Arterial hypertension is one of the most common diseases of the heart and blood vessels, affecting about 25% of the adult population. No wonder it is sometimes referred to as a non -communicable epidemic. High blood pressure with its complications has a significant impact on the mortality of the population. Estimates show that up to 25% of deaths in people over the age of 40 are directly or indirectly caused by hypertension. The possibility of complications determines the degree of hypertension. How many levels of hypertension does it have, how is it classified? See below.
Important! According to the latest World Health Organization estimates from 1993, hypertension in adults is considered a persistent increase in blood pressure up to 140/90 mm Hg. Art.
Classification of arterial hypertension, determination of the level of disease risk
According to the WHO, according to etiology, hypertension is classified into primary and secondary.
In primary (essential) hypertension (EH), the primary organic cause of increased blood pressure (BP) is unknown. A combination of genetic factors, external influences and violations of internal regulatory mechanisms are taken into account.
External factors:
- Environment;
- excessive calorie consumption, development of obesity;
- increased salt intake;
- deficiency of potassium, calcium, magnesium;
- excessive alcohol consumption;
- repetitive stress situations.
Primary hypertension is the most common hypertension, accounting for about 95% of cases.
There are 3 stages of hypertension:
- Stage I - high blood pressure without changes in organs;
- Stage II - an increase in blood pressure with changes in the organs, but without interfering with their function (left ventricular hypertrophy, proteinuria, angiopathy);
- Stage III - changes in the organs, accompanied by a violation of their function (left heart failure, hypertensive encephalopathy, stroke, hypertensive retinopathy, renal failure).
Secondary (symptomatic) hypertension is an increase in blood pressure as a symptom of an underlying disease with an identifiable cause. The classification of arterial hypertension in the secondary form is as follows:
- renoparenchymal hypertension - occurs as a result of kidney disease; causes: diseases of the renal parenchyma (glomerulonephritis, pyelonephritis), tumors, kidney damage;
- renovascular hypertension - narrowing of the renal arteries by fibromuscular dysplasia or atherosclerosis, renal vein thrombosis;
- endocrine hypertension - primary hyperaldosteronism (Conn syndrome), hyperthyroidism, pheochromocytoma, Cushing's syndrome;
- drug -induced hypertension;
- gestational hypertension - high blood pressure during pregnancy, after childbirth, the condition often returns to normal;
- aortic cortex.
Pregnancy hypertension can lead to congenital diseases of children, in particular, retinopathy. There are 2 phases of retinopathy (premature and full -term infants):
- active - consists of 5 stages of development, can cause vision loss;
- cicatricial - leads to corneal turbidity.
Important! Both premature and premature infant retinopathy stages lead to anatomical disorders!
Hypertension according to the international system (according to ICD-10):
- main form - I10;
- secondary form - I15.
The degree of hypertension also determines the degree of dehydration - dehydration. In this case, the classifier is the lack of water in the body.
There are 3 degrees of dehydration:
- degree 1 - mild - deficiency 3. 5%; symptoms - dry mouth, strong thirst;
- grade 2 - moderate - deficiency - 3-6%; symptoms - sharp fluctuations in pressure or decrease in pressure, tachycardia, oliguria;
- degree 3 - third degree is the most severe, characterized by a lack of 7-14% water; indicated by hallucinations, delusions; clinic - coma, hypovolemic shock.
Depending on the degree and degree of dehydration, decompensation is carried out by introducing a solution:
- 5% glucose + isotonic NaCl (mild);
- 5% NaCl (simple);
- 4. 2% NaHCO3(severe degree).
GB rating
Subjective symptoms, especially in mild and moderate stages of hypertension, are often absent, so an increase in blood pressure is often found already at the level of dangerous indicators. The clinical picture is divided into 3 stages. Each stage of arterial hypertension has a typical symptomatology, from which the GB classification is based.
I'm on stage
In the first stage of hypertension, patients complain of headaches, fatigue, palpitations, confusion, and sleep disturbances. At stage 1 AH, objective findings on the heart, ECG, eye background, laboratory tests are present in the normal range.
stage II
At stage 2 AH, the subjective complaints were similar, at the same time there were signs of left ventricular hypertrophy, there were signs of angiopathic hypertension of the retina, and microalbuminuria or proteinuria in the urine. Occasionally there is a multiplication of red blood cells in the urine sediment. At stage 2 hypertension, there are no symptoms of renal failure.
Level III
In stage III hypertension, functional disorders are diagnosed in organs at high risk for hypertension:
- damage to the heart - first indicated by shortness of breath, then - symptoms of cardiac asthma or pulmonary edema;
- vascular complications - damage to peripheral and coronary arteries, the risk of cerebral atherosclerosis;
- changes in the fundus - have the character of hypertensive retinopathy, neuroretinopathy;
- changes in cerebral blood vessels - indicated by transient ischemic attacks, thrombotic vascular stroke or normal hemorrhage;
- in stage III, cerebral stroke, brain lesions are diagnosed in almost all patients;
- benign nephrosclerosis of the renal tract - leads to limitation of glomerular filtration, increased proteinuria, erythrocytosis, hyperuricemia, and later - to chronic renal failure.
What is the most dangerous stage or stage of hypertension? Although there are a variety of symptoms, all stages and degrees of arterial hypertension are dangerous, it requires appropriate systemic or symptomatic treatment.
Degrees
Consistent with the indicator of blood pressure (blood pressure), determined at the time of diagnosis, there are 3 degrees of hypertension:
- light;
- average;
- heavy.
There is also a 4th concept - the definition of resistant (persistent) hypertension, where even with the right choice of combination of antihypertensive drugs, blood pressure does not drop below 140/90 mm Hg. Art.
A clearer overview of the level of arterial hypertension is presented in the table.
Classification of hypertension and stratification of normal blood pressure according to the ESH/ESC Guidelines 2007.
| category | Systolic pressure, mm HgSeni. | Diastolic pressure, mm HgSeni. |
|---|---|---|
| Optimum | < 120 | < 80 |
| Get used to it | 120–129 | 80–84 |
| Increased normal | 130–139 | 85–89 |
| 1 degree | 140–159 | 90–99 |
| 2 degrees | 160–179 | 100–109 |
| 3 degrees | over 180 | over 110 |
| Isolated systolic hypertension | over 140 | less than 90 |
The difficulty of the patient varies according to the division of hypertension in degrees. The choice of treatment regimen for this disease depends on the determination of the stage.
I have a degree
Disease detection is only possible with frequent blood pressure measurements. Measurements should be performed in a relaxed atmosphere, at least 3 times in a given period.
This is the only way to assess the presence or absence of hypertension. Depending on the degree of increased blood pressure, the clinical picture of the disease varies.
II degree
For stage 2 hypertension, a period of increased pressure is characteristic, alternating with a decrease in the indicator, or an increase only in the diastolic value. With this level of hypertension, there are typical cases of increased pressure in certain conditions, in particular, in patients with unstable nervous systems.
III degree
Stage III hypertension is characterized by a critical increase in blood pressure.
Grade III GB is characterized by severe complications resulting from the harmful effects of high blood pressure on all organs and systems. First of all, the heart, kidneys, eyes, brain are affected. With grade III hypertension, symptoms and treatment are closely related - with inadequate or improper treatment, the disease can lead to serious consequences: stroke, encephalopathy, renal failure, irreversible damage to the eyes, blood vessels. Lack of treatment for grade III hypertension increases the risk of developing isolated systolic hypertension.
At this stage of arterial hypertension, the risk level increases significantly! There are violations of memory, mental activity, frequent loss of consciousness.
Hypertensive crisis occurs as a stage III complication, and is considered stage IV. GB.
risk
Consistent with the classification of hypertension according to stage and degree, patients were divided into risk groups, depending on the severity of hypertension. There are 4 categories (that is, there are as many of them as the degree of hypertension), determined by the principle of probability of damage to internal organs in the future.
Risks by disease stage:
- risk less than 15%;
- risk up to 20%;
- risk 20–30%;
- the risk exceeds 30%.
Low, not important
Low -risk groups include men under the age of 55 and women under the age of 65 with stage I. arterial hypertension. In this group, the risk of cardiovascular disease over a period of up to 10 years is less than 15%. For people in low -risk groups, lifestyle changes are recommended. If non-drug therapy does not show effectiveness within 6-12 months, it is advisable to prescribe medication.
Average
The average risk group included people with Arts I – II. hypertension in the presence of 1-2 risk factors. The risk increases with high weight, smoking, high cholesterol, impaired glucose tolerance, lack of movement. Hereditary factors are also important. The risk of cardiovascular complications in this person is higher, and is 15-20% within 10 years. People who belong to this group are encouraged to maintain a healthy lifestyle. If stress reduction does not occur within 6 months, pharmacotherapy is prescribed.
height
High-risk groups include people I-II Art. hypertension, subject to the presence of at least 3 risk factors, which include:
- diabetes;
- target organ damage;
- atherosclerotic vascular disease;
- left ventricular hypertrophy;
- increased creatinine;
- ocular changes.
This group also includes patients with stage III hypertension who do not have risk factors (risk of cardiovascular disease is 20–30% within 10 years). Representatives of this group are under the supervision of a cardiologist.
Very high
The group of hypertensive patients with a very high risk of cardiovascular disease (more than 30% within 10 years) included those with stage III. hypertension in the presence of at least 1 risk factor. In addition, this group includes patients with stage AH I – II. with the presence of cerebrovascular accidents, ischemia, nephropathy. This group is controlled by a cardiologist and requires active therapy.
Conclusion
The problem of arterial hypertension is that the disease has no typical symptoms and is characterized by a diverse clinical picture. Therefore, often a person is not aware of the presence of the disease. Therefore, high blood pressure is detected incidentally, during examination, or when complications occur. When diagnosing hypertension, it is important to tell the patient correctly that he or she can significantly affect the course of his or her disease by following a healthy lifestyle.