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-infectious epidemic. High blood pressure with its complications has a significant impact on mortality. 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 determines the stages of hypertension. How many stages does hypertension have, how are they classified? See below.
Important! According to the latest estimates by the World Health Organization in 1993, hypertension in adults is considered a prolonged increase in blood pressure to 140/90 mm Hg. Art.
Classification of arterial hypertension, determining the degree of risk of the disease
According to the WHO, according to the etiology, hypertension is classified into primary and secondary.
In primary (essential) hypertension (ES), the underlying organic cause of high blood pressure (BP) is unknown. A combination of genetic factors, external influences and violations of internal regulatory mechanisms is reported.
External factors:
- Environment;
- 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 the organs;
- Stage II - increase in blood pressure with changes in the organs, but without impairment of their function (left ventricular hypertrophy, proteinuria, angiopathy);
- 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 an underlying disease with an identified 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;
- drug-induced hypertension;
- gestational hypertension - high blood pressure during pregnancy, after birth 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 stages of retinopathy (premature and full-term babies):
- active - consists of 5 stages of development, can lead to vision loss;
- scarring - leads to corneal opacity.
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 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 - lack of 3, 5%; symptoms - dry mouth, strong thirst;
- degree 2 - medium - deficit - 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 7-14% water; manifested by hallucinations, delusions; clinic - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is performed by introducing solutions:
- 5% glucose + isotonic NaCl (drug);
- 5% NaCl (medium);
- 4. 2% NaHCO3(severe).
GB stages
Subjective symptoms, especially in mild and moderate stages of hypertension, are often absent, so the increase in blood pressure is often already detected at the level of dangerous indicators. The clinical picture is divided into 3 stages. Each stage of arterial hypertension has typical symptoms, on which the classification of GB is based.
I stage
In stage 1 hypertension, the patient complains of headache, fatigue, palpitations, disorientation and sleep disturbances. In stage 1 AH objective findings for the heart, ECG, ocular background, laboratory tests are within normal limits.
Stage II
In stage 2 AH, the subjective complaints are similar, at the same time there are signs of left ventricular hypertrophy, there are signs of hypertensive retinal angiopathy and microalbuminuria or proteinuria in the urine. Sometimes there is a proliferation of red blood cells in the urine sediment. In stage 2 hypertension there are no symptoms of renal failure.
Stage III
In stage III hypertension, functional disorders are diagnosed in organs that are 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;
- 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, hyperuricemia and later - to chronic renal failure.
Which stage or degree of hypertension is the most dangerous? Despite the various symptoms, all stages and degrees of hypertension are dangerous, requiring appropriate systemic or symptomatic treatment.
Degrees
According to 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 right choice of a combination of antihypertensive drugs, blood pressure does not fall 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 ESH / ESC Guidelines 2007.
> zxtable border = "1" cellpadding = "0" >The patient's difficulties vary according to the division of hypertension into degrees. The choice of treatment regimen for the disease depends on the degree.
I degree
Detection of the disease is possible only with regular measurement of blood pressure. Measurements must be made in a calm 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 increased pressure, alternating with a decrease in indicators or an increase in diastolic value only. In this degree of hypertension, there are typical cases of hypertension in 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 as a result of the harmful effects of high blood pressure on all organs and systems. The heart, kidneys, eyes and brain are affected in the first place. In grade III hypertension, the symptoms and treatment are closely related - in case of insufficient or incorrect treatment, the disease can lead to serious consequences: stroke, encephalopathy, renal 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 disorders of memory, 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 below 15%;
- risk up to 20%;
- risk 20-30%;
- the risk is over 30%.
Low, insignificant
The low-risk group includes men under 55 and women under 65 with stage I. hypertension. In this group, the risk of cardiovascular disease 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 advisable to prescribe medication.
Average
The group with medium 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 is 15-20% within 10 years. People belonging to this group are encouraged to maintain a healthy lifestyle. If the reduction in pressure does not occur 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 target organs;
- atherosclerotic vascular diseases;
- left ventricular hypertrophy;
- increased creatinine;
- eye changes.
This group also includes patients with stage III hypertension who do not have risk factors (the risk of cardiovascular disease is 20-30% in 10 years). Representatives of this group are under the supervision of a cardiologist.
Very tall
The group of hypertensives 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 stage IH-II AH. in the presence of cerebrovascular accident, ischemia, nephropathy. This group is controlled by cardiologists and requires active therapy.
Conclusion
The problem with high blood pressure is that the disease has no typical symptoms and is characterized by a diverse clinical picture. Therefore, often one does not know about the presence of the disease. Therefore, high blood pressure is detected accidentally, during an examination or when complications occur. When diagnosing hypertension, it is important to properly inform the patient that he can significantly affect the course of his disease by leading a healthy lifestyle.