High blood pressure is one of the most common diseases of the heart and blood vessels, affecting approximately 25% of the adult population. Not surprisingly, it is sometimes called a non-infectious epidemic. Arterial hypertension with its complications significantly affects the mortality of the population. Estimates show that up to 25% of deaths in people over the age of 40 are caused directly or indirectly by hypertension. The probability of complications predetermines the stages of hypertension. How many stages does hypertension have, how are they classified? See below.
Important! According to the latest estimates of the World Health Organization in 1993, hypertension in adults is considered to be a sustained increase in blood pressure 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 the etiology, arterial hypertension is classified into primary and secondary.
In primary (essential) hypertension (HE), the main organic cause of the increase in blood pressure (BP) is unknown. A combination of genetic factors, external influences and violations of internal regulatory mechanisms are taken into account.
External factors:
- Environment;
- excessive consumption of calories, the development of obesity;
- increased salt intake;
- lack of potassium, calcium, magnesium;
- excessive alcohol consumption;
- repetitive stressful situations.
Primary hypertension is the most common hypertension, accounting for about 95% of cases.
There are 3 stages of hypertension:
- Stage I - high blood pressure without organ changes;
- Stage II - an increase in blood pressure with changes in the organs, but without disturbing their function (left ventricular hypertrophy, proteinuria, angiopathy);
- Stage III - changes in the organs, accompanied by a violation of their function (left heart failure, hypertensive encephalopathy, stroke, hypertensive retinopathy, renal failure).
Secondary (symptomatic) hypertension is an increase in blood pressure as a symptom of an underlying disease with an identifiable cause. The classification of hypertension in 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;
- medication-induced hypertension;
- 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 of the child, in particular, retinopathy. There are 2 phases of retinopathy (premature and full-term babies):
- active - consists of 5 stages of development, can lead to vision loss;
- cicatricial - leads to opacity of the cornea.
Important! Both stages of retinopathy of 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 degrees of hypertension also predetermine 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, intense thirst;
- grade 2 - medium - deficiency - 3-6%; symptoms: sharp fluctuations in pressure or decrease in pressure, tachycardia, oliguria;
- grade 3: the third grade is the most serious, characterized by a lack of 7-14% of water; 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(severe degree).
gb stages
Subjective symptoms, especially in mild and moderate stages of hypertension, are often absent, so an increase in blood pressure to the level of dangerous indicators is often already found. The clinical picture is divided into 3 stages. Each stage of arterial hypertension has a typical symptomatology, from which the classification of GB is based.
I stage
In the first stage of hypertension, the patient complains of headache, fatigue, palpitations, disorientation, and sleep disturbances. In stage 1 AH, objective findings on the heart, ECG, fundus, and laboratory tests are present within the normal range.
second stage
In stage 2 AH, the subjective complaints are similar, at the same time there are signs of left ventricular hypertrophy, signs of hypertensive retinal angiopathy, and microalbuminuria or proteinuria in the urine. Sometimes there is a multiplication of red blood cells in the urine sediment. In stage 2 hypertension, there are no symptoms of kidney failure.
third stage
In stage III hypertension, functional disorders are diagnosed in organs that are at increased risk of hypertension:
- 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, risk of cerebral atherosclerosis;
- changes in the background - have the character of hypertensive retinopathy, neuroretinopathy;
- changes in cerebral blood vessels, manifested by transient ischemic attacks, typical thrombotic or hemorrhagic vascular strokes;
- in stage III, cerebral stroke, brain lesions are diagnosed in almost all patients;
- Benign nephrosclerosis of the renal vessels - leads to a limitation of glomerular filtration, an increase in proteinuria, erythrocytosis, hyperuricemia, and later to chronic renal failure.
What stage or degree of hypertension is the most dangerous? Despite the various symptoms, all stages and degrees of arterial hypertension are dangerous and require adequate systemic or symptomatic treatment.
Degrees
According to the indicators of blood pressure (blood pressure), 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, in which even with the appropriate choice of a combination of antihypertensive drugs, blood pressure does not fall below 140/90 mm Hg. Art.
A clearer description 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, mm HgArt. |
|---|---|---|
| Optimum | ||
| Normal | 120–129 | 80–84 |
| rise of normal | 130–139 | 85–89 |
| 1 degree | 140–159 | 90–99 |
| 2 degrees | 160–179 | 100–109 |
| 3rd grade | over 180 | more than 110 |
| Isolated systolic hypertension | more than 140 | less than 90 |
The patient's difficulties vary according to the division of hypertension into grades. The choice of treatment regimen for the disease depends on the determination of the grade.
I grade
Detection of the disease is only possible with regular blood pressure measurement. Measurements should be taken in a relaxed environment, at least 3 times in a given period.
This is the only way to assess the presence or absence of hypertension. Depending on the degree of increased blood pressure, the clinical picture of the disease is different.
II degree
For the second degree of hypertension, periods of increased pressure are characteristic, alternating with a decrease in indicators or an increase only in the diastolic value. With this degree of hypertension, there are typical cases of increased pressure under certain circumstances, in particular, 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 serious complications resulting from the deleterious effects of high blood pressure on all organs and systems. First of all, the heart, kidneys, eyes and brain are affected. With III degree hypertension, symptoms and treatment are closely related: with insufficient or improper treatment, the disease can have serious consequences: stroke, encephalopathy, kidney failure, irreversible eye damage, blood vessels. Failure to treat grade III hypertension increases the risk of developing isolated systolic hypertension.
At this stage of arterial hypertension, the degree of risk increases significantly! There are violations of memory, mental activity, frequent loss of consciousness.
A 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 grades, patients are divided into risk groups, depending on the severity of hypertension. There are 4 categories (that is, there are as many as degrees of hypertension), determined by the principle of probability of damage to internal organs in the future.
Risks according to the degree of the disease:
- risk less than 15%;
- risk up to 20%;
- risk 20-30%;
- the risk is greater than 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 in the period of up to 10 years is less than 15%. For people in the low-risk group, lifestyle changes are recommended. If non-pharmacological therapy does not show effectiveness within 6 to 12 months, it is advisable to prescribe medication.
Average
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, glucose intolerance, lack of movement. Hereditary factors are also important. The risk of cardiovascular complications in these people is higher and is 15-20% in 10 years. People in this group are encouraged to maintain a healthy lifestyle. If pressure reduction does not occur within 6 months, drug therapy is prescribed.
High
The high-risk group includes people I-II Art. hypertension, subject to the presence of at least 3 risk factors, 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% in 10 years). Representatives of this group are under the supervision of a cardiologist.
Very 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. in the presence of stroke, ischemia, nephropathy. This group is monitored by cardiologists and requires active therapy.
conclusion
The problem with arterial hypertension is that the disease does not have typical symptoms and is characterized by a diverse clinical picture. Therefore, often a person is not aware of the presence of the disease. Therefore, high blood pressure is detected by chance, during examination, or when complications occur. When diagnosing hypertension, it is important to correctly inform the patient that he can significantly influence the course of his disease by following a healthy lifestyle.