Arterial hypertension belongs to 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.Predictions show that up to 25% of the deaths of people over 40 are directly or indirectly caused by hypertension.The likelihood of complications determines the stages of hypertension.How many stages are hypertension, how are they classified?See below.
Important!According to recent estimates of the World Health Organization in 1993, hypertension in adults is a constant increase in blood pressure to 140/90 mm Hg.Art.
Classification of arterial hypertension, determining the degree of risk of illness
In the WHO, according to etiology, hypertension is classified in primary and secondary.
With primary (essential) hypertension (GB), the main organic cause of increased blood pressure (blood pressure) is unknown.A combination of genetic factors, external influences and disorders of internal regulatory mechanisms are reported.
External factors:
- environment;
- excessive calorie use, obesity development;
- Increased salt consumption;
- lack of potassium, calcium, magnesium;
- excessive drinking;
- Repeated stressful situations.
Primary hypertension is the most common hypertension, in approximately 95% of cases.
3 stages of hypertension are divided:
- Stage I - increased blood pressure without changes in the organs;
- Stage II - increase in blood pressure with changes in organs, but without disrupting their function (left ventricular hypertrophy, proteinuria, angiopathy);
- Stage III - organs accompanied by impaired function (left heart failure, hypertensive encephalopathy, stroke, hypertonic retinopathy, renal failure).
Secondary (symptomatic) hypertension is an increase in blood pressure as a symptom of the underlying disease with the identified cause.The classification of secondary arterial hypertension is as follows:
- Renoparechimal hypertension - occurs due to kidney disease;Causes: renal parenchymal disease (glomerulonephritis, pyelonephritis), tumors, kidney damage;
- Renovid hypertension - narrowing of the renal arteries with fibromoscular dysplasia or atherosclerosis, thrombosis of the renal vein;
- Endocrine hypertension - primary hyperaldosteronism (horse syndrome), hyperthyroidism, pheochromocytoma, Cushing syndrome;
- hypertension caused by medicines;
- Gestational hypertension - high pressure during pregnancy, after birth, the condition is often normalized;
- Aortic coarctation.
Gestational hypertension can lead to congenital diseases of the child, more special, retinopathy.2 phases of retinopathy (premature and full children) are divided ::
- Active - consists of 5 stages of development, can lead to loss of vision;
- Ruti - leads to a cloudy of the cornea.
Important!Both stages of retinopathy of premature and full -term children lead to anatomical disorders!
Hypertonic 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 a lack of water in the body.
Share 3 degrees Dehydration:
- Grade 1 - light - lack of 3.5%;Symptoms - dry mouth, severe thirst;
- Grade 2 - average - deficit - 3-6%;Symptoms - acute fluctuations in reducing pressure or pressure, tachycardia, oliguria;
- Grade 3 -the third degree is the most severe, characterized by the absence of 7-14% of the water;manifests with hallucinations, delirium;Clinic - coma, hypovolemic shock.
Depending on the degree and stage of dehydration, decompensation is carried out by introducing solutions:
- 5% glucose + isotonic NaCl (mild degree);
- 5% NaCl (medium degree);
- 4.2% nahco3(Severe degree).
Stages of GB
The subjective symptoms, especially with a mild and moderate stage of hypertension, are often absent, so there is a frequent increase in blood pressure at the level of dangerous indicators.The clinical picture is divided into 3 stages.Each stage of arterial hypertension has typical symptoms that come from the classification of GB.
Stage I.
In stage 1 hypertension, the patient complains of headache, fatigue, rapid heart rate, disorientation, sleep disorders.In stage 1 of GB, objective detection of the heart, ECG, eye background, in laboratory tests are present in the normal range.
Stage II
At the 2nd stages of AH, the subjective complaints are similar, at the same time there are signs of left ventricular hypertrophy, there are signs of retinal hypertonic angiopathy, microalbuminuria or proteinuria in the urine.Sometimes there is a multiplication of red blood cells in urine precipitation.At 2 stages of hypertension, the symptoms of renal failure are absent.
Stage III
With stage III hypertension, functional disorders are diagnosed in organs belonging to an increased degree of risk of hypertension:
- Damage to the heart - at first shortness of breath occurs, then - symptoms of cardiac asthma or pulmonary edema;
- Vascular complications - damage to the peripheral and coronary arteries, the risk of atherosclerosis of the brain;
- Changes in the fundus - have the nature of hypertonic retinopathy, neuroretinopathy;
- Changes in brain blood vessels are 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 kidney vessels - leads to limitation of glomerular filtration, increased proteinuria, red blood cells, 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 arterial hypertension are dangerous, they require appropriate systemic or symptomatic treatment.
Degree
In accordance with blood pressure (blood) indicators determined during diagnosis, 3 degrees hypertension are distinguished:
- light;
- medium;
- Heavy.
There is also the 4th concept-determination of resistant (persistent) hypertension, in which even with the right choice of antihypertensive drugs, blood pressure indicators are not reduced below 140/90 mm Hg.Art.
A more clear examination of the degrees of arterial hypertension is presented in the table.
Classification AG and stratification of normal blood pressure according to the instructions of ESH/ESC 2007.
| Category | Systolic pressure, mm Hg.Art. | Diastolic pressure, mm Hg.Art. |
|---|---|---|
| Optimal | <120 | <80 |
| Normally | 120–129 | 80-84 |
| Increased normally | 130–139 | 85-89 |
| 1 degree | 140–159 | 90–99 |
| 2 degrees | 160–179 | 100–109 |
| 3 degrees | more than 180 | more than 110 |
| Systolic hypertension | more than 140 | less than 90 |
The patient's difficulties vary in accordance with the division of hypertension into degrees.The choice of the treatment regimen depends on the determination of the degree.
Degree
The disease can only be detected with regular blood pressure measurement.Measurements should be made in a relaxed environment, at least 3 times in a certain period.
This is the only way to evaluate the presence or absence of hypertension.Depending on the degree of increase in blood pressure, the clinical picture of the disease differs.
II degree
The second degree of hypertension is characterized by periods of high pressure, alternating with reducing indicators or increasing only diastolic value.To this extent, hypertension, cases of increased pressure in certain circumstances, are typical, more special in patients with unstable nervous system.
III degree
Grade III AG is characterized by a critical increase in blood pressure.
Grade III GB is characterized by severe complications that result from the harmful effects of high blood pressure on all organs and systems.First, 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 have serious consequences: stroke, encephalopathy, renal failure, irreversible eye lesions, blood vessels.The lack of treatment for III degree of hypertension increases the risk of isolated systolic hypertension.
At this stage of arterial hypertension, the degree of risk increases significantly!Memory disorders, mental activity, frequent loss of consciousness manifest themselves.
The hypertensive crisis arises as a complication of the 3rd century and is considered the 4th art.GB.
Risks
In accordance with the classification of hypertension due to stages and degrees, patients are divided into risk groups, depending on the severity of AG.4 categories differ (that is, there are as many of them as the degrees of hypertension), which are determined by the principle of probability of damage to the internal organs in the future.
Risks to the degree of illness:
- risk lower than 15%;
- risk up to 20%;
- risk 20-30%;
- The risk is over 30%.
Low, insignificant
A low -risk group includes men up to 55 years of age and women up to 65 years of I Art.Arterial hypertension.In this group, the risk of cardiovascular pathology for up to 10 years is less than 15%.People belonging to a low -risk group are recommended to change their lifestyle.If within 6-12 months, which is not therapy, is not effective, it is advisable to prescribe medication.
Average
The average risk group includes people from I - II Art.Hypertension, provided there are 1-2 risk factors.The risk is increased with high body weight, smoking, increased 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% for 10 years.People associated with this group are recommended to comply with a healthy lifestyle.If no pressure reduction is observed within 6 months, pharmacotherapy is prescribed.
High
The high -risk group includes people from the I - II centuries.Hypertension subjected to at least 3 risk factors that include:
- diabetes;
- damage to the target organs;
- atherosclerotic vascular diseases;
- Left ventricular hypertrophy;
- increased creatinine;
- Changes in eye vessels.
This group also includes hypertension of the 2nd century, which have no risk factors (the risk of cardiovascular disease is 20-30% for 10 years).Representatives of this group are under the supervision of a cardiologist.
Very high
A group of hypertension at a very high risk of cardiovascular disease (more than 30% in 10 years) includes people with III art.Hypertension, provided there is at least 1 risk factor.In addition, this group includes patients with AH I - II art.In the presence of a violation of cerebral circulation, ischemia, nephropathy.This group is controlled by cardiologists, requires active therapy.
Conclusion
The problem with arterial hypertension is that the disease has no typical symptoms, characterized by various clinical pictures.Therefore, often one does not know about the presence of the disease.Therefore, high pressure is detected accidentally, during inspection or in the case of complications.When diagnosing hypertension, it is important to properly inform the patient that he or she can largely affect the course of his or her illness after a healthy lifestyle.