Arterial hypertension is one of the most common diseases of the heart and blood vessels, affecting about 25% of the adult population. No wonder it is sometimes considered a non-communicable disease. High blood pressure with its complications significantly affects the mortality rate of the population. It is estimated 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 of high blood pressure are classified? See below.
Important! According to the latest World Health Organization estimates from 1993, hypertension in adults is defined as a persistent increase in blood pressure up to 140/90 mm Hg. Art.
Classification of arterial hypertension, determining the degree of risk of the disease
According to the World Health Organization (WHO), according to the etiology, hypertension is classified into primary and secondary.
In primary (basic) hypertension (EH), the primary organic cause of hypertension (BP) remains unknown. The combination of genetic factors, external influences and violations of internal regulatory mechanisms are taken into account.
External factors:
- Environment;
- consuming too many calories, the development of obesity;
- increased salt intake;
- lack of potassium, calcium, magnesium;
- drinking too much alcohol;
- repetitive stressful situations.
Primary hypertension is the most common hypertensive disease, accounting for about 95% of cases.
Hypertension has 3 stages:
- Stage I - high blood pressure without changes in organs;
- Stage II - hypertension with changes in the organs, but without disrupting their function (left ventricular hypertrophy, proteinuria, vascular disease);
- 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 a pre-existing medical condition with an identifiable cause. Classification of arterial hypertension of the secondary form is as follows:
- parenchymal remodeling hypertension - occurs due to kidney disease; causes: renal parenchymal disease (glomerulonephritis, pyelonephritis), tumor, kidney damage;
- vascular hypertension - renal artery stenosis due to fibromuscular dysplasia or atherosclerosis, renal vein thrombosis;
- endocrine hypertension - primary hyperaldosteronism (Conn's syndrome), hyperthyroidism, pheochromocytoma, Cushing's syndrome;
- drug-induced hypertension;
- gestational hypertension - high blood pressure during pregnancy, which usually returns to normal after childbirth;
- coarctation of the aorta.
Gestational hypertension can lead to congenital diseases of the baby, namely retinopathy. There are 2 stages of retinopathy (premature and full-term infants):
- active - includes 5 stages of development, which can lead to loss of vision;
- cicatricial - leads to corneal sheath.
Important! Both stages of retinopathy of preterm and term infants lead to anatomical disturbances!
Hypertension according to the international system (according to ICD-10):
- primary form - I10;
- secondary form - I15.
The degree of hypertension also predetermines the degree of dehydration - dehydration. In this case, the categorical factor is dehydration.
There are 3 levels of dehydration:
- grade 1 - mild - lack 3, 5%; symptoms - dry mouth, intense thirst;
- grade 2 - moderate - deficiency - 3-6%; symptoms - sharp fluctuations in pressure or pressure drop, tachycardia, oliguria;
- grade 3 - grade 3 is the most severe, characterized by a lack of 7-14% water; manifested by hallucinations, paranoia; clinic - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is accomplished by offering the following solutions:
- 5% glucose + isotonic NaCl (mild);
- 5% NaCl (average);
- 4. 2% NaHCO3(severity).
GB stage
Subjective symptoms, especially in the mild and moderate stages of hypertension, are often absent, so hypertension is often detected already at dangerous levels. The clinical picture is divided into 3 stages. Each stage of arterial hypertension has a typical symptom, from which GB is classified.
I stage
In stage 1 of hypertension, the patient complains of headache, fatigue, palpitations, disorientation, and sleep disturbance. At stage 1 AH, the objective findings of the heart, electrocardiogram, eye background, and laboratory tests are all within normal limits.
Phase II
In stage 2 AH, the same subjective complaints were present, along with signs of left ventricular hypertrophy, signs of retinal hypertensive vascular disease, and microalbuminuria or proteinuria. in 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.
Phase III
In stage III hypertension, dysfunctions are diagnosed in organs at risk for hypertension:
- heart damage - manifested first by shortness of breath, then - symptoms of cardiac asthma or pulmonary edema;
- vascular complications - damage to the peripheral and coronary arteries, the risk of cerebral atherosclerosis;
- changes in the background - have features of hypertensive retinopathy, neuropathy;
- cerebrovascular changes - manifested by transient ischemic attacks, typical thrombotic or hemorrhagic strokes;
- in stage III, cerebral stroke, brain damage is diagnosed in most patients;
- Benign sclerosis of the renal vessels - leads to limited glomerular filtration, increased proteinuria, erythrocytosis, hyperuricemia, and subsequently - leads to chronic renal failure.
At what stage or degree of high blood pressure is the most dangerous? Although symptoms vary, all stages and degrees of arterial hypertension are dangerous and require appropriate systemic or symptomatic treatment.
Degree
According to the indicators of blood pressure (blood pressure), determined at the time of diagnosis, there are 3 degrees of hypertension:
- light;
- medium;
- heavy.
There is also a 4th concept - the definition of resistant (persistent) hypertension, where even with the choice of an appropriate antihypertensive drug combination, blood pressure does not fall below 140/90mm Hg. Art.
A clearer overview of the grades 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. |
|---|---|---|
| Optimal | <120 | <80 |
| Normal | 120–129 | 80–84 |
| Normal increase | 130–139 | 85–89 |
| 1 degree | 140–159 | 90–99 |
| 2 degrees | 160–179 | 100–109 |
| 3 degrees | more than 180 | over 110 |
| Isolated systolic hypertension | more than 140 | less than 90 |
The different patient difficulties correspond to the classification of hypertension by degree. The choice of treatment regimen depends on determining the extent.
I have a degree
Diagnosis of the disease can only be made with regular blood pressure measurements. Measurements should be taken in a relaxed 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 also varies depending on the degree of hypertension.
Degree II
For grade 2 hypertension, hypertensive episodes are characteristic, alternating with decreases in indices, or only increases in diastolic values. With this degree of hypertension, there are typical cases of increased pressure in certain circumstances, in particular, in patients with unstable nervous systems.
Grade III
Grade III hypertension is characterized by a severe increase in blood pressure.
Grade III GB is characterized by serious complications due to the harmful effects of high blood pressure on all organs and systems. First of all, the heart, kidneys, eyes, brain are all affected. With grade III hypertension, symptoms and treatment are closely related - if treatment is inadequate or improper, the disease can lead to serious consequences: stroke, encephalopathy, heart failurekidney, eye damage, blood vessels are not reversible. Lack of treatment for grade III hypertension increases the risk of developing isolated systolic hypertension.
At this stage of arterial hypertension, the level of risk increases dramatically! 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.
Risk
According to the classification of hypertension by stage and degree, patients are divided into risk groups, depending on the degree of hypertension. There are 4 types (i. e. how many of them are degrees of hypertension), which are determined according to the principle of probability of future damage to internal organs.
Risk by degree of disease:
- risk less than 15%;
- risk up to 20%;
- 20–30% risk;
- The risk is more than 30%.
Low, insignificant
The low-risk group includes men under 55 and women under 65 with stage I. arterial hypertension. In this group, the risk of cardiovascular disease by age 10 is less than 15%. For people in low-risk groups, lifestyle changes are recommended. If non-drug therapy does not show effectiveness within 6-12 months, you should 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, inactivity. Genetic factors are also important. The risk of cardiovascular complications in these people is higher, and is 15-20% within 10 years. People in this group are encouraged to maintain a healthy lifestyle. If decompression is not relieved within 6 months, pharmacotherapy will be prescribed.
High
The high-risk group includes people I-II Art. High blood pressure, with at least 3 risk factors, including:
- Diabetes;
- target organ damage;
- atherosclerotic vascular diseases;
- left ventricular hypertrophy;
- increased creatinine;
- eye change.
This group also included patients with stage III hypertension without risk factors (cardiovascular disease risk 20–30% over 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% within 10 years) includes those with stage III disease. Hypertension in the presence of at least 1 risk factor. In addition, this group includes patients with AH stages I – II. in cases of cerebrovascular accident, ischemia, kidney disease. This group is controlled by a cardiologist and needs aggressive treatment.
Inference
The problem with arterial hypertension is that it has no 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 discovered incidentally, during a medical examination, or in the presence of complications. When diagnosing hypertension, it is important to correctly inform the patient that he can significantly influence the course of his disease by adhering to a healthy lifestyle.