Arterial hypertension is one of the most common diseases of the heart and blood vessels, affecting approximately 25% of the adult population. No wonder it is sometimes referred to as a non-contagious epidemic. Hypertension with its complications significantly affects the mortality of the population. It is estimated 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 determines the stages of hypertension. How many stages does high blood pressure have, how are they classified? See below.
Important! According to the latest estimates by the World Health Organization from 1993, high blood pressure in adults is defined as a persistent increase in blood pressure of up to 140/90 mm Hg. Art.
Classification of arterial hypertension, determination of the degree of risk of the disease
According to the WHO, hypertension is divided into primary and secondary hypertension depending on the etiology.
In primary (essential) hypertension (EH), the main organic cause of the elevated blood pressure (BP) is unknown. A combination of genetic factors, external influences and violations of internal regulatory mechanisms is taken into account.
External factors:
- Vicinity;
- excessive consumption of calories, development of obesity;
- increased salt intake;
- lack of potassium, calcium, magnesium;
- excessive alcohol consumption;
- repetitive stressful situations.
Primary hypertension is the most common type of hypertension, accounting for about 95% of cases.
There are 3 stages of high blood pressure:
- Stage I - hypertension without organ changes;
- Stage II - an increase in blood pressure with changes in the organs, but without disrupting their functioning (left ventricular hypertrophy, proteinuria, angiopathy);
- Stage III - changes in organs, accompanied by a violation of their function (left ventricular failure, hypertensive encephalopathy, stroke, hypertensive retinopathy, renal failure).
Secondary (symptomatic) hypertension is an increase in blood pressure that is a symptom of an underlying condition with an identifiable cause. The classification of arterial hypertension of the secondary form is as follows:
- renoparenchymal hypertension - occurs due to kidney disease; Causes: renal parenchymal disease (glomerulonephritis, pyelonephritis), tumors, kidney damage;
- renovascular hypertension - narrowing of the renal arteries due to fibromuscular dysplasia or atherosclerosis, renal vein thrombosis;
- endocrine hypertension - primary hyperaldosteronism (Conn's syndrome), hyperthyroidism, pheochromocytoma, Cushing's syndrome;
- high blood pressure caused by medication;
- Gestational hypertension - high blood pressure during pregnancy, after childbirth the condition often returns to normal;
- coarctation of the aorta.
Gestational hypertension can lead to congenital diseases in the child, especially retinopathy. There are 2 phases of retinopathy (premature and term babies):
- active - consists of 5 stages of development, can lead to loss of vision;
- cicatricial - leads to clouding of the cornea.
Important! Both stages of retinopathy in premature and full-term babies lead to anatomical disorders!
Hypertensive disease according to the international system (according to ICD-10):
- primary 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:
- Grade 1 - mild - lack of 3. 5%; Symptoms - dry mouth, severe thirst;
- grade 2 - medium - deficiency - 3-6%; symptoms - sharp pressure fluctuations or pressure drops, tachycardia, oliguria;
- Degree 3 - the third degree is the most severe, characterized by a lack of water of 7-14%; manifested by hallucinations, delusions; Clinic - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is carried out by introducing solutions:
- 5% glucose + isotonic NaCl (mild);
- 5% NaCl (medium);
- 4. 2% NaHCO3(heavy grade).
GB levels
Subjective symptoms, especially in the mild and moderate stages of hypertension, are often absent, so an increase in blood pressure is often detected already at the level of dangerous indicators. The clinical picture is divided into 3 stages. Each stage of arterial hypertension has a typical symptomatology on which the GB classification is based.
I direct
In the first stage of hypertension, the patient complains of headaches, tiredness, tachycardia, disorientation and sleep disorders. In stage 1 AH there are objective findings on the heart, ECG, fundus of the eye, laboratory tests in the normal range.
Stage II
In stage 2 AH, the subjective complaints are similar, at the same time there are signs of left ventricular hypertrophy, there are signs of hypertensive angiopathy on the retina and microalbuminuria or proteinuria in the urine. Sometimes there is an increase in red blood cells in the urine sediment. In stage 2 hypertension, there are no symptoms of renal insufficiency.
III. stage
With stage III hypertension, functional disorders in organs that have an increased risk of hypertension are diagnosed:
- Damage to the heart - first manifested 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 - manifested by transient ischemic attacks, typical thrombotic or hemorrhagic vascular strokes;
- at stage III, stroke, brain lesions are diagnosed in almost all patients;
- benign nephrosclerosis of the renal vessels - leads to a reduction in glomerular filtration, an increase in proteinuria, erythrocytosis, hyperuricemia, and later - to chronic renal failure.
Which stage or degree of hypertension is most dangerous? Despite the variety of symptoms, all stages and degrees of arterial hypertension are dangerous and require appropriate systemic or symptomatic treatment.
Degree
In accordance with the indicators of blood pressure (blood pressure) determined at the time of diagnosis, there are 3 degrees of hypertension:
- bright;
- Average;
- difficult.
There is also a fourth concept - the definition of resistant (persistent) hypertension, in which blood pressure does not drop below 140/90 mm Hg even with the correct choice of a combination of antihypertensive drugs. Art.
A clearer overview of the degrees of arterial hypertension is presented in the table.
Classification of hypertension and stratification of normal blood pressure according to the 2007 ESH/ESC guidelines.
| category | Systolic pressure, mm HgArt. | Diastolic pressure, mmHgArt. |
|---|---|---|
| Optimal | < 120 | < 80 |
| normal | 120-129 | 80-84 |
| Increased normally | 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 patient's difficulty varies according to the grading of hypertension. The choice of treatment regimen for the disease depends on determining the degree.
me right now
The disease can only be detected with regular blood pressure measurements. The measurements should be carried out in a relaxed atmosphere at least 3 times in a certain period of time.
This is the only way to assess the presence or absence of hypertension. Depending on the degree of blood pressure increase, the clinical picture is different.
II degree
For the 2nd degree of hypertension, periods of increased pressure are characteristic, alternating with a decrease in indicators or an increase in only the diastolic value. At this level of hypertension, typical cases of increased pressure may occur, particularly in patients with an unstable nervous system.
III. Degree
hypertension III. Grade is characterized by a critical rise in blood pressure.
GB grade III is characterized by severe complications resulting from the harmful effects of hypertension 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 insufficient or improper treatment, the disease can lead to serious consequences: stroke, encephalopathy, kidney failure, irreversible damage to the eyes, blood vessels. The lack of treatment for grade III hypertension increases the risk of developing isolated systolic hypertension.
At this stage of arterial hypertension, the risk increases significantly! There are memory disorders, mental activity, frequent loss of consciousness.
Hypertensive crisis occurs as a stage III complication and is referred to as stage IV. GB.
risks
According to the classification of high blood pressure by stages and grades, patients are divided into risk groups depending on the severity of the high blood pressure. There are 4 categories (i. e. there are as many as degrees of hypertension), which are determined by the principle of the probability of future damage to internal organs.
Risks depending on the degree of the disease:
- risk 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 years of age and women under 65 years of age with stage I arterial hypertension. In this group, the risk of cardiovascular disease is less than 15% over a period of up to 10 years. Lifestyle changes are recommended for people in the low-risk group. If non-drug therapy does not show an effect within 6–12 months, it is advisable to prescribe medication.
Average
The group of average risk includes people with I-II art. Hypertension in the presence of 1-2 risk factors. The risk increases with high body weight, smoking, high cholesterol levels, impaired glucose tolerance, and lack of exercise. Hereditary factors are also important. The risk of cardiovascular complications is higher in these people and is 15-20% within 10 years. People belonging to this group are encouraged to maintain a healthy lifestyle. If there is no reduction in pressure within 6 months, pharmacotherapy is prescribed.
Large
The risk group includes people I-II Art. High blood pressure, provided that at least 3 risk factors are present, including:
- Diabetes;
- target organ damage;
- atherosclerotic vascular diseases;
- left ventricular hypertrophy;
- increased creatinine;
- eye changes.
This group also includes stage III hypertensive patients who have no risk factors (the risk of cardiovascular disease is 20-30% over 10 years). Representatives of this group are under the supervision of a cardiologist.
Very large
The group of hypertensive patients with a very high risk of cardiovascular disease (over 30% within 10 years) includes people in stage III. Hypertension in the presence of at least 1 risk factor. In addition, this group includes patients in stage AH I–II. in cerebrovascular accident, ischemia, nephropathy. This group is controlled by cardiologists and requires active therapy.
Conclusion
The problem with arterial hypertension is that the disease has no typical symptoms and is characterized by a diverse clinical picture. Therefore, a person is often unaware of the presence of the disease. Therefore, high blood pressure is detected incidentally, during the examination, or when complications arise. When diagnosing high blood pressure, it is important to properly inform the patient that a healthy lifestyle can have a significant impact on the course of the disease.