Arterial hypertension is one of the most common heart and blood vessel diseases, affecting about 25% of adults. No wonder it is sometimes called a non-communicable epidemic. Hypertension and its complications significantly affect mortality in the population. Estimates suggest that up to 25% of deaths in people over the age of 40 are directly or indirectly caused by high blood pressure. The likelihood of complications predetermines the stage of hypertension. There are several stages of hypertension and how are they classified? as follows.
important! According to the latest estimates from the World Health Organization in 1993, hypertension in adults is considered to be a sustained increase in blood pressure to 140/90 mmHg. Art.
Classification of arterial hypertension, determination of disease risk
According to the World Health Organization, hypertension is divided into primary and secondary based on etiology.
In essential (essential) hypertension (EH), the primary organic cause of elevated blood pressure (BP) is unknown. Consider a combination of genetic factors, external influences, and violations of internal regulatory mechanisms.
External factor:
- environment;
- Excessive consumption of calories, the development of obesity;
- increase salt intake;
- Lack of potassium, calcium, magnesium;
- excessive drinking;
- Repeated stress situations.
Essential hypertension is the most common form of hypertension, accounting for about 95%.
Hypertension is divided into 3 stages:
- Stage 1 - high blood pressure without organ changes;
- Stage II - blood pressure increases with changes in organs without disrupting their function (left ventricular hypertrophy, proteinuria, vascular disease);
- Stage III - changes of the organ, accompanied by the destruction of its function (left heart failure, hypertensive encephalopathy, stroke, hypertensive retinopathy, renal failure).
Secondary (symptomatic) hypertension is an increase in blood pressure that is a symptom of an underlying disorder with an identifiable cause. Secondary hypertension is classified as follows:
- Renal parenchymal hypertension - occurs due to renal disease; causes: renal parenchymal disease (glomerulonephritis, pyelonephritis), tumor, renal injury;
- Renovascular hypertension - stenosis of the renal arteries caused by fibromuscular dysplasia or atherosclerosis, renal vein thrombosis;
- Endocrine hypertension - primary aldosteronism (Con's syndrome), hyperthyroidism, pheochromocytoma, Cushing's syndrome;
- drug-induced hypertension;
- Gestational hypertension - high blood pressure during pregnancy, after delivery, the condition often returns to normal;
- Coarctation of the aorta.
Hypertension during pregnancy can lead to congenital disorders in children, especially retinopathy. There are 2 stages of retinopathy (preterm and term):
- Active - consists of 5 stages of development that can lead to vision loss;
- Keloid - Causes clouding of the cornea.
important! Both stages of retinopathy of prematurity and term lead to anatomical disturbances!
Hypertensive disorders according to the international system (according to ICD-10):
- Primary form - I10;
- Minor Form - I15.
The degree of high blood pressure also predetermines the degree of dehydration -- dehydration. In this case, the classifier is the lack of water in the body.
There are 3 levels of dehydration:
- Grade 1 - mild - deficiency 3. 5%; symptoms - dry mouth, thirst;
- Grade 2 - Moderate - Deficient - 3-6%; Symptoms - sharp fluctuations in pressure or drop in pressure, tachycardia, oliguria;
- Grade 3 - Grade 3 is the most severe and is characterized by 7-14% dehydration; hallucinations, delusions; clinical - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is performed by introducing a solution:
- 5% glucose + isotonic NaCl (mild);
- 5% sodium chloride (medium);
- 4. 2% sodium bicarbonate3(severity).
GB stage
Subjective symptoms, especially in mild and moderate stages of hypertension, are often absent, so elevated blood pressure is often found already at the level of risk indicators. Clinical manifestations are divided into 3 stages. Each stage of arterial hypertension has a typical symptom on which the GB classification is based.
i stage
In the first stage of hypertension, patients complain of headache, fatigue, palpitations, disorientation, and sleep disturbance. In stage AH 1, objective results of cardiac, ECG, ocular background, and laboratory tests were within normal limits.
Phase II
In stage AH 2, the subjective complaints were similar, along with signs of left ventricular hypertrophy, retinal signs of hypertensive vasculopathy, and microalbuminuria or proteinuria in the urine. Sometimes there is red blood cell proliferation in the urine sediment. In stage 2 hypertension, there are no symptoms of renal failure.
The third phase
In stage III hypertension, dysfunction is diagnosed in organs at increased risk of hypertension:
- damage to the heart - first manifested as shortness of breath, then - symptoms of cardiac asthma or pulmonary edema;
- Vascular complications - peripheral and coronary artery damage, risk of cerebral atherosclerosis;
- Fundus changes - with features of hypertensive retinopathy, neuroretinopathy;
- Cerebrovascular changes - manifested as transient ischemic attack, typically thrombotic or hemorrhagic vascular stroke;
- In stage III, stroke, brain injury is diagnosed in almost all patients;
- Benign nephrosclerosis of renal vessels - leading to restricted glomerular filtration, increased proteinuria, polycythemia, hyperuricemia, and later - leading to chronic renal failure.
What stage or degree of high blood pressure is most dangerous? Despite the various symptoms, all stages and degrees of arterial hypertension are dangerous and they require appropriate systemic or symptomatic treatment.
degree
According to the blood pressure (blood pressure) indicators determined at the time of diagnosis, there are 3 degrees of hypertension:
- Light;
- Average;
- Heavy.
There is also a fourth concept - the definition of resistant (persistent) hypertension, where blood pressure does not fall below 140/90 mm Hg even with an appropriate combination of antihypertensive drugs. Art.
A clearer overview of the degree of arterial hypertension is provided in the table.
Hypertension classification and normotensive stratification according to the 2007 ESH/ESC guidelines.
| category | Systolic blood pressure, mmHg Art. | Diastolic blood pressure, mmHg Art. |
|---|---|---|
| optimal | < 120 | < 80 |
| normal | 120–129 | 80–84 |
| increase 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 degree of difficulty of the patient varies according to the degree of classification of hypertension. The choice of disease treatment regimen depends on the degree of determination.
my degree
The disease can only be detected by measuring blood pressure regularly. The measurement should be carried out in a relaxed atmosphere, with at least 3 measurements within a certain period of time.
This is the only way to assess the presence of high blood pressure. The clinical presentation of the disease varies according to the degree of blood pressure elevation.
secondary
For grade 2 hypertension, periods of elevated pressure are characteristic, alternating with lower markers, or only elevated diastolic blood pressure. With this degree of hypertension, the classic case of elevated pressure occurs in some cases, especially in patients with neurological instability.
Ⅲ degree
Degree III hypertension is characterized by a sharp rise in blood pressure.
Grade III GB is characterized by the deleterious effects of hypertension on all organs and systems leading to serious complications. First, the heart, kidneys, eyes, brain are affected. Closely related to class III hypertension, symptoms and treatment - if treatment is inadequate or inappropriate, 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 isolated systolic hypertension.
At this stage of arterial hypertension, the degree of risk increases significantly! There are violations of memory, mental activity, and frequent loss of consciousness.
Hypertensive crisis is a complication of stage III and is considered stage IV. National standard.
risk
According to the classification of hypertension stage and degree, patients were divided into risk groups according to the severity of hypertension. There are 4 categories (i. e. , how much is as much as the degree of hypertension), determined by the principle of the probability of future damage to internal organs.
Risk according to the extent of the disease:
- Risk is less than 15%;
- Risk up to 20%;
- Risk 20–30%;
- The risk is over 30%.
low, insignificant
The low-risk group includes men under 55 and stage I women under 65. Arterial hypertension. In this group, the risk of cardiovascular disease up to 10 years was less than 15%. For low-risk groups, lifestyle changes are recommended. Medications are recommended if non-pharmacological treatments do not show results within 6-12 months.
Average
The average risk group included people with I-II arts. Hypertension with 1-2 risk factors. High body weight, smoking, high cholesterol, impaired glucose tolerance, and physical inactivity increase the risk. Genetic factors are also important. These individuals have a higher risk of cardiovascular complications, 15-20% over 10 years. Those who belong to this group are encouraged to maintain a healthy lifestyle. Medications are prescribed if no reduction in pressure occurs within 6 months.
High
High-risk groups include the I-II art population. High blood pressure, which is influenced by at least 3 risk factors, including:
- diabetes;
- target organ damage;
- atherosclerotic vascular disease;
- left ventricular hypertrophy;
- increased creatinine;
- eye changes.
This group also included patients with stage III hypertension without risk factors (20-30% risk of cardiovascular disease within 10 years). Representatives of this group are under the supervision of a cardiologist.
very high
Hypertensive patients at very high risk of cardiovascular disease (more than 30% over 10 years) include stage III patients. Hypertension with at least 1 risk factor. In addition, this group included patients with AH stages I-II. In the presence of cerebrovascular accident, ischemia, renal disease. This group is controlled by a cardiologist and requires aggressive treatment.
in conclusion
The problem with arterial hypertension is that the disease has no typical symptoms and is characterized by different clinical manifestations. As a result, people are often unaware of the existence of the disease. Therefore, hypertension is detected incidentally during the examination or when complications arise. When diagnosing hypertension, it is important to properly inform the patient that by following a healthy lifestyle, he can significantly influence the course of the disease.