Arterial hypertension is one of the most common cardiovascular diseases, affecting approximately 25% of the adult population. No wonder it is sometimes called a non-communicable epidemic. High blood pressure, along with its complications, significantly affects the mortality of the population. It is estimated that 25% of deaths among people over the age of 40 are caused directly or indirectly by high blood pressure. The likelihood of complications predetermines the stages of high blood pressure. How many stages do high blood pressure have, how are they classified? See below.
Important! According to the latest 1993 estimates from the World Health Organization, high blood pressure in adults is considered to be a sustained 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, according to etiology, high blood pressure is divided into primary and secondary.
The primary organ cause of hypertension (BP) in primary hypertension (EH) is unknown. A combination of genetic factors, external influences, and violations of internal regulatory mechanisms are considered.
External factors:
- Environment;
- excessive calorie intake, development of obesity;
- increased salt intake;
- lack of potassium, calcium, magnesium;
- excessive alcohol consumption;
- recurring stressful situations.
Primary hypertension is the most common hypertension, accounting for 95% of cases.
There are 3 stages of high blood pressure:
- Stage I - high blood pressure without organ changes;
- II. stage - increase in blood pressure with changes in the organs but without disturbing their function (left ventricular hypertrophy, proteinuria, angiopathy);
- III. stage - changes in the organs with impaired 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 disease with an identifiable cause. The classification of secondary arterial hypertension is as follows:
- occurs due to renoparenchymal hypertension - 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;
- drug-induced hypertension;
- high blood pressure during pregnancy - high blood pressure during pregnancy, the condition often returns to normal after childbirth;
- aortic coarctation.
High blood pressure during pregnancy can lead to congenital disease in the child, especially retinopathy. There are 2 phases of retinopathy (premature and full-term babies):
- active - consists of 5 developmental stages, can lead to vision loss;
- cicatricial - leads to clouding of the cornea.
Important! Both stages of retinopathy in premature and adult 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 high blood pressure also predisposes to the degree of dehydration and dehydration. In this case, the classifier is the lack of water in the body.
There are 3 stages of dehydration:
- 1st degree - a slight - 3, 5% deficit; symptoms - dry mouth, strong thirst;
- Grade 2 - medium - deficit - 3-6%; symptoms - sharp pressure fluctuations or pressure drop, tachycardia, oliguria;
- Grade 3 - the third grade is the most severe, characterized by a water shortage of 7-14%; manifested by hallucinations, delusions; clinic - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is performed by introducing solutions:
- 5% glucose + isotonic NaCl (mild);
- 5% NaCl (medium);
- 4. 2% NaHCO3(severe grade).
GB sections
Subjective symptoms, especially in the mild to moderate stages of high blood pressure, are often absent, so an increase in blood pressure is often already at the level of dangerous indicators. The clinical picture is divided into 3 stages. Each stage of arterial hypertension has a characteristic set of symptoms on which the classification of GB is based.
I set the stage
In stage 1 of high blood pressure, the patient complains of headache, fatigue, palpitations, disorientation, and sleep disturbances. In stage 1 AH, the objective heart, ECG, eye background, and laboratory findings are within the normal range.
Section II
In stage 2 AH, subjective complaints are similar, however, signs of left ventricular hypertrophy, retinal hypertensive angiopathy, and urinary microalbuminuria or proteinuria. Occasionally, an increase in red blood cells is observed in the urine sediment. There are no symptoms of kidney failure in stage 2 high blood pressure.
Section III
Hypertension III. stage are diagnosed with functional disorders in organs at increased risk of hypertension:
- heart damage - first manifested by shortness of breath and then - symptoms of heart asthma or pulmonary edema;
- vascular complications - damage to peripheral and coronary arteries, risk of cerebral atherosclerosis;
- fundus changes - hypertensive retinopathy, neuroretinopathy;
- changes in the blood vessels of the brain - manifested by transient ischemic attacks, typical thrombotic or haemorrhagic vascular strokes;
- a III. stage of cerebral stroke, brain lesions are diagnosed in almost all patients;
- benign nephrosclerosis of the kidneys - leads to limited glomerular filtration, increased proteinuria, erythrocytosis, hyperuricemia, and later chronic renal failure.
Which stage or degree of high blood pressure is most dangerous? Despite the variety of symptoms, all stages and degrees of arterial hypertension require dangerous, appropriate systemic or symptomatic treatment.
degrees
According to the blood pressure (blood pressure) indicators determined at the time of diagnosis, there are 3 degrees of high blood pressure:
- light;
- average;
- hard.
There is also a concept 4 - the definition of resistant hypertension, in which even if the right combination of antihypertensive drugs is chosen, blood pressure does not fall below 140/90 mmHg. Art.
A clearer overview of the degrees of arterial hypertension can be found in the table.
Classification of hypertension and stratification of normal blood pressure according to ESH / ESC Guidelines 2007.
| Category | Systolic Pressure, Hgmm Art. | Diastolic pressure, Hgmm Art. |
|---|---|---|
| Optimal | < 120 | < 80 |
| Normal | 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 patient's difficulties vary according to the degree distribution of hypertension. The choice of treatment regimen depends on the extent of the disease.
my education
The disease can only be detected by regular blood pressure measurements. Measurements should be made in a relaxed atmosphere at least 3 times over a period of time.
This is the only way to assess the presence or absence of high blood pressure. Depending on the extent of the increase in blood pressure, the clinical picture of the disease is different.
Grade II
Grade 2 hypertension is characterized by periods of increased pressure, alternating with decreasing rates or increasing diastolic values only. Elevated blood pressure at this level is characterized by increased pressure under certain conditions, especially in patients with an unstable nervous system.
Grade III
Grade III hypertension is characterized by a critical increase in blood pressure.
Grade III GB is characterized by severe complications resulting from the detrimental effects of hypertension on all organs and systems. First, the heart, kidneys, eyes, brain are affected. A III. In case of high blood pressure, the symptoms and treatment are closely related - in case of insufficient or inadequate treatment, the disease can have serious consequences: stroke, brain disease, kidney failure, irreversible damage to the eyes and blood vessels. A III. lack of treatment for grade 2 hypertension increases the risk of developing isolated systolic hypertension.
At this stage of arterial hypertension, the risk increases significantly! There are violations of memory, mental activity, frequent loss of consciousness.
The hypertensive crisis in the III. occurs as a complication of stage IV, and IV. GB.
Risks
According to the classification of hypertension by stages and grades, patients are divided into risk groups depending on the severity of the hypertension. There are 4 categories (i. e. , as many of them as the degree of hypertension) that are defined by the principle of probability of future damage to internal organs.
Risks depending on the severity of the disease:
- risk less than 15%;
- risk up to 20%;
- risk 20-30%;
- the risk is more than 30%.
Low, insignificant
The low-risk group includes men under 55 and women under 65 in stage I. arterial hypertension. In this group, the risk of cardiovascular disease up to the age of 10 is less than 15%. Lifestyle changes are recommended for those in the low-risk group. If non-drug therapy does not work within 6 to 12 months, it is advisable to prescribe medication.
Average
The average risk group is classified as I-II. hypertension in the presence of 1-2 risk factors. The risk increases with high body weight, smoking, high cholesterol, decreased glucose tolerance, and lack of exercise. Hereditary factors are also important. The risk of cardiovascular complications is higher in these people, 15-20% within 10 years. People in this group are encouraged to maintain a healthy lifestyle. If the hypotension does not occur within 6 months, pharmacotherapy is prescribed.
High
The high-risk group includes I-II. hypertension, depending on the presence of at least 3 risk factors, including:
- diabetes;
- target organ damage;
- vascular atherosclerotic diseases;
- left ventricular hypertrophy;
- increased creatinine;
- eye changes.
This group includes those in Annex III. patients with stage I hypertension who do not have a risk factor (20-30% risk of cardiovascular disease in 10 years). Representatives of this group are under the supervision of a cardiologist.
Very high
In the group of hypertensive patients with a very high risk of cardiovascular disease (more than 30% within 10 years), III. hypertension in the presence of at least 1 risk factor. In addition, patients in stage AH I-II are included in this group. in the presence of cerebrovascular accident, ischemia, nephropathy. This group is led 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, often a person is unaware of the presence of the disease. Therefore, hypertension is inadvertently detected during the study or when complications occur. When diagnosing high blood pressure, it is important to properly inform the patient that following a healthy lifestyle can significantly affect the course of their disease.