উচ্চ ৰক্তচাপ: বিভিন্ন সংশোধনসমূহৰ মাজৰ পাৰ্থক্য

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ভাঙনি
59 নং শাৰী:
গৰ্ভধাৰণৰ দ্বিতীয় ভাগ আৰু সন্তান প্ৰসৱৰ পাছত হোৱা গুৰুতৰ অৱস্থা প্ৰি-এক্লেম্প্‌চিয়াত উচ্চ ৰক্তচাপ আৰু প্ৰস্ৰাৱত প্ৰ'টিন পোৱা যায়।<ref name="ABC" /> প্ৰায় ৫% গৰ্ভাৱস্থাত হোৱা এই ৰোগত বিশ্বজুৰি প্ৰায় ১৬% মাতৃৰ মৃত্যু হয়।<ref name="ABC" /> ইয়াৰ সাধাৰণতে কোনো লক্ষণ নাথাকে আৰু নিয়মমাফিক পৰীক্ষাৰ জৰিয়তে ধৰা পৰে। কেতিয়াবা লক্ষণ থাকিলে মূৰৰ বিষ, চকুৰে ভালকৈ নেদেখা, বমি, পেটৰ বিষ আৰু হাত-ভৰি ফুলা আদিয়ে দেখা দিয়ে। প্ৰি-এক্লেম্প্‌চিয়াৰ চিকিৎসা নকৰিলে প্ৰাণনাশী উচ্চ ৰক্তচাপীয় সংকট [[এক্লেম্প্‌চিয়া]]ই দেখা দিয়ে যাৰ ফলত [[অন্ধত্ব]], মস্তিষ্ক ফুলা, কঁপনি, বৃক্কৰ ব্যৰ্থতা, DIC (তেজ গোট মৰা ৰোগ) আদি হ'ব পাৰে।<ref name="ABC" /><ref name="urlHypertension and Pregnancy: eMedicine Obstetrics and Gynecology">{{cite web |url=http://emedicine.medscape.com/article/261435-overview |title=Hypertension and Pregnancy |author=Gibson, Paul |date=July 30, 2009 |work=eMedicine Obstetrics and Gynecology |publisher=Medscape |pages= |accessdate=16 June 2009}}</ref>
 
===Childrenশিশু===
নৱজাতক আৰু কেঁচুৱাৰ উচ্চ ৰক্তচাপ হ'লে ওজন নবঢ়া, খিংখিঙীয়া, সপ্ৰতিভ নোহোৱা, উশাহ লোৱাৰ কষ্ট আদিয়ে দেখা দিয়ে।<ref name="urlHypertension: eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine">{{cite web |url=http://emedicine.medscape.com/article/889877-overview |title=Hypertension |author=Rodriguez-Cruz, Edwin |author2=Ettinger, Leigh M |date=April 6, 2010 |work=eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine |publisher=Medscape |pages= |accessdate=16 June 2009}}</ref> শিশু অৱস্থাত উচ্চ ৰক্তচাপে মূৰৰ বিষ, চট্‌ফটনি, বেছি ভাগৰ, চকুৰে ধুঁৱলি-কুঁৱলি দেখা, নাকেৰে তেজ ওলোৱা, [[বেলৰ পক্ষাঘাত|মুখৰ পক্ষাঘাত]] আদি লক্ষণ সৃষ্টি কৰে।<ref name="urlHypertension: eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine"/><ref name=Dionne/>
 
75 নং শাৰী:
 
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==ৰোগ-প্ৰক্ৰিয়া==
==Pathophysiology==
{{Main article|উচ্চ ৰক্তচাপৰ ৰোগ্-প্ৰক্ৰিয়া}}
{{Main article|Pathophysiology of hypertension}}
[[File:Mean arterial pressure.png|thumb|Determinantsগড় ofধমনী meanচাপৰ arterial pressureকাৰকসমূহ]]
[[File:Blausen 0486 HighBloodPressure 01.png|thumb|Illustrationউচ্চ depictingৰক্তচাপৰ theপ্ৰভাৱ effectsদেখুওৱা of high blood pressureছবি]]
In most people with established [[essentialপ্ৰাথমিক (primary)উচ্চ hypertension|essential hypertensionৰক্তচাপ]], increasedভোগা resistanceবেছিসংখ্যক toলোকৰে bloodৰক্ত flowপ্ৰবাহৰ অৱৰোধ বেছি ([[total peripheral resistance]]) accountsপোৱা forযায় the high pressure whileআৰু [[cardiacকাৰ্ডিয়েক outputআউটপুট]] remainsসাধাৰণ normal.অৱস্থাত থাকে।<ref>{{cite journal |author=Conway J |title=Hemodynamic aspects of essential hypertension in humans |journal=Physiol. Rev. |volume=64 |issue=2 |pages=617–60 |date=April 1984 |pmid=6369352 |doi= |url=}}</ref> There[[প্ৰাক্‌ isউচ্চ evidence that some younger people with [[prehypertensionৰক্তচাপ]](prehypertension) বা or 'borderline hypertension' haveথকা highকিছু cardiacসংখ্যক output,ডেকা anবয়সৰ elevatedলোকৰ heartবেছি rateকাৰ্ডিয়েক andআউটপুট, normalবেছি peripheralহৃদস্পন্দন resistance,আৰু termedসাধাৰণ প্ৰান্তীয় অৱৰোধ পোৱা যায় (hyperkinetic borderline hypertension.)।<ref name = Palatini>{{cite journal |author=Palatini P, Julius S |title=The role of cardiac autonomic function in hypertension and cardiovascular disease |journal=Curr. Hypertens. Rep. |volume=11 |issue=3 |pages=199–205 |date=June 2009 |pmid=19442329 |doi= 10.1007/s11906-009-0035-4|url=|last2=Julius }}</ref> Theseএওঁলোকে individualsপাছৰ developবয়সত theপ্ৰাথমিক typicalউচ্চ featuresৰক্তচাপত of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age.ভোগে।<ref name = Palatini /> Whetherউচ্চ thisৰক্তচাপ patternথকা isসকলোৰে typicalএনে ofঘটে allনে peopleতাক whoলৈ ultimatelyবিবাদ develop hypertension is disputed.আছে।<ref>{{cite journal |author=Andersson OK, Lingman M, Himmelmann A, Sivertsson R, Widgren BR |title=Prediction of future hypertension by casual blood pressure or invasive hemodynamics? A 30-year follow-up study |journal=Blood Press. |volume=13 |issue=6 |pages=350–54 |year=2004 |pmid=15771219 |doi= 10.1080/08037050410004819|url=|last2=Lingman |last3=Himmelmann |last4=Sivertsson |last5=Widgren }}</ref> Theউচ্চ increasedৰক্তচাপৰ peripheralবেছি resistanceপ্ৰান্তীয় inঅৱৰোধৰ establishedকাৰণ hypertensionসৰু isসৰু mainlyধমনীবোৰৰ attributableসংকোচন toবুলি structuralঠাৱৰ narrowingকৰা of small arteries and arterioles,হৈছে।<ref>{{cite journal |author=Folkow B |title=Physiological aspects of primary hypertension |journal=Physiol. Rev. |volume=62 |issue=2 |pages=347–504 |date=April 1982 |pmid=6461865 |doi= |url=}}</ref> althoughসুক্ষ্ম aনলীকাবোৰৰ reduction(capillaries) inঘনত্ব theকমাটোও numberএটা orকৰণ densityহ'ব of capillaries may also contribute.পাৰে।<ref>{{cite journal |author=Struijker Boudier HA, le Noble JL, Messing MW, Huijberts MS, le Noble FA, van Essen H |title=The microcirculation and hypertension |journal=J Hypertens Suppl |volume=10 |issue=7 |pages=S147–56 |date=December 1992 |pmid=1291649 |doi= 10.1097/00004872-199212000-00016|url=|last2=Le Noble |last3=Messing |last4=Huijberts |last5=Le Noble |last6=Van Essen }}</ref> <!-- Whether increased active arteriolar [[vasoconstriction]] plays a role in established essential hypertension is unclear.<ref>{{cite journal |author=Schiffrin EL |title=Reactivity of small blood vessels in hypertension: relation with structural changes. State of the art lecture |journal=Hypertension |volume=19 |issue=2 Suppl |pages=II1–9 |date=February 1992 |pmid=1735561 |doi= 10.1161/01.HYP.19.2_Suppl.II1-a|url=}}</ref> Hypertension is also associated with decreased peripheral [[Compliance (physiology)|venous compliance]]<ref>{{cite journal |author=Safar ME, London GM |title=Arterial and venous compliance in sustained essential hypertension |journal=Hypertension |volume=10 |issue=2 |pages=133–9 |date=August 1987 |pmid=3301662 |doi= 10.1161/01.HYP.10.2.133|url=|last2=London }}</ref> which may increase [[venous return]], increase cardiac [[Preload (cardiology)|preload]] and, ultimately, cause [[diastolic dysfunction]].-->
 
[[Pulseউচ্চ pressure]]ৰক্তচাপ (theথকা differenceবয়সীয়া betweenলোকৰ systolicPulse andpressure diastolic(ছীষ্ট'লিক bloodআৰু pressure)ডায়েষ্ট'লিক isচাপৰ frequentlyব্যৱধান) increasedপ্ৰায়েই inবাঢ়ি olderথকা peopleপোৱা withযায়। hypertension.ইয়াৰ Thisঅৰ্থ canএয়েই meanযে thatছীষ্ট'লিক systolic pressure isচাপ abnormallyঅস্বাভাৱিকভাৱে highবেছি, butকিন্তু diastolicডায়েষ্ট'লিক pressureচাপ mayসাধাৰণ beবা normalনিম্ন। orইয়াক low"বিচ্ছিন্ন aছীষ্ট'লিক conditionউচ্চ termedৰক্তচাপ" [[isolated(Isolated systolic hypertension]].) বোলা হয়।<ref>{{cite journal |author=Chobanian AV |title=Clinical practice. Isolated systolic hypertension in the elderly |journal=N. Engl. J. Med. |volume=357 |issue=8 |pages=789–96 |date=August 2007 |pmid=17715411 |doi=10.1056/NEJMcp071137 |url=}}</ref> Theউচ্চ highৰক্তচাপ pulseবা pressureবিচ্ছিন্ন inছীষ্ট'লিক elderlyউচ্চ peopleৰক্তচাপ withথকা hypertensionবয়সীয়া orলোকৰ isolatedবেছি systolicPulse hypertensionpressure-ৰ isকাৰণ explainedবয়সৰ byলগে increasedলগে [[arterialবঢ়া stiffness]],ধমনীৰ whichকঠিনতা typically(arterial accompaniesstiffness) agingবুলি andঠাৱৰ mayকৰা be exacerbated by high blood pressure.হৈছে।<ref>{{cite journal |author=Zieman SJ, Melenovsky V, Kass DA |title=Mechanisms, pathophysiology, and therapy of arterial stiffness |journal=Arterioscler. Thromb. Vasc. Biol. |volume=25 |issue=5 |pages=932–43 |date=May 2005 |pmid=15731494 |doi=10.1161/01.ATV.0000160548.78317.29 |url=|last2=Melenovsky |last3=Kass }}</ref>
 
Manyউচ্চ mechanismsৰক্তচাপৰ haveবেছি beenপ্ৰান্তীয় proposedঅৱৰোধৰ toকাৰণ accountহিচাপে forকেইবাটাও theপ্ৰক্ৰিয়া riseআগবঢ়োৱা inহৈছে। peripheralবৃক্কৰ resistanceলৱণ inআৰু hypertension.পানীৰ Mostপৰিশোধন evidence implicates either disturbances in the kidneys' salt and water handlingপ্ৰক্ৰিয়াত (particularlyবিশেষকৈ abnormalities in the intrarenal [[renin-angiotensin system]]) গোলমাল হোৱাৰ প্ৰমাণ পোৱা গৈছে।<ref>{{cite journal |author=Navar LG |title=Counterpoint: Activation of the intrarenal renin-angiotensin system is the dominant contributor to systemic hypertension |journal=J. Appl. Physiol. |volume=109 |issue=6 |pages=1998–2000; discussion 2015 |date=December 2010 |pmid=21148349 |pmc=3006411 |doi=10.1152/japplphysiol.00182.2010a |url=}}</ref> orছীম্‌পেথেকিক abnormalitiesস্নায়ু ofপ্ৰণালীৰো theইয়াত [[sympatheticহাত nervous system]].আছে।<ref>{{cite journal |author=Esler M, Lambert E, Schlaich M |title=Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension |journal=J. Appl. Physiol. |volume=109 |issue=6 |pages=1996–98; discussion 2016 |date=December 2010 |pmid=20185633 |doi=10.1152/japplphysiol.00182.2010 |url=|last2=Lambert |last3=Schlaich }}</ref> Theseএই mechanismsপ্ৰক্ৰিয়াবোৰ areএকচেটিয়া notনহয় mutuallyআৰু exclusiveপ্ৰায়বোৰ andপ্ৰাথমিক itউচ্চ isৰক্তচাপৰ likelyৰোগীত thatদুয়োটা bothপ্ৰক্ৰিয়া contributeঘটিব toপাৰে। someউচ্চ extentৰক্তচাপত inবেছি mostপ্ৰান্তীয় casesঅৱৰোধ ofআৰু essentialনলীকাৰ hypertension.ক্ষতিৰ Itকাৰণ hasহিচাপে also been suggested that [[endothelial dysfunction]] andআৰু vascularনলীকাৰ [[inflammation]]প্ৰদাহকো mayআঙুলিয়াই alsoদিয়া contribute to increased peripheral resistance and vascular damage in hypertension.হৈছে।<ref>{{cite journal |author=Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S |title=Endothelium-dependent contractions and endothelial dysfunction in human hypertension |journal=Br. J. Pharmacol. |volume=157 |issue=4 |pages=527–36 |date=June 2009 |pmid=19630832 |pmc=2707964 |doi=10.1111/j.1476-5381.2009.00240.x |url=|last2=Daghini |last3=Virdis |last4=Ghiadoni |last5=Taddei }}</ref><ref>{{cite journal |author=Marchesi C, Paradis P, Schiffrin EL |title=Role of the renin-angiotensin system in vascular inflammation |journal=Trends Pharmacol. Sci. |volume=29 |issue=7 |pages=367–74 |date=July 2008 |pmid=18579222 |doi=10.1016/j.tips.2008.05.003 |url=|last2=Paradis |last3=Schiffrin }}</ref> [[Interleukinউচ্চ 17]]ৰক্তচাপত hasভূমিকা garneredথকা interestকেইবাবিধো forপ্ৰতিৰক্ষা itsপ্ৰণালীৰ roleৰাসায়নিক inপদাৰ্থ increasing the production of several other [[cytokine|(immune system chemical signals]]) thoughtইণ্টাৰলিউকিনৰ to be involved in hypertension such as [[tumor necrosis factor alpha]], [[(interleukin) 1]],ফলত [[interleukinবাঢ়ে 6]],বুলি andঅধ্যয়নত [[interleukinপোৱা 8]].গৈছে।<ref name="Gooch2014">{{cite journal |author=Gooch JL, Sharma AC |title=Targeting the immune system to treat hypertension: where are we?|journal=Curr Opin Nephrol Hypertens |volume=23 |issue=5|pages=000–000|date=July 2014|pmid=25036747|doi=10.1097/MNH.0000000000000052|last2=Sharma}}</ref>
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A 2007 review article <ref name=> {{cite journal |vauthors=Adrogué HJ, Madias NE |title=Sodium and potassium in the pathogenesis of hypertension |journal=[[New England Journal of Medicine]] |volume=356 |pages=1966–1978 |year=2007 |pmid= |doi= 10.1056/NEJMra064486 |url=http://www.earthsave.org/louisville/Potassium%20Hypertension.pdf }} </ref> states that while excessive sodium consumption has long been recognized as contributing to the risk of essential (also known as primary or what they describe as essential, primary or [[idiopathy|idiopathic]]) hypertension, "potassium, the main intracellular cation, has usually been viewed as a minor factor in the pathogenesis of hypertension. However, abundant evidence indicates that a potassium deficit has a critical role in hypertension and its cardiovascular sequelae." The authors state that modern, western, high sodium, low potassium diets result in corresponding changes in intracellular concentration of these, the two most important cations in animal cells. This imbalance leads to contraction of vascular smooth muscle, restricting blood flow and so driving up blood pressure. The authors cite studies which showing that potassium supplementation is effective in reducing hypertension.-->
 
Epidimiological২০১৪ supportচনত forকৰা thisএটা hypothesis can be found in a 2014 metaমেটা-analysis এনালাইচিছত<ref name=pmid=25398734>{{cite journal |vauthors=Perez V, Chang ET |title=Sodium-to-Potassium Ratio and Blood Pressure, Hypertension, and Related Factors|journal=[[Advances in Nutrition]] |volume=56 |pages=712-741 |year=2014 |pmid=25398734}}</ref> whichকোৱা statesহৈছে thatযে "theপ্ৰাপ্তবয়স্ক sodium-to-potassiumলোকৰ ratioউচ্চ appearsৰক্তচাপত toকেৱল beছ'ডিয়াম moreআৰু stronglyপটাছিয়ামতকৈ associated with blood pressure outcomes than either sodium or potassium alone inছ'ডিয়াম-পটাছিয়াম hypertensiveঅনুপাতৰ adultভূমিকা populations.".অধিক।
 
==ৰোগ নিৰ্ণয়==
==Diagnosis==
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|-
|+ সাধাৰণতে কৰা পৰীক্ষা
|+ Typical tests performed
! প্ৰণালী
! System
! পৰীক্ষা
! Tests
|-
| [[মূত্ৰ তন্ত্ৰ|বৃক্ক]]
| [[Urinary system|Kidney]]
| প্ৰস্ৰাৱৰ পৰীক্ষা, প্ৰস্ৰাৱত প্ৰ'টিন, ব্লাড-ইউৰিয়া নাইট্ৰ'জেন আৰু/বা ক্ৰিয়েটিনিন।
| [[Urinalysis|Microscopic urinalysis]], [[proteinuria|protein in the urine]], [[blood urea nitrogen|BUN]] and/or [[creatinine]]
|-
| [[অন্তঃস্ৰাৱী তন্ত্ৰ|অন্তঃস্ৰাৱী]]
| [[Endocrine system|Endocrine]]
| ছেৰাম ছ'ডিয়াম, পটাছিয়াম, কেল্‌চিয়াম, থাইৰ‌ইড ষ্টিমুলেটিং হৰম'ন
| Serum [[sodium]], [[potassium]], [[calcium]], [[Thyroid-stimulating hormone|TSH]]
|-
| [[বিপাক ক্ৰিয়া|বিপাক]]
| [[Metabolic]]
| ফাষ্টিং ব্লাড গ্লুক'জ, HDL, LDL, আৰু ট'টেল ক'লেষ্টেৰল, ট্ৰাইগ্লিচাৰাইড
| [[Glucose test|Fasting blood glucose]], [[High-density lipoprotein|HDL]], [[LDL]], and total cholesterol, [[triglycerides]]
|-
| Otherআন
| হিমাট'ক্ৰিট, ই চি জি, আৰু বুকুৰ এক্স ৰে'
| [[Hematocrit]], [[electrocardiogram]], and [[chest radiograph]]
|-
| colspan=2 | Sources: ''Harrison's principles of internal medicine''<ref name="isbn0-07-147691-1">{{cite book |author1=Loscalzo, Joseph |author2=Fauci, Anthony S. |author3=Braunwald, Eugene |author4=Dennis L. Kasper |author5=Hauser, Stephen L |author6=Longo, Dan L. |title=Harrison's principles of internal medicine |edition= |publisher=McGraw-Hill Medical |year=2008 |pages= |isbn=0-07-147691-1 |doi= |url= |accessdate=}}</ref> ''others''<ref name="pmid19417858">{{cite journal |author=Padwal RS |title=The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk |journal=Canadian Journal of Cardiology |volume=25 |issue=5 |pages=279–86 |date=May 2009 |pmid=19417858 |doi= 10.1016/S0828-282X(09)70491-X|url= |pmc=2707176 |name-list-format=vanc|author2=Hemmelgarn BR |author3=Khan NA |display-authors=3 |last4=Grover |first4=S |last5=McKay |first5=DW |last6=Wilson |first6=T |last7=Penner |first7=B |last8=Burgess |first8=E |last9=McAlister |first9=FA |first10=Peter|last10=Bolli}}</ref><ref name="pmid18548142">{{cite journal |author=Padwal RJ |title=The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk |journal=Canadian Journal of Cardiology |volume=24 |issue=6 |pages=455–63 |date=June 2008 |pmid=18548142 |pmc=2643189 |doi= 10.1016/S0828-282X(08)70619-6|url= |name-list-format=vanc|author2=Hemmelgarn BR |author3=Khan NA |display-authors=3 |last4=Grover |first4=S |last5=McAlister |first5=FA |last6=McKay |first6=DW |last7=Wilson |first7=T |last8=Penner |first8=B |last9=Burgess |first9=E}}</ref><ref name="pmid17534459">{{cite journal |author=Padwal RS |title=The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk |journal=Canadian Journal of Cardiology |volume=23 |issue=7 |pages=529–38 |date=May 2007 |pmid=17534459 |pmc=2650756 |doi= 10.1016/S0828-282X(07)70797-3|url= |name-list-format=vanc|author2=Hemmelgarn BR |author3=McAlister FA |display-authors=3 |last4=McKay |first4=DW |last5=Grover |first5=S |last6=Wilson |first6=T |last7=Penner |first7=B |last8=Burgess |first8=E |last9=Bolli |first9=P}}</ref><ref name="pmid16755312">{{cite journal |author=Hemmelgarn BR |title=The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I – Blood pressure measurement, diagnosis and assessment of risk |journal=Canadian Journal of Cardiology |volume=22 |issue=7 |pages=573–81 |date=May 2006 |pmid=16755312 |pmc=2560864 |doi= 10.1016/S0828-282X(06)70279-3|url= |name-list-format=vanc|author2=McAlister FA |author3=Grover S |display-authors=3 |last4=Myers |first4=MG |last5=McKay |first5=DW |last6=Bolli |first6=P |last7=Abbott |first7=C |last8=Schiffrin |first8=EL |last9=Honos |first9=G}}</ref><ref name="pmid16003448">{{cite journal |author=Hemmelgarn BR |title=The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1- blood pressure measurement, diagnosis and assessment of risk |journal=Canadian Journal of Cardiology |volume=21 |issue=8 |pages=645–56 |date=June 2005 |pmid=16003448 |doi= |url= |name-list-format=vanc|author2=McAllister FA |author3=Myers MG |display-authors=3 |last4=McKay |first4=DW |last5=Bolli |first5=P |last6=Abbott |first6=C |last7=Schiffrin |first7=EL |last8=Grover |first8=S |last9=Honos |first9=G}}</ref>