium channel blocker a ni.
• ACE inhibitor/angiotensin receptor blocker (ACE inhibitor/ARBs) te hi a awm a, hei hi a chhuahna tur hmun leh a hmanna tur a ni.

I potassium level a zirin i doctor chuan i diuretic dose chu a let hnih a tihpun a ngai mai thei a, damdawi palina – aldosterone antagonist spironolactone ang chi – i thisen sang control nan a dah belh a ngai mai thei. A nih loh leh i doctor chuan beta-blocker a thlang thei bawk.

Enkawlna avanga side effects awm thei

Damdawi zawng zawng deuhthaw hian side effect a nei thei. Thisen sang damdawi ei avanga side effects awm thei te chu:

• Luak chhuak thei.
• Lu na.
• Zun fo a ngai.
• Constipation (toilet kal harsa).
• Dry cough a ni.
• Chau lutuk.

Engtin nge ‘thisen sang thunun loh’ hlauhawmna tihziaawm theih ang?

I thisen sang chu enkawlna laka a do theih loh nan a hnuaia mi ang hian ti rawh:

• I thisen sang damdawi ei chungchangah i doctor thupek dik tak zawm rawh .
• I taksa rihna hrisel tak, i duh ang angin vawng reng ang che.
• Kar khatah minute 150 chhung exercise la (ni thum atanga ni nga chhung theh darh).
• Chi i ei zat tihtlem rawh .
• Zu i in zat khap tlat ang che.
• Zan tin mut tha rawh .

‘Thisen sang thunun loh’ ka neih chuan eng nge ka beisei ang?

‘Thisen sang thunun loh’ nei tam tak chuan damdawi hmangin an thisen sang an thunun thei a ni. Damdawi i pek bakah hian i doctor chuan kawng hrang hrang tlemte a lo enchhin duh mai thei. Entirnan, diuretic pakhat atanga a chak zawka inthlak emaw, zan lama i non-diuretic damdawi ei tir emaw.

Engtin nge ka in enkawl ang?

Thisen sang nena nun hi nitin, nitin i tih tur a ni. Mahni in enkawl danah hian:

• I thisen sang damdawi chu a hun takah leh a zat dik takah ei .
• Chi leh zu i ei leh in zat tihtlem .
• Ni ruat (checkup appointment)-a doctor pan.
• Exercise neih fo thin .
• I taksa rihna hrisel tak, i duh ang taka vawn reng.
• In lama i thisen sang enfiah.

‘Thisen sang thunun theih loh’ i neih laia ei tur tha ber berte chu engte nge ni?

Salt hian i thisen sang a tisang a , chuvangin ei loh a tha ber. Mahse eng ei tur nge chi a awm tih i hre lo mai thei. Restaurant chaw leh processed food-ah hian chi a tam hle tih i hriat chuan mak i ti hle ang . Heng ei tur te hi pumpelh leh/ emaw tihtlem hian chi i ei zat tihtlem nan a pui thei a ni.

Engtikah nge ka doctor ka hmuh ang?

I doctor hmu ang che:

• I doctor-in damdawi a pek che ei harsatna i neih chuan.
• I damdawi zawng zawng i ei angin i ei vek a, mahse i thisen sang level a la sang reng a nih chuan .

Engtikah nge Emergency Treatment Unit (ETU) ah ka kal ang ?

Hypertensive crisis hi damdawi lam pan vat ngai a ni . Chutiang a nih chuan i thisen sang chu a sang nghal hle (180/120 millimeters of mercury - `180/120 mmHg`), a natna lan chhuah dan te chu:

• Lu na na tak.
• Chest na (thud ri nasa tak ang mai).
• Luak chhuak thei.
• Thâwk harsa.

Doctor hnenah eng zawhna nge ka zawh ang?

I doctor hnenah hetiang zawhna hi i zawt thei ang:

• Damdawi ka thlak a ngai em?
• Blood pressure damdawi combination eng nge ka tan a tha ber?
• In lamah engzat nge ka thisen sang ka enfiah ang?
• Follow-up appointment atan engzat nge ka rawn hmu tur che?

Damdawi tam tak i ei a, hmasawnna i hmuh loh chuan a lungchhiatthlak thei hle. Thisen sang damdawi chi hrang hrang pathum i ei lai hian i thisen sang chu a pangngaia awm leh theih nan harsatna tak tak angin a lang thei. I doctor nena rinawm taka inbiakna chuan he harsatna chinfel dan tur i zawng thei a ni. I hriat chian loh zawng zawng zawhna zawh hi i tan a tha ber.

A tawp berah chuan hei hi hre reng ang che (Take-Home Message) .

Resistant hypertension hi a buaithlak deuh a, mahse chu chu i control thei lo tihna erawh a ni lo.

• Diagnosis dik tak neih a pawimawh hle. I thisen sang chhan bulpui dang a awm thei bawk.
• I damdawi ei tur dik tak, a hun taka ei tur leh a pek zat tur anga ei a pawimawh hle. Zawhna i neih chuan doctor nen inbia ang che.
• Nunphung inthlak danglamna hian nghawng lian tak a nei thei a ni. Chi ei tlem te, exercise lak te, leh taksa rihna hrisel tak neih te hi theihnghilh suh.
• I doctor nen inbiakpawhna tha tak nei rawh. I harsatna te, i rilru put hmang te, leh i damdawi ei avanga a side effect te chu tlang takin sawi rawh.
• Damdawi ei kha bansan ngai suh la, nangmah chauhin a dose pawh thlak ngai suh.

He zinkawngah hian nangmah chauh i ni lo tih hre reng ang che. I doctor leh healthcare team te chu i tanpui turin an awm a ni. Dawhtheihna tlem te te, enkawlna dik tak te, leh nunphung tihdanglam te chuan nang pawhin he natna hi i thunun thei ang!