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 called a non-communicable epidemic. High blood pressure 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 directly or indirectly caused by hypertension. The likelihood of complications predetermines the stages of hypertension. How many stages does hypertension have, how are they classified? See below.
Bitan! According to the latest estimates of the World Health Organization from 1993, hypertension in adults is considered to be a constant increase in blood pressure up to 140/90 mm Hg. Art.
Classification of arterial hypertension, determining the degree of risk of disease
According to the WHO, according to the etiology, hypertension is divided into primary and secondary.
In primary (essential) hypertension (EH), the main organic cause of high blood pressure (BP) is unknown. A combination of genetic factors, external influences and violations of internal regulatory mechanisms is taken into account.
External factors:
- surroundings;
- excessive calorie consumption, development of obesity;
- increased salt intake;
- lack of potassium, calcium, magnesium;
- excessive alcohol consumption;
- recurring 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 changes in organs;
- Phase II - increase in blood pressure with changes in the organs, but without impairment of their function (left ventricular hypertrophy, proteinuria, angiopathy);
- Phase 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 a identifiable cause. The classification of secondary arterial hypertension is as follows:
- renoparenchymal hypertension - occurs due to kidney disease; causes: diseases of the renal parenchyma (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;
- drug-induced hypertension;
- gestational hypertension - high blood pressure during pregnancy, after childbirth, the condition often returns to normal;
- aortic coarctation.
Gestational hypertension can lead to congenital diseases of the child, especially retinopathy. There are 2 stages of retinopathy (premature and newborn babies):
- active - consists of 5 stages of development, can lead to vision loss;
- cicatricial - leads to corneal opacity.
Bitan! 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;
- middle form - I15.
The degree of hypertension also determines the degree of dehydration - dehydration. In this case, the classifier is the lack of water in the body.
There are 3 degrees of dehydration:
- degree 1 - mild - deficiency of 3, 5%; symptoms - dry mouth, intense thirst;
- degree 2 - medium - deficiency - 3-6%; symptoms - sharp fluctuations in pressure or drop in pressure, tachycardia, oliguria;
- degree 3 - the third degree is the most severe, characterized by a lack of 7-14% water; manifested by hallucinations, delusions; clinic - coma, hypovolemic shock.
Depending on the degree and phase of dehydration, decompensation is carried out by introducing a solution:
- 5% glucose + isotonic NaCl (mild);
- 5% NaCl (medium);
- 4. 2% NaHCO3(severe degree).
GB phase
Subjective symptoms, especially in mild and moderate stages of hypertension, are often absent, so the increase in blood pressure is often already at the level of dangerous indicators. The clinical picture is divided into 3 phases. Each stage of arterial hypertension has a typical symptomatology on which the GB classification is based.
I stage
In stage 1 hypertension, the patient complains of headache, fatigue, palpitations, disorientation and sleep disturbance. In stage 1 AH objective findings on the heart, ECG, ocular background, laboratory tests are present within normal limits.
Phase II
In stage 2 AH, the subjective problems 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 red blood cells multiply in the urine sediment. In stage 2 hypertension, there are no symptoms of renal failure.
Phase III
Stage III hypertension diagnoses functional disorders in organs that are at increased risk of hypertension:
- heart damage - first manifested by shortness of breath, and then - symptoms of cardiac asthma or pulmonary edema;
- vascular complications - damage to peripheral and coronary arteries, risk of cerebral atherosclerosis;
- changes in the fundus - 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, stroke, brain lesions are diagnosed in almost all patients;
- benign nephrosclerosis of the renal vessels - leads to limited glomerular filtration, increased proteinuria, erythrocytosis, hyperuricaemia, and later - to chronic renal failure.
Which stage or degree of hypertension is the most dangerous? Despite the different symptoms, all stages and degrees of arterial hypertension are dangerous, requiring appropriate systemic or symptomatic treatment.
Degrees
In accordance with 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 the 4th concept - the definition of resistant hypertension, in which even with the right choice of combination of antihypertensive drugs, blood pressure does not fall below 140/90 mm Hg. Art.
A clearer overview of the degree of arterial hypertension is given in the table.
Classification of hypertension and stratification of normal blood pressure according to ESH / ESC guidelines 2007.
> zxtable border = "1" cellpadding = "0" >Patients' difficulties vary according to the degree of hypertension. The choice of treatment regimen depends on the degree.
I degree
Detection of the disease is possible only with regular measurement of blood pressure. Measurements should be performed in a relaxed atmosphere, 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 increase in blood pressure, the clinical picture of the disease is different.
II degree
Grade 2 hypertension is characterized by periods of high blood pressure, which alternate with a decrease in the indicator or an increase in only the diastolic value. With this degree of hypertension, there are typical cases of high blood pressure under certain circumstances, especially in patients with an 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 arising from the detrimental effects of high blood pressure on all organs and systems. First of all, the heart, kidneys, eyes and brain are affected. In grade III hypertension, symptoms and treatment are closely linked - with insufficient or improper treatment, the disease can lead to serious consequences: stroke, encephalopathy, kidney failure, irreversible damage to the eyes, blood vessels. Lack of treatment for grade III hypertension increases the risk of developing isolated systolic hypertension.
In this phase of arterial hypertension, the degree of risk increases significantly! There are memory disorders, mental activity, frequent 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 (ie there are as many as degrees of hypertension), determined by the principle of the 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 over 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 diseases in the period up to 10 years 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.
Average
The group of average risk includes persons 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. The risk of cardiovascular complications in these people is higher and amounts to 15-20% within 10 years. People who belong to this group are encouraged to lead a healthy lifestyle. If the pressure does not decrease within 6 months, pharmacotherapy is prescribed.
High
The high-risk group includes persons I-II Art. hypertension, in the presence of at least 3 risk factors, which include:
- diabetes;
- damage to the target organ;
- atherosclerotic vascular diseases;
- left ventricular hypertrophy;
- increased creatinine;
- ocular changes.
This group also includes stage III hypertensive patients who do not have risk factors (the risk of cardiovascular diseases is 20-30% over 10 years). Representatives of this group are under the supervision of a cardiologist.
Very high
The group of hypertensives with a very high risk of cardiovascular diseases (more than 30% within 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 IH-II AH. in the presence of cerebrovascular infarction, ischemia, nephropathy. This group is under the control of a cardiologist 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 unaware of the presence of the disease. Therefore, high blood pressure is detected accidentally, during the examination or when complications occur. When diagnosing hypertension, it is important to properly inform the patient that a healthy lifestyle can significantly affect the course of their disease.