Arterial hypertension belongs to the most common diseases of the heart and blood vessels, affecting about 25% of the adult population.No wonder it is sometimes mentioned as a non -infectious epidemic.High blood pressure with its complications significantly affects the mortality of the population.Estimates show that up to 25% of deaths of people over 40 years of age are directly or indirectly caused by hypertension.The probability of complications determines the stages of hypertension.How many stages does hypertension have, how are they classified?Look below.
Important!According to the latest estimates by the World Health Organization of 1993, hypertension in adults is 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
In WHO, according to etiology, hypertension is classified into primary and secondary.
With the primary (essential) hypertension (GB), the main organic cause of increasing blood pressure (blood pressure) is unknown.A combination of genetic factors, external influences and violations of internal regulatory mechanisms is taken into account.
External factors:
- environment;
- excessive use of calories, the development of obesity;
- Increased salt consumption;
- lack of potassium, calcium, magnesium;
- excessive drinking;
- Repeating stressful situations.
Primary hypertension is the most common hypertension, in approximately 95% of cases.
3 stages of hypertension are separated:
- Stage I - increased blood pressure without changes in organs;
- Stage II - an increase in blood pressure with changes in organs, but without impaired their function (hypertrophy of the left ventricle, proteinuria, angiopathy);
- Stage III - organs accompanied by impaired function (left heart failure, hypertensive encephalopathy, stroke, hypertonic retinopathy, renal failure).
Secondary (symptomatic) hypertension is an increase in blood pressure as a symptom of the underlying disease with the identified cause.Classification of secondary arterial hypertension is as follows:
- Renoparechymal hypertension - occurs due to kidney disease;Reasons: renal parenchymal disease (glomerulonephritis, pyelonephritis), tumors, kidney damage;
- renovascular hypertension - narrowing of the renal arteries with fibromoscular dysplasia or atherosclerosis, renal vein thrombosis;
- Endocrine hypertension - primary hyperaldosteronism (Conn's syndrome), hyperthyroidism, pheochromocytoma, Kushing syndrome;
- hypertension caused by drugs;
- Gestational hypertension - high pressure during pregnancy, after childbirth, the condition is often normalized;
- Coarctation of the aorta.
Gestational hypertension can lead to congenital diseases of the child, in particular, retinopathy.2 phases of retinopathy (premature and full -term kids) are separated::
- active - consists of 5 stages of development, can lead to loss of vision;
- Rubts - leads to clouding of the cornea.
Important!Both stages of retinopathy of premature and full -term children lead to anatomical disorders!
Hypertensive disease according to the international system (according to ICD-10):
- Primary form - i10;
- Secondary form - i15.
The degrees of hypertension also determine the degree of dehydration - dehydration.In this case, the classifier is a lack of water in the body.
Share 3 degrees of dehydration:
- degree 1 - light - lack of 3.5%;Symptoms - dry mouth, severe thirst;
- degree 2 - average - deficiency - 3-6%;Symptoms - sharp fluctuations in pressure or pressure reduction, tachycardia, oliguria;
- degree 3 - the third degree is the most severe, characterized by a lack of 7-14% of water;manifests itself with hallucinations, delirium;Clinic - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is carried out by introducing solutions:
- 5% glucose + isotonic NACL (mild degree);
- 5% NACL (average degree);
- 4.2% Nahco3(severe degree).
Stages of GB
Subjective symptoms, especially with the mild and moderate stage of hypertension, are often absent, so an increase in blood pressure is often found at the level of dangerous indicators.The clinical picture is divided into 3 stages.Each stage of arterial hypertension has typical symptoms, from which the classification of GB comes.
Stage I
At 1 stage of hypertension, the patient complains of headache, fatigue, rapid heartbeat, disorientation, sleep disturbance.At 1 stage of GB, objective detection on the heart, ECG, eye background, in laboratory studies are present within the normal range.
Stage II
At the 2nd Stages of AH, subjective complaints are similar, at the same time there are signs of hypertrophy of the left ventricle, there are signs of hypertensive angiopathy on the retina, microalbuminuria or proteinuria in the urine.Sometimes there is a multiplication of red blood cells in the precipitation of urine.At 2 stages of hypertension, symptoms of renal failure are absent.
Stage III
With hypertension of the III stage, functional disorders are diagnosed in organs belonging to an increased degree of risk for hypertension:
- Damage to the heart - in the beginning, shortness of breath is manifested, then - symptoms of heart asthma or pulmonary edema;
- vascular complications - damage to the peripheral and coronary arteries, the risk of atherosclerosis of the brain;
- Changes on the fundus - have the nature of hypertensive retinopathy, neuroretinopathy;
- Changes in cerebral blood vessels are manifested by transient ischemic bouts, typical thrombotic or hemorrhagic vascular strokes;
- At stage III, a brain stroke, brain lesions are diagnosed in almost all patients;
- benign nephrosclerosis of the kidney vessels - leads to limiting glomerular filtration, an increase in proteinuria, red blood cells, hyperuricemia, and later to chronic renal failure.
Which stage or degree of hypertension is the most dangerous?Despite various symptoms, all stages and degrees of arterial hypertension are dangerous, they require appropriate systemic or symptomatic treatment.
Degree
In accordance with the indicators of blood pressure (blood), determined at the time of diagnosis, 3 degrees of hypertension are distinguished:
- light;
- average;
- heavy.
There is also a 4th concept-the determination of resistant (persistent) hypertension, in which even with the proper choice of a combination of antihypertensive drugs, blood pressure indicators are not reduced below 140/90 mm Hg.Art.
A more clear overview of the degrees of arterial hypertension is presented in the table.
Classification AG and stratification of normal blood pressure according to ESH/ESC Guidelines 2007.
| Category | Systolic pressure, mm Hg.Art. | Diastolic pressure, mm Hg.Art. |
|---|---|---|
| Optimal | <120 | <80 |
| Normal | 120–129 | 80–84 |
| Increased normal | 130–139 | 85–89 |
| 1 degree | 140–159 | 90–99 |
| 2 degree | 160–179 | 100–109 |
| 3 degree | more than 180 | more than 110 |
| Isolated systolic hypertension | more than 140 | less than 90 |
The patient’s difficulties vary in accordance with the separation of hypertension into degrees.The choice of the treatment regimen of the disease depends on the determination of the degree.
I degree
The disease can only be detected with regular measurement of blood pressure.Measurements should be carried out in a relaxed environment, at least 3 times in a certain period.
This is the only way to assess the presence or absence of hypertension.Depending on the degree of increase in blood pressure, the clinical picture of the disease differs.
II degree
The 2nd degree of hypertension is characterized by periods of increased pressure alternating with a decrease in indicators, or an increase in only diastolic value.In this extent, hypertension, cases of increasing pressure in certain circumstances are typical, in particular in patients with an unstable nervous system.
III degree
III degree of AG is characterized by a critical increase in blood pressure.
The III degree of GB is characterized by severe complications that arise as a result of the harmful effects of high blood pressure on all organs and systems.First of all, the heart, kidneys, eyes, brain are affected.With hypertension of the III degree, symptoms and treatment are closely associated - with insufficient or improper treatment, the disease can lead to serious consequences: stroke, encephalopathy, renal failure, irreversible eye lesions, blood vessels.The lack of treatment for III degree of hypertension increases the risk of isolated systolic hypertension.
At this stage of arterial hypertension, the degree of risk increases significantly!Disorders of memory, mental activity, frequent loss of consciousness are manifested.
Hypertonic crisis arises as a complication of the III century, and is considered IV Art.GB.
Risks
In accordance with the classification of hypertension due to stages and degrees, patients are divided into risk groups, depending on the severity of AG.4 categories are distinguished (that is, there are as many of them as the degrees of hypertension), which are determined by the principle of the probability of damage to the internal organs in the future.
Risks on the degree of disease:
- risk less than 15%;
- risk up to 20%;
- risk 20-30%;
- The risk is above 30%.
Low, insignificant
A low risk group includes men up to 55 years of age and women to 65 years of age from I Art.arterial hypertension.In this group, the risk of cardiovascular pathology in the period up to 10 years is less than 15%.People belonging to a low risk group are recommended to change the lifestyle.If within 6-12 months non -drug therapy does not show effectiveness, it is advisable to prescribe drugs.
Average
The average risk group includes people from I - II Art.hypertension, provided that there are 1-2 risk factors.The risk increases with high body weight, smoking, an increase in cholesterol, a violation of glucose tolerance, a lack of movement.Hereditary factors are also important.The risk of cardiovascular complications in these people is higher, and is 15–20% for 10 years.People related to this group are recommended to comply with a healthy lifestyle.If a pressure decrease does not occur within 6 months, pharmacotherapy is prescribed.
High
The high -risk group includes people of the I - II century.hypertension, subject to the presence of at least 3 risky factors, which include:
- diabetes;
- defeat of target organs;
- atherosclerotic vascular diseases;
- left ventricular hypertrophy;
- increased creatinine;
- changes in the eye vessels.
This group also includes hypertension of the 3rd century, which have no risky factors (the risk of cardiovascular diseases is 20-30% for 10 years).Representatives of this group are under the supervision of a cardiologist.
Very high
A group of hypertension with a very high risk of cardiovascular disease (more than 30% for 10 years) includes people with III Art.hypertension, provided that there are at least 1 risky factor.In addition, this group includes patients with AH I - II Art.In the presence of a violation of cerebral circulation, ischemia, nephropathy.This group is controlled by cardiologists, requires active therapy.
Conclusion
The problem of arterial hypertension is that the disease has no typical symptoms, is characterized by a variety of clinical picture.Therefore, often a person does not know about the presence of the disease.Therefore, high pressure is detected by accident, during inspection or in the manifestation of complications.When diagnosing hypertension, it is important to correctly inform the patient that he can largely affect the course of his illness, following a healthy lifestyle.