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 referred to 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 in people over 40 years of age are directly or indirectly caused by hypertension. The likelihood of complications predetermine 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 from 1993, hypertension in adults is considered 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 WHO, according to etiology, hypertension is classified into primary and secondary.
In primary (essential) hypertension (EH), the main organic cause of increased blood pressure (BP) is unknown. A combination of genetic factors, external influences and violations of internal regulatory mechanisms is 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 changes in organs;
- Stage II - an increase in blood pressure with changes in organs, but without disrupting their function (left ventricular hypertrophy, proteinuria, angiopathy);
- Stage III - changes in 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 arterial hypertension of 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 by fibromuscular dysplasia or atherosclerosis, renal vein thrombosis;
- endocrine hypertension - primary hyperaldosteronism (Conn's syndrome), hyperthyroidism, pheochromocytoma, Cushing's syndrome;
- hypertension caused by drugs;
- 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 loss of vision;
- cicatricial - leads to clouding 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:
- degree 1 - mild - lack of 3. 5%; symptoms - dry mouth, intense thirst;
- degree 2 - medium - deficiency - 3-6%; symptoms - sharp fluctuations in pressure or a decrease in pressure, tachycardia, oliguria;
- degree 3 - the third degree is the most severe, 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 the mild and moderate stages of hypertension, are often absent, so an increase in blood pressure is often found already at the level of dangerous indicators. 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
At the 1st stage of hypertension, the patient complains of headache, fatigue, palpitations, disorientation, and sleep disturbances. At stage 1 AH, objective findings on the heart, ECG, eye background, laboratory tests are present within the normal range.
II stage
At stage 2 AH, subjective complaints are similar, at the same time there are signs of left ventricular hypertrophy, there are signs of hypertensive angiopathy on the retina, and microalbuminuria or proteinuria in the urine. Sometimes there is a multiplication of red blood cells in the urine sediment. At stage 2 hypertension, there are no symptoms of renal failure.
III stage
In stage III hypertension, functional disorders are diagnosed in organs that are at increased risk for 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, the 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;
- at stage III, cerebral stroke, brain lesions are diagnosed in almost all patients;
- benign nephrosclerosis of the kidney 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, they require 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 a 4th concept - the definition of resistant (persistent) hypertension, in which even with the proper choice of a combination of antihypertensive drugs, blood pressure does not decrease below 140/90 mm Hg. Art.
A clearer overview of the degrees of arterial hypertension is presented in the table.
Classification of hypertension and stratification of normal blood pressure according to the ESH/ESC Guidelines 2007.
| Category | Systolic pressure, mm HgArt. | Diastolic pressure, mm HgArt. |
|---|---|---|
| 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 | over 180 | over 110 |
| Isolated systolic hypertension | over 140 | less than 90 |
The difficulties of the patient vary in accordance with the division of hypertension in degrees. The choice of the treatment regimen for the disease depends on the determination of the degree.
I degree
Detection of the disease is possible only with regular measurement of blood pressure. Measurements should be taken in a relaxed atmosphere, 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 is different.
II degree
For the 2nd degree of hypertension, periods of increased pressure are characteristic, alternating with a decrease in indicators, or an increase in only 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.
III degree
III degree of hypertension is characterized by a critical increase in blood pressure.
Grade III GB is characterized by severe complications resulting from the harmful effects of high blood pressure on all organs and systems. First of all, the heart, kidneys, eyes, brain are affected. With grade III hypertension, symptoms and treatment are closely related - 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.
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
In accordance with the classification of hypertension by stages and degrees, patients are divided into risk groups, depending on the severity of hypertension. There are 4 categories (i. e. , there are as many of them 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 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 up to 10 years is less than 15%. For people in the low-risk group, lifestyle changes are recommended. If non-drug therapy does not show effectiveness within 6–12 months, it is advisable to prescribe drugs.
Average
The group of average risk 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, lack of movement. Hereditary factors are also important. The risk of cardiovascular complications in these people is higher, and is 15-20% within 10 years. People belonging to this group are encouraged to maintain a healthy lifestyle. If pressure reduction does not occur within 6 months, pharmacotherapy is prescribed.
Tall
The high-risk group includes people I-II Art. hypertension, subject to the presence of at least 3 risk factors, which include:
- diabetes;
- target organ damage;
- 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 disease is 20–30% over 10 years). Representatives of this group are under the supervision of a cardiologist.
Very tall
The group of hypertensive patients with a very high risk of cardiovascular disease (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 AH I–II stage. in the presence of cerebrovascular accident, ischemia, nephropathy. This group is controlled by cardiologists and requires active therapy.
Conclusion
The problem of 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.