Arterial hypertension is one of the most common cardiovascular diseases and affects about 25% of the adult population. Not surprisingly, it is sometimes called a non-infectious epidemic. It has a significant impact on the mortality of the population with the complications of high blood pressure. Estimates show that up to 25% of deaths in people over the age of 40 are caused directly or indirectly by hypertension. The likelihood of complications predetermines the stages of hypertension. How many stages does hypertension consist of, and how are they classified? See below.
It is important! According to the latest estimates of the World Health Organization since 1993, hypertension in adults is considered a steady increase in blood pressure 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 the etiology, hypertension is classified as primary and secondary.
The underlying organic cause of the increase in blood pressure (BP) in primary hypertension (EH) is unknown. The combination of genetic factors, external influences and disruption of internal regulatory mechanisms is taken into account.
External factors:
- Environment;
- excessive calorie intake, the development of obesity;
- increased salt intake;
- potassium, calcium, magnesium deficiency;
- excessive alcohol consumption;
- recurrent stressful situations.
Primary hypertension is the most common hypertension and accounts for about 95% of cases.
There are 3 stages of hypertension:
- Stage I - high blood pressure without changes in the organs;
- Stage II - increase in blood pressure with changes in the organs, but without disrupting their function (hypertrophy of the left ventricle, proteinuria, angiopathy);
- Stage III - changes in the organs accompanied by dysfunction (left heart failure, hypertensive encephalopathy, stroke, hypertensive retinopathy, renal failure).
Secondary (symptomatic) hypertension is an increase in blood pressure as a symptom of the underlying disease for an identifiable reason. The classification of secondary arterial hypertension 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 with fibromuscular dysplasia or atherosclerosis, thrombosis of the renal vessels;
- endocrine hypertension - primary hyperaldosteronism (Conn's syndrome), hyperthyroidism, pheochromocytoma, Cushing's syndrome;
- drug-induced hypertension;
- gestational hypertension - high blood pressure during pregnancy, the condition often returns to normal after birth;
- coarctation of the aorta.
Gestational hypertension can lead to congenital diseases of the child, especially retinopathy. There are 2 stages of retinopathy (premature and full-term infants):
- active - consists of 5 stages of development, can cause vision loss;
- cicatricial - leads to cloudiness of the cornea.
It is important! Both stages of premature and full-term retinopathy in infants lead to anatomical abnormalities!
Hypertensive disease according to the international system (according to ICD-10):
- primary form - I10;
- secondary form - I15.
Degrees of hypertension also predetermine the degree of dehydration - dehydration. The classification in this case is the lack of water in the body.
There are 3 degrees of thirst:
- degree 1 - mild - lack of 3, 5%; symptoms - dry mouth, severe thirst;
- degree 2 - moderate - deficiency - 3-6%; symptoms - sharp fluctuations in blood pressure or decrease in blood pressure, tachycardia, oliguria;
- Grade 3 - the third degree is the most severe, characterized by a lack of water of 7-14%; manifests itself with hallucinations, delusions; clinic - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is carried out with the application of solutions:
- 5% glucose + isotonic NaCl (soft);
- 5% NaCl (medium);
- 4, 2% NaHCO3(severe degree).
GB stages
Subjective symptoms are often absent, especially in the mild and moderate stages of hypertension, so an increase in blood pressure is often already detected at the level of dangerous indicators. The clinical picture is divided into 3 stages. Each stage of arterial hypertension has a typical symptomatology, based on the classification of GB.
i scene
In the first stage of hypertension, the patient complains of headaches, fatigue, palpitations, impaired orientation, sleep disturbances. In the 1st stage of AH, the heart, ECG, objective findings in the background of the eye, laboratory tests are within the norm.
Phase II
Subjective complaints in stage 2 AH are similar, with signs of left ventricular hypertrophy, signs of hypertonic angiopathy in the retina, and microalbuminuria or proteinuria in the urine. Sometimes there is an increase in red blood cells in the urine. There are no symptoms of renal failure in stage 2 hypertension.
Phase III
In stage III hypertension, functional disorders are diagnosed in organs at high risk of hypertension:
- damage to the heart - first manifests itself with 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 - hypertensive retinopathy, neuroretinopathy;
- changes in cerebral blood vessels - manifested by transient ischemic attacks, typical thrombotic or hemorrhagic strokes;
- In stage III, almost all patients are diagnosed with cerebral stroke, brain lesions;
- benign nephrosclerosis of the renal vessels - leads to limited glomerular filtration, increased proteinuria, erythrocytosis, hyperuricemia, and then chronic renal failure.
Which stage or degree of hypertension is the most dangerous? Despite the various symptoms, all stages and degrees of arterial hypertension are dangerous and require 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 hypertension:
- light;
- average;
- heavy.
There is also a 4th concept - the definition of resistant (persistent) hypertension, even with the correct choice of a combination of antihypertensive drugs, blood pressure does not fall below 140/90 mm Hg. Art.
A clearer overview of arterial hypertension rates is presented in the table.
Classification of hypertension and normal blood pressure stratification according to ESH / ESC Guidelines 2007.
| category | Systolic pressure, mm HgArt. | Diastolic pressure, mm HgArt. |
|---|---|---|
| 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 | More than 180 | Above 110 |
| Isolated systolic hypertension | Above 140 | Less than 90 |
The patient's difficulties vary according to the classification of hypertension. The choice of treatment regimen for the disease depends on the degree.
I degree
Detection of the disease is possible only with regular measurement of blood pressure. Measurements should be made in a comfortable atmosphere at least 3 times in a given period of time.
This is the only way to assess the presence or absence of hypertension. The clinical picture of the disease is different depending on the degree of increase in blood pressure.
II degree
Grade 2 hypertension is characterized by periods of increasing pressure that vary with a decrease in values or an increase in diastolic value only. With this degree of hypertension, there are typical cases of increased blood pressure in certain conditions, especially in patients with unstable nervous system.
III degree
Grade 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 and brain are affected. Symptoms and treatment of grade III hypertension 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 increases significantly! There are memory disorders, mental activity, often loss of consciousness.
Hypertensive crisis occurs as a complication of stage III and is considered stage IV. GB.
Risks
According to the classification of hypertension by stages and degrees, patients are divided into risk groups depending on the severity of hypertension. There are 4 categories defined by the principle of probability of damage to internal organs in the future (ie there are as many of them as the degree of hypertension).
Risks depending on the degree of the disease:
- the risk is 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 the age of 55 and women under the age of 65 with stage I. arterial hypertension. In this group, the risk of cardiovascular disease under the age of 10 is less than 15%. Lifestyle changes are recommended for people at low risk. If non-drug therapy does not show effectiveness within 6-12 months, it is recommended to prescribe medication.
Medium
The medium risk group 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, impaired glucose tolerance, lack of exercise. Hereditary factors are also important. These people have a higher risk of cardiovascular complications and are 15-20% over 10 years. People in this group are encouraged to lead a healthy lifestyle. If the decrease in blood pressure does not occur within 6 months, pharmacotherapy is prescribed.
He is tall
High-risk group I-II Art. Hypertension, provided there are at least 3 risk factors, includes:
- diabetes;
- target organ damage;
- atherosclerotic vascular diseases;
- left ventricular hypertrophy;
- increased creatinine;
- eye changes.
This group also includes patients with stage III hypertension without risk factors (the risk of cardiovascular disease is 20-30% over 10 years). Representatives of this group are under the supervision of a cardiologist.
It's too high
The group of hypertensive patients with a very high risk of cardiovascular disease (more than 30% in 10 years) includes people with stage III. hypertension in the presence of at least 1 risk factor. In addition, this group includes patients with stage AH I-II. When cerebrovascular accident, ischemia, nephropathy. This group is managed by cardiologists and requires active therapy.
The result
The problem of arterial hypertension is the absence of typical symptoms of the disease and its different clinical picture. Therefore, often a person is not aware of the presence of the disease. Therefore, high blood pressure is detected accidentally, during the examination or in case of complications. When diagnosing hypertension, it is important to properly inform the patient that a healthy lifestyle can have a significant impact on the course of the disease.