Arterial hypertension belongs to the most common diseases of the heart and blood vessels, which affects approximately 25% of the adult population.It is not surprising that sometimes it is mentioned as a non -infectious epidemic.High blood pressure with its complications significantly affects population mortality.Estimates show that up to 25% of the deaths of people over 40 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 of the 1993 World Health Organization, adult hypertension is a constant 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 as primary and secondary.
With primary (essential) (GB) hypertension, the main organic cause of blood pressure (blood pressure) is unknown.A combination of genetic factors, external influences and violations of internal regulatory mechanisms are taken into account.
External factors:
- atmosphere;
- Excessive use of calories, the development of obesity;
- Increased salt consumption;
- Lack of potassium, calcium, magnesium;
- excessive drinking;
- Repeat 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 the organs;
- Stage II: an increase in blood pressure with changes in the organs, but without harming its function (hypertrophy of the left ventricle, proteinuria, angiopathy);
- Stage III: organs accompanied by a deteriorated 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.The classification of secondary arterial hypertension is as follows:
- RENEPARECMAL HYPERTENSION: occurs due to kidney disease;Reasons: renal parenchymal disease (glomerulonephritis, pyelonephritis), tumors, renal damage;
- Renovascular hypertension: narrowing of renal arteries with fibromosular dysplasia or atherosclerosis, renal venous thrombosis;
- Endocrine hypertension: Primary hyperaldosteronism (Conn Syndrome), hyperthyroidism, pheochromocytoma, kushing syndrome;
- hypertension caused by drugs;
- Gestational hypertension: high pressure during pregnancy, after childbirth, the condition is often normalized;
- Coarstation of the aorta.
Gestational hypertension can lead to congenital diseases of the child, in particular, retinopathy.2 phases of retinopathy are separated (premature and long -term children) ::
- Active: It consists of 5 stages of development, it can lead to loss of vision;
- Rubts: leads to the cloud of the cornea.
Important!Both stages of premature children's retinopathy and at all times lead to anatomical disorders!
Hypertensive disease according to the international system (according to ICD-10):
- Primary form - i10;
- Secondary form - i15.
Hypertension degrees 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:
- Grade 1 - Light - Lack of 3.5%;Symptoms: dry mouth, serious thirst;
- Grade 2 - Average - Deficiency - 3-6%;Symptoms: acute fluctuations in pressure or pressure reduction, tachycardia, oliguria;
- Grade 3: The third degree is the most severe, characterized by a lack of 7-14% water;It manifests with hallucinations, delirium;Clinic - Coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is carried out when introducing solutions:
- 5% glucose + isotonic naCl (mild grade);
- 5% NaCl (average grade);
- 4.2% Nahco3(Severe grade).
GB stages
Subjective symptoms, especially with the stage of mild and moderate hypertension, are often absent, so there is often an increase in blood pressure at the level of dangerous indicators.The clinical image is divided into 3 stages.Each stage of arterial hypertension has typical symptoms, of which the GB classification comes.
Stage i
In 1 hypertension stage, the patient complains with a headache, fatigue, rapid beat, disorientation, sleep disorder.In 1 GB stage, objective detection in the heart, ECG, ocular background, in laboratory studies are present within the normal range.
Stage II
In the second 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 in the retina, microalbuminuria or proteinuria in the urine.Sometimes there is a multiplication of red blood cells in urine precipitation.In 2 stages of hypertension, renal insufficiency symptoms are absent.
Stage III
With the hypertension of stage III, functional disorders are diagnosed in organs that belong to a greater degree of hypertension risk:
- Damage to the heart: At first, the lack of breath manifests, then, symptoms of cardiac asthma or pulmonary edema;
- Vascular complications: damage to peripheral and coronary arteries, the risk of brain atherosclerosis;
- Fund changes: they have the nature of hypertensive retinopathy, neurorretinopathy;
- Changes in cerebral blood vessels are manifested by transient ischemic episodes, thrombotic or typical hemorrhagic vascular strokes;
- In stage III, a brain stroke, brain injuries are diagnosed in almost all patients;
- Benign nephrosisis of renal vessels: leads to limiting glomerular filtration, an increase in proteinuria, red blood cells, hyperuricemia and then to chronic renal failure.
What stage or degree of hypertension is the most dangerous?Despite several symptoms, all stages and degrees of arterial hypertension are dangerous, require a proper systemic or symptomatic treatment.
Degree
According to blood pressure (blood) indicators, determined at the time of diagnosis, 3 degrees of hypertension are distinguished:
- light;
- average;
- heavy.
There is also a fourth concept: the determination of resistant (persistent) hypertension, in which even with the proper choice of a combination of antihypertensive medications, blood pressure indicators are not reduced below 140/90 mm Hg.Art.
The table shows a clearer description of the degrees of arterial hypertension.
AG classification and normal blood pressure stratification according to ESH/ESH 2007 guidelines.
| Category | Systolic pressure, mm Hg.Art. | Diastolic pressure, mm Hg.Art. |
|---|---|---|
| Optimum | <120 | <80 |
| Normal | 120–129 | 80–84 |
| Normal increase | 130–139 | 85–89 |
| 1 grade | 140–159 | 90–99 |
| 2 degrees | 160–179 | 100-109 |
| 3 degrees | More than 180 | More than 110 |
| Isolated systolic hypertension | More than 140 | Less than 90 |
The patient's difficulties vary according to the separation of hypertension in degrees.The choice of the disease treatment regime depends on the determination of the degree.
I direct to
The disease can only be detected with the regular measurement of blood pressure.Measurements must be carried out in a relaxed environment, at least 3 times in a certain period.
This is the only way to evaluate the presence or absence of hypertension.Depending on the degree of increased blood pressure, the clinical image of the disease differs.
II Grade
The second degree of hypertension is characterized by periods of greater alternating pressure with a decrease in the indicators, or an increase in only the diastolic value.In this sense, hypertension, cases of growing pressure in certain circumstances are typical, particularly in patients with an unstable nervous system.
III grade
III The degree of AG is characterized by a critical increase in blood pressure.
GB Grade III is characterized by serious complications that arise as a result of the harmful effects of high blood pressure in all organs and systems.First, the heart, kidneys, eyes, brain are affected.With the hypertension of grade III, symptoms and treatment are closely associated, with insufficient or inappropriate treatment, the disease can cause serious consequences: stroke, encephalopathy, renal insufficiency, irreversible ocular lesions, blood vessels.The lack of treatment for the degree of hypertension III increases the risk of isolated systolic hypertension.
At this stage of arterial hypertension, the degree of risk increases significantly!Memory disorders, mental activity, frequent loss of consciousness are manifested.
The hypertonic crisis arises as a complication of the third century, and IV art is considered.GB.
Risks
According to 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 in the degree of disease:
- risk of less than 15%;
- risk up to 20%;
- Risk 20-30%;
- The risk is greater than 30%.
Under, insignificant
A low -risk group includes men up to 55 years and women at 65 years of age from I Art. Hypertension.In this group, the risk of cardiovascular pathology in the period of up to 10 years is less than 15%.People who belong to a low -risk group to change the lifestyle are recommended.If within 6-12 months non-fragable therapy does not show effectiveness, it is advisable to prescribe medications.
Average
The average risk group includes art I - II.hypertension, provided there are 1-2 risk factors.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 fulfill a healthy lifestyle.If a decrease in pressure does not occur within 6 months, pharmacotherapy is prescribed.
High
The high -risk group includes people from the 1st century.Hypertension, subject to the presence of at least 3 risk factors, which include:
- diabetes;
- defeat of the target organs;
- atherosclerotic vascular diseases;
- left ventricular hypertrophy;
- increase in creatinine;
- Changes in eye vessels.
This group also includes hypertension of the third century, which have no risk factors (the risk of cardiovascular diseases is 20-30% for 10 years).The representatives of this group are under the supervision of a cardiologist.
Very high
A hypertension group with a very high risk of cardiovascular disease (more than 30% for 10 years) includes people with Tar III.Hypertension, provided there are at least 1 risk factor.In addition, this group includes patients with art Ah I - II.In the presence of a violation of brain 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, it is characterized by a variety of clinical images.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 who can greatly affect the course of his illness, following a healthy lifestyle.