High blood pressure is one of the most common diseases of the heart and blood vessels, affecting around 25% of the adult population. No wonder we sometimes speak of 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 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.
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. From Art.
Classification of arterial hypertension, determination of the degree of risk of the disease
According to the WHO, depending on the etiology, hypertension is classified into primary and secondary.
In primary (essential) hypertension (HE), the primary organic cause of the 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, development of obesity;
- increased salt intake;
- lack of potassium, calcium, magnesium;
- excessive consumption of alcohol;
- repetitive stressful situations.
Primary hypertension is the most common hypertension, accounting for approximately 95% of cases.
There are 3 stages of hypertension:
- Stage I - arterial hypertension 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 - organ changes, 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 secondary hypertension is as follows:
- renoparenchymal hypertension - occurs due to kidney disease; causes: kidney 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;
- hypertension caused by medication;
- 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, especially 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;
- scarring - leads to clouding of the cornea.
Important! Both stages of retinopathy in preterm 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;
- degree 2 - medium - deficiency - 3-6%; symptoms - sharp fluctuations in pressure or decrease in pressure, tachycardia, oliguria;
- degree 3 - the third degree is the most severe, characterized by a lack of water from 7 to 14%; manifested by hallucinations, delusions; clinical - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is carried out by introducing solutions:
- 5% glucose + isotonic NaCl (soft);
- 5% NaCl (medium);
- 4. 2% NaHCO3(severe degree).
GB steps
Subjective symptoms, especially in mild and moderate stages of hypertension, are often absent, so an increase in blood pressure is often already at the level of dangerous indicators. The clinical picture is divided into 3 stages. Each stage of high blood pressure has a typical symptomatology, from which the classification of GB is based.
I stage
In the 1st stage of hypertension, the patient complains of headaches, fatigue, palpitations, disorientation and sleep disturbances. At stage 1 AH, the objective results on the heart, ECG, ocular fundus, laboratory tests are present in 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. In stage 2 hypertension, there are no symptoms of kidney failure.
Stage III
In stage III hypertension, functional disorders are diagnosed in organs at increased risk of hypertension:
- heart damage - 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 fundus - have the character of hypertensive retinopathy, neuroretinopathy;
- cerebral blood vessel changes - manifesting as transient ischemic attacks, typical thrombotic or hemorrhagic strokes;
- in stage III, stroke, brain damage is diagnosed in almost all patients;
- benign nephrosclerosis of the renal vessels - leads to limitation of glomerular filtration, increased 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;
- medium;
- heavy.
There is also a 4th concept - the definition of resistant (persistent) hypertension, in which even with the correct choice of a combination of antihypertensives, blood pressure does not drop below 140/90 mm Hg. From l'art.
A clearer overview of the degrees of high blood pressure is presented in the table.
Classification of hypertension and stratification of normal blood pressure according to ESH/ESC 2007 guidelines.
| Category | Systolic pressure, mm HgFrom Art. | Diastolic pressure, mm HgFrom Art. |
|---|---|---|
| optimal | < 120 | < 80 |
| Normal | 120–129 | 80–84 |
| Normal increased | 130–139 | 85–89 |
| 1 degree | 140–159 | 90–99 |
| 2 degrees | 160–179 | 100–109 |
| 3 degrees | over 180 | over 110 |
| Isolated systolic hypertension | over 140 | less than 90 |
The difficulties of the patient vary according to the division of hypertension into degrees. The choice of the treatment regimen for the disease depends on the determination of the degree.
I graduate
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 diastolic value. With this degree of hypertension, there are typical cases of increased pressure under certain circumstances, especially 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 intertwined - with insufficient or improper treatment, the disease can lead to serious consequences: stroke, encephalopathy, kidney failure, irreversible eye damage, blood vessels. Lack of treatment for grade III hypertension increases the risk of developing isolated systolic hypertension.
At this stage of high blood pressure, the degree of risk increases significantly! There are violations of memory, mental activity, frequent loss of consciousness.
A hypertensive crisis occurs as a stage III complication and is considered stage IV. Go.
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 (that is, there are as many as degrees of hypertension), determined by the principle of the likelihood 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%.
Weak, insignificant
The low-risk group includes men under 55 and women under 65 with stage I high blood pressure. 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 treatment does not show effectiveness within 6-12 months, it is advisable to prescribe medication.
Medium
The medium risk group includes people with I-II Art. hypertension in the presence of 1 to 2 risk factors. The risk increases with high body weight, smoking, high cholesterol, poor glucose tolerance, lack of movement. Hereditary factors are also important. The risk of cardiovascular complications in these people is higher and is 15 to 20% in 10 years. People in this group are encouraged to maintain a healthy lifestyle. If the reduction in pressure 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% over 10 years). Representatives of this group are under the supervision of a cardiologist.
Very large
The group of hypertensive patients at 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 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 high blood pressure 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 an examination or during complications. 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.