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 are caused directly or indirectly by hypertension. The possibility of complications predetermines the stages of hypertension. How many stages is hypertension, 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 steady increase in blood pressure up to 140/90 mm Hg. Art.
Classification of arterial hypertension, determination of the degree of disease risk
According to the WHO, according to the etiology, hypertension is divided into primary and secondary.
In primary (essential) hypertension (EH), the underlying organic cause of elevated blood pressure (BP) is unknown. A combination of genetic factors, external influences, and violations of internal regulatory mechanisms is considered.
External factors:
- Environment;
- excessive calorie consumption, 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:
- Phase I - high blood pressure without changes in organs;
- Stage II - an increase in blood pressure with changes in the organs, but without interruption 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 identifiable cause. The classification of secondary arterial hypertension is as follows:
- renoparenchymal hypertension - occurs due to kidney disease; causes: parenchymal kidney 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 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, in particular, retinopathy. There are 2 stages of retinopathy (premature and full-term infants):
- active - consists of 5 stages of development, can lead to vision loss;
- scarring - leads to corneal turbulence.
Important! Both stages of retinopathy of premature and full-term infants 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 predetermines the degree of dehydration. In this case, the classifier is the lack of water in the body.
There are 3 degrees of dehydration:
- degree 1 - easy - lack 3. 5%; symptoms - dry mouth, strong thirst;
- grade 2 - medium - deficiency - 3-6%; symptoms - sharp fluctuations in blood pressure or decrease in pressure, tachycardia, oliguria;
- degree 3 - the third degree is more severe, characterized by 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 (mild);
- 5% NaCl (average);
- 4. 2% NaHCO3(heavy scale).
GB phases
Subjective symptoms, especially in the mild and moderate stages of hypertension, are often absent, so an increase in blood pressure is often already found at the level of dangerous indicators. The clinical picture is divided into 3 stages. Each stage of hypertension has a typical symptomatology, on which the classification of GB is based.
I scan
In the first stage of hypertension, the patient complains of headaches, fatigue, palpitations, disorientation, and sleep disturbances. In stage 1 AH, objective findings on the heart, ECG, background of the eye, laboratory tests are present within normal limits.
Phase 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 angiopathy in the retina 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 kidney failure.
Phase III
In stage III hypertension, functional disorders are diagnosed in organs that are at increased risk for 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 shock;
- in stage III, stroke, brain lesions are diagnosed in almost all patients;
- benign nephrosclerosis of the renal vessels - leads to a restriction of glomerular filtration, an increase in proteinuria, erythrocytosis, hyperuricemia and later - to chronic renal failure.
Which stage or degree of hypertension is most dangerous? Regardless of the different symptoms, all stages and degrees of hypertension are dangerous, they require proper systemic or symptomatic treatment.
Diplomat
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 right choice of a combination of antihypertensive drugs, blood pressure does not drop below 140/90 mm Hg. Art.
A clearer picture of the rates of hypertension is presented in the table.
Classification of hypertension and stratification of normal blood pressure according to the guidelines of ESH / ESC 2007.
| category | Systolic pressure, mm HgArt. | Diastolic pressure, mm HgArt. |
|---|---|---|
| optimum | < 120 | < 80 |
| Normal | 120–129 | 80–84 |
| Normal adult | 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 patient's difficulties vary according to the degree of hypertension division. The choice of 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 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.
degree II
For the second degree of hypertension, periods of increased pressure are characteristic, alternating with a decrease in indicators or an increase in diastolic value only. With this degree of hypertension, there are typical cases of increased pressure in certain circumstances, especially in patients with an unstable nervous system.
degree III
Grade III hypertension is characterized by a critical increase in blood pressure.
Grade III GB is characterized by severe complications arising 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 eyes, blood vessels. Lack of treatment for grade III hypertension increases the risk of developing isolated systolic hypertension.
At this stage of hypertension, the risk rate increases significantly! There are disorders of memory, mental activity, frequent loss of consciousness.
The hypertensive crisis appears as a complication of stage III and is considered stage IV. GB.
The Risks
In accordance with the classification of hypertension according to 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 the degrees of hypertension), defined by the principle of 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 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%. 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 medication.
Average
The medium risk group includes persons with Art I-II. 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.
Tall
High risk group includes people I-II Art. hypertension, subject to 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 patients with stage III hypertension, 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 tall
The group of patients with hypertension with a very high risk of cardiovascular disease (more than 30% within 10 years) includes persons 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 cerebrovascular accidents, ischemia, nephropathy. This group is controlled by cardiologists and requires active therapy.
Conclusion
The problem with hypertension is that the disease has no 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 accidentally, during examination or when complications occur. When diagnosing hypertension, it is important to accurately inform the patient that he or she can significantly influence the course of his or her disease by following a healthy lifestyle.