WHO classification of arterial hypertension. Arterial hypertension WHO classification. stage of hypertension

under the term " arterial hypertension", "arterial hypertension" refers to the syndrome of increased blood pressure (BP) in hypertension and symptomatic arterial hypertension.

It should be emphasized that the semantic difference in terms " hypertension" and " hypertension"practically none. As follows from the etymology, hyper - from the Greek over, over - a prefix indicating an excess of the norm; tensio - from Latin. - stress; tonos - from Greek. - stress. Thus, the terms "hypertension" and " "hypertension" essentially means the same thing - "overstress".

Historically (since the time of G.F. Lang), it has developed so that in Russia the term "hypertension" and, accordingly, "arterial hypertension" are used, in foreign literature the term " arterial hypertension".

Hypertensive disease (AH) is commonly understood as a chronic disease, the main manifestation of which is the syndrome of arterial hypertension, not associated with the presence of pathological processes, in which an increase in blood pressure (BP) is due to known, in many cases, eliminated causes ("symptomatic arterial hypertension") (Recommendations of VNOK, 2004).

Classification of arterial hypertension

I. Stages of hypertension:

• Hypertension (AH) stage I suggests the absence of changes in the "target organs".
• Hypertension (AH) stage II is established in the presence of changes from one or more "target organs".
• Hypertension (AH) stage III established in the presence of associated clinical conditions.

II. Degrees of arterial hypertension:

The degrees of arterial hypertension (Blood pressure (BP) levels) are presented in Table No. 1. If the values ​​of systolic Arterial pressure (BP) and diastolic Arterial pressure (BP) fall into different categories, then a higher degree of arterial hypertension (AH) is established. The most accurate degree of Arterial hypertension (AH) can be established in the case of newly diagnosed Arterial hypertension (AH) and in patients not taking antihypertensive drugs.

Table number 1. Definition and classification of blood pressure (BP) levels (mm Hg)

III. Criteria for risk stratification of patients with hypertension:

I. Risk factors:

a) Basic:
- men > 55 years old - women > 65 years old
- smoking.

b) Dyslipidemia
TC > 6.5 mmol/L (250 mg/dL)
HDLR > 4.0 mmol/L (> 155 mg/dL)
HSLPV

c) (in women

G) abdominal obesity: waist circumference > 102 cm for men or > 88 cm for women

e) C-reactive protein:
> 1 mg/dl)

e):

- Sedentary lifestyle
- Increased fibrinogen

and) Diabetes:
- Fasting blood glucose > 7 mmol/l (126 mg/dl)
- Blood glucose after a meal or 2 hours after ingestion of 75 g glucose > 11 mmol/L (198 mg/dL)

II. Target organ damage (stage 2 hypertension):

a) Left ventricular hypertrophy:
ECG: Sokolov-Lyon sign> 38 mm;
Cornell product > 2440 mm x ms;
EchoCG: LVMI > 125 g/m 2 for men and > 110 g/m 2 for women
Rg-graphy of the chest - cardio-thoracic index> 50%

b) (thickness of the intima-media layer of the carotid artery >

in)

G) microalbuminuria: 30-300 mg/day; urine albumin/creatinine ratio > 22 mg/g (2.5 mg/mmol) for men and >

III. Associated (comorbid) clinical conditions (stage 3 hypertension)

a) Main:
- men > 55 years old - women > 65 years old
- smoking

b) Dyslipidemia:
TC > 6.5 mmol/L (> 250 mg/dL)
or CHLDL > 4.0 mmol/L (> 155 mg/dL)
or HSLVP

in) Family history of early cardiovascular disease(among women

G) abdominal obesity: waist circumference > 102 cm for men or > 88 cm for women

e) C-reactive protein:
> 1 mg/dl)

e) Additional risk factors that negatively affect the prognosis of a patient with arterial hypertension (AH):
- Impaired glucose tolerance
- Sedentary lifestyle
- Increased fibrinogen

and) Left ventricular hypertrophy
ECG: Sokolov-Lyon sign> 38 mm;
Cornell product > 2440 mm x ms;
EchoCG: LVMI > 125 g/m 2 for men and > 110 g/m 2 for women
Rg-graphy of the chest - cardio-thoracic index> 50%

h) Ultrasound signs of thickening of the artery wall(thickness of the carotid intima-media layer >0.9 mm) or atherosclerotic plaques

and) Slight increase in serum creatinine 115-133 µmol/L (1.3-1.5 mg/dL) for men or 107-124 µmol/L (1.2-1.4 mg/dL) for women

to) microalbuminuria: 30-300 mg/day; urine albumin/creatinine ratio > 22 mg/g (2.5 mg/mmol) for men and > 31 mg/g (3.5 mg/mmol) for women

l) Cerebrovascular disease:
Ischemic stroke
Hemorrhagic stroke
Transient cerebrovascular accident

m) heart disease:
myocardial infarction
angina pectoris
Coronary revascularization
Congestive heart failure

m) kidney disease:
diabetic nephropathy
Renal failure (serum creatinine > 133 µmol/L (> 5 mg/dL) for men or > 124 µmol/L (> 1.4 mg/dL) for women
Proteinuria (>300 mg/day)

about) Peripheral artery disease:
Dissecting aortic aneurysm
Symptomatic peripheral arterial disease

P) Hypertensive retinopathy:
Hemorrhages or exudates
Optic nerve edema

Table number 3. Risk stratification of patients with arterial hypertension (AH)

Abbreviations in the table below:
HP - low risk,
UR - moderate risk,
VS - high risk.

Abbreviations in the table above:
HP - low risk of arterial hypertension,
UR - moderate risk of arterial hypertension,
VS - high risk of arterial hypertension.

A person may not even feel the onset of the disease - it is almost asymptomatic, but already in the second or third stage of hypertension, complications in the work of the kidneys, heart or brain are possible. In order to keep the disease under control, a person must change his lifestyle, strictly adhere to the recommendations of the doctor and constantly monitor the pressure.

Disease Definition

Doctors diagnose hypertension when a patient has persistent high blood pressure. The cause of hypertension is a violation of blood circulation in the body. The walls of the vessels thicken, the passage of blood flow is complicated. Narrower vessels make the heart spend more energy on pumping blood, and this leads to rapid wear of the myocardium. The narrowing of the passages of blood flow is influenced by many factors, including:

• constant stress;
• alcohol;
• smoking;
• excess weight;
• the presence of chronic diseases;
• salty and fried foods;
• hereditary predisposition;
• sedentary lifestyle.

Frequent headaches in the temporal part of the head are one of the first signs of increased pressure.

At the initial stage of the disease, with a correctly diagnosed diagnosis and following the doctor's recommendations, you can get rid of it, and at more advanced stages, keep the disease under control. It should also be remembered that each person is an individual organism, which chooses for itself the pressure that suits it. However, when the first symptoms of hypertension appear, you should consult a doctor. Signs of hypertension include:

• headache in the temples;
• fainting;
• sleep disturbance;
• noise in ears;
• chills;
• arrhythmia;
• weakness in the limbs;
• vomiting;
• squeezing pain in the eyes;
• numbness of the fingers and toes.

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Classification of hypertension by stages

Normally, the upper or systolic pressure should be 120 mm Hg. Art., and the lower, diastolic, equal to 80 mm Hg. The WHO classification of hypertension states that arterial hypertension occurs when the tonometer needle rises by 20 divisions, when the pressure is 140/90 mm Hg. Art. - comes the first degree of hypertension. Note that the WHO classification includes the division of hypertension into stages. Varieties of hypertension with respect to stages are presented in the table.

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Types of hypertension according to the level and stability of pressure

There are three stages of the disease, depending on the pressure indicators.

Hypertension is an insidious disease in which the first two stages can be asymptomatic, and in the third, due to neglect, irreversible changes in the body already occur. The WHO classification of hypertension also includes such stages in the development of the disease. For doctors, this division makes it possible to more accurately determine the stage of progression of hypertension.

• Soft - the pressure is unstable, is at a level of 140/60 mm Hg. Art. up to 159/99 mm Hg. Art.
• Moderate - the tonometer scale almost always keeps at a level of 160/100 mm Hg. Art. up to 179/109 mm Hg
• Severe - the pressure is consistently high from 180/110 mm Hg. Art. and higher.

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Classification of hypertension according to the degree of risk

The classification of GB includes an additional clarifying diagnosis, which sounds like a "degree of risks" - a concept that helps to find out what is the possibility of damage to internal organs due to hypertension. If there is a risk of 1 or 2, it means that the admissibility of damage to internal organs is at least 20%, and the factors affecting the aggravation of the disease are either less than three, or they are not at all. In the presence of risk 3, the possibility of organ damage increases to 30%, and a history of hypertension has more than three factors that affect the course of the disease. When the diagnosis sounds like a risk of 4, then most likely one of the target organs is already affected, or the likelihood of problems with the heart, kidneys or brain is about 40%. Those who:

• smokes;
• abuses alcohol;
• is overweight;
• is in chronic stress;
• has diseases of the endocrine system;
• leads a sedentary lifestyle.

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Type of hypertension according to the level of diastolic pressure

Elevated diastolic pressure threatens stroke, myocardial infarction.

Usually, if hypertension is diagnosed, then an increase in the levels of both upper and lower pressure is recorded, but there are times when the upper pressure remains normal, while the lower one jumps. This pressure is called isolated diastolic - this is one of the types of hypertension. Elevated diastolic pressure is recorded when the tonometer shows more than 90 mm Hg. Art. With an increase in pressure by 5 divisions, the risk of hemorrhagic stroke increases three times. The chance of getting a myocardial infarction is increased by more than 20%. When the tonometer rises by 10 divisions, the possibility of a stroke doubles, and a heart attack - by 40%.

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Types of hypertension according to the degree of target organ damage

With an increase in pressure by several points, the possibility of diseases of internal organs increases by the same percentage. Arterial hypertension has chosen several internal organs as targets and affects them. Damage to organs begins at 3, less often at late 2 degrees of hypertension. If there are disorders in the target organs, they will not work without failures, but you can minimize the risks by taking the right medications.

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Other classifications of hypertension

A visit to the doctor is mandatory in case of a benign course of the disease.

The classification of blood pressure includes a division into malignant and benign hypertension. With a benign variant of the development of hypertension, it slowly goes through all three stages of its development, affecting target organs. In a malignant course, the disease appears in childhood or adolescence, is difficult, immediately passes to the 3rd stage of development, affecting the brain and heart muscle. But this type of hypertension is rare.

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Diagnosis and treatment of hypertension

At the first signs of arterial hypertension, you should visit a doctor to establish an accurate diagnosis, as well as undergo an examination of the body and do an electrocardiogram, echocardiography, MRI of the head, examine the fundus, and take a urine test for protein. In order for the treatment of hypertension to be successful, the patient must follow a diet, daily routine and take medication.

A patient with hypertension should avoid noisy places, stuffy rooms, drinking alcohol, fatty and salty foods. It is necessary to strictly observe the regime of the day, walk in the fresh air and stick to a diet, as well as monitor the pressure - it must be measured twice a day. You should keep a diary where the readings of the tonometer will be noted, and there should also be a table that includes data on what medications the hypertensive patient takes, how he sleeps and what he eats.

Classification of hypertension by degrees and stages

• Classifications of hypertension
• Modern classification
• Certain types of hypertension

Hypertension is one of the most common pathologies of the cardiovascular system and is common throughout the world, especially in civilized countries. It is most susceptible to active people whose lives are full of actions and emotions. According to the classification, various forms, degrees and stages of hypertension are distinguished.

According to statistics, from 10 to 20% of adults in the world are sick. It is believed that half of them do not know about their disease: hypertension can occur without any symptoms. Half of the patients who receive this diagnosis go untreated, and of those who do, only 50% get it right. The disease develops equally often in both men and women, it occurs even in adolescent children. Mostly people are ill after 40 years. Half of all older people have been diagnosed with it. Hypertension often leads to stroke and heart attack and is a common cause of death, including among people of working age.

It is a disease of high blood pressure, which is scientifically called arterial hypertension. The latter term refers to any increase in blood pressure, regardless of the reasons. As for hypertension, which is also called primary or essential hypertension, it is an independent disease of unclear etiology. It should be distinguished from secondary, or symptomatic, arterial hypertension, which develops as a sign of various diseases: cardiac, renal, endocrine, and others.

Hypertension is characterized by a chronic course, a persistent and prolonged increase in pressure, not associated with pathologies of any organs or systems. This is a violation of the heart and the regulation of vascular tone.

Classifications of hypertension

Over the entire period of studying the disease, more than one classification of hypertension has been developed: according to the appearance of the patient, the reasons for the increase in pressure, etiology, the level of pressure and its stability, the degree of organ damage, the nature of the course. Some of them have lost their relevance, others continue to be used by physicians today, most often this is a classification by degree and stage.

In recent years, the upper limits of the pressure norm have changed. If more recently the value is 160/90 mm Hg. column was considered normal for an elderly person, today this figure has changed. According to WHO, for all ages, the upper limit of normal is 139/89 mm Hg. pillar. BP equal to 140/90 mm Hg. column, is the initial stage of hypertension.

The classification of pressure by level is of practical importance:

1. The optimal is 120/80 mm Hg. pillar.
2. Normal is in the range of 120/80–129/84.
3. Border - 130/85-139/89.
4. Hypertension 1 degree - 140/90-159/99.
5. AH 2 degrees - 160/100-179/109.
6. AH 3 degrees - from 180/110 and above.

The classification of hypertension is very important for the correct diagnosis and choice of treatment depending on the form and stage.

According to the very first classification, which was adopted at the beginning of the 20th century, hypertension was divided into pale and red. The form of pathology was determined by the type of patient. In the pale variety, the patient had an appropriate complexion and cold extremities due to spasms of small vessels. Red hypertension was characterized by vasodilatation at the time of an increase in arterial hypertension, as a result of which the patient's face turned red, it became covered with spots.

In the 30s, two more varieties of the disease were identified, which differed in the nature of the course:

1. The benign form is a slowly progressive disease, in which three stages were distinguished according to the degree of stability of pressure changes and the severity of pathological processes in the organs.
2. Malignant arterial hypertension progresses rapidly and often begins to develop at a young age. As a rule, it is secondary and has an endocrine origin. It usually proceeds hard: the pressure is constantly kept at high levels, there are symptoms of encephalopathy.

Origin classification is very important. It is necessary to distinguish primary (idiopathic) hypertension, which is called hypertension, from the secondary (symptomatic) form. If the first occurs for no apparent reason, then the second is a sign of other diseases and accounts for about 10% of all hypertension. Most often, there is an increase in blood pressure with renal, cardiac, endocrine, neurological pathologies, as well as as a result of the constant intake of a number of drugs.

Modern classification of hypertension

There is no single systematization, but most often doctors use the classification that was recommended by WHO and the International Society for Hypertension (ISH) in 1999. According to WHO, hypertension is classified primarily by the degree of increase in blood pressure, which are divided into three:

1. The first degree - mild (borderline hypertension) - is characterized by pressure from 140/90 to 159/99 mm Hg. pillar.
2. In the second degree of hypertension - moderate - AH is in the range from 160/100 to 179/109 mm Hg. pillar.
3. In the third degree - severe - the pressure is 180/110 mm Hg. pillar and above.

You can find classifiers in which 4 degrees of hypertension are distinguished. In this case, the third form is characterized by pressure from 180/110 to 209/119 mm Hg. column, and the fourth - very heavy - from 210/110 mm Hg. pillar and above. The degree (mild, moderate, severe) indicates only the level of pressure, but not the severity of the course and the patient's condition.

In addition, physicians distinguish three stages of hypertension, which characterize the degree of organ damage. Classification by stages:

1. I stage. The increase in pressure is insignificant and intermittent, the work of the cardiovascular system is not disturbed. Complaints in patients, as a rule, are absent.
2. II stage. Arterial pressure increased. There is an increase in the left ventricle. Usually there are no other changes, but there may be local or generalized vasoconstriction of the retina.
3. III stage. There are signs of organ damage:
   • heart failure, myocardial infarction, angina pectoris;
   • chronic renal failure;
   • stroke, hypertensive encephalopathy, transient circulatory disorders of the brain;
   • from the side of the fundus: hemorrhages, exudates, swelling of the optic nerve;
   • lesions of peripheral arteries, aortic aneurysm.

When classifying hypertension, options for increasing pressure are also taken into account. There are the following forms:

• systolic - only upper pressure is increased, lower - less than 90 mm Hg. pillar;
• diastolic - increased lower pressure, upper - from 140 mm Hg. pillar and below;
• systolic-diastolic;
• labile - the pressure rises for a short time and normalizes by itself, without drugs.

Certain types of hypertension

Some varieties and stages of the disease are not reflected in the classification and stand apart.

Hypertensive crises

This is the most severe manifestation of arterial hypertension, in which the pressure rises to critical levels. As a result, cerebral circulation is disturbed, intracranial pressure rises, and hyperemia of the brain occurs. The patient experiences severe headaches and dizziness, accompanied by nausea or vomiting.

Hypertensive crises, in turn, are divided according to the mechanism of pressure increase. With a hyperkinetic form, systolic pressure rises, with a hypokinetic form, diastolic pressure rises, with a eukinetic crisis, both upper and lower pressures increase.

Refractory hypertension

In this case, we are talking about arterial hypertension, which is not treatable with medications, that is, the pressure does not decrease even when using three or more drugs. This form of hypertension is easily confused with those cases where treatment is ineffective due to an incorrect diagnosis and the wrong choice of drugs, as well as due to non-compliance by patients with doctor's prescriptions.

white coat hypertension

This term in medicine means a condition in which an increase in pressure occurs only in a medical facility during pressure measurement. Do not leave such a seemingly harmless phenomenon unattended. According to doctors, a more dangerous stage of the disease may occur.

Features of hypertension of the 2nd degree

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WHO classification of hypertension

Irina Evgenievna Chazova

At the end of the century, it is customary to sum up the results of the development of mankind over the past century, evaluate the successes achieved and count the losses. At the end of the 20th century, the most sad result can be considered the epidemic of arterial hypertension (AH), with which we met the new millennium. A “civilized” lifestyle has led to the fact that 39.2% of men and 41.1% of women in our country have high blood pressure (BP).

At the same time, 37.1% and 58.0%, respectively, know that they have a disease, only 21.6% and 45.7% are treated, and only 5.7% and 17.5% are treated effectively. Obviously, this is the fault of both doctors who are not sufficiently persistent in explaining to patients the need for strict control of blood pressure and compliance with preventive recommendations to reduce the risk of such serious consequences of an increase in blood pressure, such as myocardial infarction and cerebral stroke, and patients who are often accustomed to neglecting their health. who are not fully aware of the danger of uncontrolled hypertension, which often does not manifest itself subjectively. At the same time, it has been proven that a decrease in the level of diastolic blood pressure by only 2 mm Hg. Art. leads to a decrease in the incidence of stroke by 15%, coronary heart disease (CHD) - by 6%. There is also a direct relationship between the level of blood pressure and the incidence of heart failure and kidney damage in hypertensive patients.

The main danger of elevated blood pressure is that it leads to the rapid development or progression of the atherosclerotic process, the occurrence of coronary artery disease, strokes (both hemorrhagic and ischemic), the development of heart failure, and kidney damage.

All these complications of hypertension lead to a significant increase in overall mortality, and especially cardiovascular. Therefore, according to the 1999 WHO/IOAG recommendations, “. The main goal of treating a patient with hypertension is to achieve the maximum reduction in the risk of cardiovascular morbidity and mortality.” This means that now for the treatment of patients with hypertension, it is not enough just to reduce the level of blood pressure to the required levels, but it is necessary to influence other risk factors as well. In addition, the presence of such factors determines the tactics, or rather, the “aggressiveness” of the treatment of patients with AH.

At the All-Russian Congress of Cardiologists, held in Moscow in October 2001, the “Recommendations for the Prevention, Diagnosis and Treatment of Arterial Hypertension” were adopted, developed by experts from the All-Russian Scientific Society of Cardiology on the basis of the recommendations of the WHO / MOAG 1999 and domestic developments. The modern classification of hypertension provides for the determination of the degree of increase in blood pressure (Table 1), the stage of hypertension (AH) and the risk group according to risk stratification criteria (Table 2).

Determination of the degree of increase in blood pressure

The classification of blood pressure levels in adults over 18 years of age is presented in Table. 1. The term "degree" is preferable to the term "stage", since the concept of "stage" implies progression over time. If the values ​​of systolic blood pressure (SBP) and diastolic blood pressure (DBP) fall into different categories, then a higher degree of arterial hypertension is established. The degree of arterial hypertension is established in the case of a newly diagnosed increase in blood pressure and in patients not receiving antihypertensive drugs.

Determining the stage of GB

In the Russian Federation, it is still relevant, especially when formulating a diagnostic conclusion, to use a three-stage classification of GB (WHO, 1993).

Stage I GB implies the absence of changes in the target organs identified during functional, radiological and laboratory studies.

Stage II hypertension suggests the presence of one or more changes in the target organs (Table 2).

Stage III GB is established in the presence of one or more associated (comorbid) conditions (Table 2).

When forming a diagnosis of HD, both the stage of the disease and the degree of risk should be indicated. In individuals with newly diagnosed arterial hypertension and those not receiving antihypertensive therapy, the degree of hypertension is indicated. In addition, detailing existing target organ damage, risk factors, and comorbid clinical conditions is recommended. The establishment of stage III of the disease does not reflect the development of the disease over time and the causal relationship between arterial hypertension and the existing pathology (in particular, angina pectoris). The presence of associated conditions makes it possible to attribute the patient to a more severe risk group and therefore requires the establishment of a higher stage of the disease, even if changes in this organ are not, according to the doctor, a direct complication of HD.

Table 1. Definition and classification of blood pressure levels

Table 2. Criteria for risk stratification

Identification of the risk group and treatment approaches

The prognosis of patients with hypertension and the decision on further tactics depends not only on the level of blood pressure. The presence of concomitant risk factors, the involvement of target organs in the process, as well as the presence of associated clinical conditions are no less important than the degree of arterial hypertension, and therefore the stratification of patients depending on the degree of risk has been introduced into the modern classification. In order to assess the total impact of several risk factors on the absolute risk of severe cardiovascular lesions, WHO/IOAG experts proposed a risk stratification into four categories (low, medium, high and very high risk - Table 3). The risk in each category is calculated based on the 10-year average risk of death from cardiovascular diseases, as well as the risk of stroke and myocardial infarction (from the Framingham study). To optimize therapy, it was proposed to divide all patients with AH according to the level of risk of cardiovascular complications (Table 3). The low-risk group includes men under 55 and women under 65 with grade 1 hypertension (mild, SBP 140–159 mmHg and/or DBP 90–99 mmHg) without any other risk factors. Among this category, the risk of cardiovascular disease within 10 years is usually less than 15%. These patients rarely come to the attention of cardiologists; as a rule, district therapists are the first to encounter them. Patients at low risk of cardiovascular complications should be advised to change their lifestyle for 6 months before the question of prescribing drugs is raised. However, if BP persists at the same level after 6–12 months of non-drug treatment, drug therapy should be initiated.

An exception to this rule are patients with the so-called borderline arterial hypertension - with SBP from 140 to 149 mm Hg. Art. and DBP from 90 to 94 mm Hg. Art. In this case, the doctor, after a conversation with the patient, may suggest that he continue to take measures related only to lifestyle changes in order to reduce blood pressure and reduce the risk of cardiovascular lesions.

The medium-risk group includes patients with 1st and 2nd degrees of arterial hypertension (moderate - with SBP 160–179 mm Hg and / or DBP 100–109 mm Hg) in the presence of 1–2 risk factors, which include smoking, an increase in the level of total cholesterol over 6.5 mmol / l, impaired glucose tolerance, obesity, a sedentary lifestyle, aggravated heredity, etc. The risk of cardiovascular complications in this category of patients is higher than in the previous one, and is 15–20% over 10 years of follow-up. These patients are also more often seen by GPs than by cardiologists. For patients in the intermediate risk group, it is desirable to continue lifestyle modification measures, and if necessary, to force them for at least 3 months before raising the question of prescribing drugs. However, if blood pressure reduction is not achieved within 6 months, drug therapy should be started.

Table 3. Distribution (stratification) by degree of risk

The next group - with a high risk of cardiovascular complications. It includes patients with 1st and 2nd degrees of arterial hypertension in the presence of three or more risk factors, diabetes mellitus or lesions of target organs, which include left ventricular hypertrophy and / or a slight increase in creatinine, atherosclerotic vascular damage, change retinal vessels; this group also includes patients with grade 3 arterial hypertension (severe - with SBP over 180 mm Hg and/or DBP over 110 mm Hg) in the absence of risk factors. Among these patients, the risk of cardiovascular disease for the next 10 years is 20-30%. As a rule, representatives of this group are “experienced hypertensive patients” who are under the supervision of a cardiologist. If such a patient comes for the first time to an appointment with a cardiologist or therapist, drug treatment should be started within a few days - as soon as repeated measurements confirm the presence of elevated blood pressure.

The group of patients with a very high risk of cardiovascular complications (more than 30% within 10 years) includes patients with the 3rd degree of arterial hypertension and the presence of at least one risk factor, as well as patients with the 1st and 2nd degrees of arterial hypertension. hypertension in the presence of such cardiovascular complications as cerebrovascular accident, ischemic heart disease, diabetic nephropathy, dissecting aortic aneurysm. This is a relatively small group of patients with hypertension - usually cardiologists, often hospitalized in specialized hospitals. Undoubtedly, this category of patients needs active medical treatment.

There is another group of patients that deserves special attention. These are patients with high normal blood pressure levels (SBP 130–139 mm Hg, DBP 85–89 mm Hg), who have diabetes mellitus and/or renal failure. They require early active drug therapy, as it has been shown that such treatment tactics prevent the progression of renal failure in this group of patients. It should be noted that the distribution of patients into groups based on the total risk of cardiovascular complications is useful not only for determining the threshold from which treatment with antihypertensive drugs should be started. It also makes sense for setting the level of blood pressure that should be achieved, and choosing the intensity of the methods to achieve it. Obviously, the higher the risk of cardiovascular complications, the more important it is to achieve the target level of blood pressure and adjust other risk factors.

Risk levels (risk of stroke or myocardial infarction in the next 10 years after the survey):

Low risk less than 15% (I level)

Average risk 15–20% (II level)

High risk 20–30% (level III)

Very high 30% or higher risk (level IV)

Classification of hypertension by stages and degrees: table

Hypertension is a pathology of the cardiovascular system, in which persistent high blood pressure is noted, which leads to dysfunctions of the corresponding target organs: heart, lungs, brain, nervous system, kidneys.

Hypertensive disease (AH) or arterial hypertension develops as a result of a malfunction in the work of higher centers that regulate the functions of the vascular system, neurohumoral and renal mechanisms.

The main clinical signs of GB:

• Dizziness, ringing and noise in the ears;
• Headache;
• Shortness of breath, a state of suffocation;
• Darkening and "stars" before the eyes;
• Pain in the chest, in the region of the heart.

There are different stages of hypertension. Determination of the degree of hypertension is carried out using the following methods and studies:

1. Biochemical blood test and urinalysis.
2. Ultrasound of the arteries of the kidneys and neck.
3. Electrocardiogram of the heart.
4. EchoCG.
5. Blood pressure monitoring.

Taking into account the risk factors and the degree of damage to target organs, a diagnosis is made and treatment is prescribed using medications and other methods.

Hypertension - definition and description

The main clinical signs of hypertension are sharp and persistent jumps in blood pressure, while blood pressure is consistently high, even if there is no physical activity and the patient's emotional state is normal. The pressure decreases only after the patient takes antihypertensive drugs.

• Systolic (upper) pressure - not higher than 140 mm. rt. Art.;
• Diastolic (lower) pressure - no higher than 90 mm. rt. Art.

If, during two medical examinations on different days, the pressure was higher than the established norm, arterial hypertension is diagnosed and adequate treatment is selected. GB develops in both men and women with approximately the same frequency, mainly after the age of 40 years. But there are clinical signs of GB in young people.

Arterial hypertension is often accompanied by atherosclerosis. One pathology complicates the course of another. Diseases that occur against the background of hypertension are called associated or concomitant. It is the combination of atherosclerosis and hypertension that causes death among the young, able-bodied population.

According to the mechanism of development, according to WHO, I distinguish primary or essential hypertension, and secondary or symptomatic. The secondary form occurs only in 10% of cases of diseases. The diagnosis of essential arterial hypertension is much more common. As a rule, secondary hypertension is a consequence of such diseases:

1. Various kidney pathologies, renal artery stenosis, pyelonephritis, hydronephrosis tuberculosis.
2. Thyroid dysfunction - thyrotoxicosis.
3. Disorders of the adrenal glands - Itsenko-Cushing's syndrome, pheochromocytoma.
4. Atherosclerosis of the aorta and coarctation.

Primary hypertension develops as an independent disease associated with impaired regulation of blood circulation in the body.

In addition, hypertension can be benign - that is, flowing slowly, with a slight deterioration in the patient's condition over a long period of time, the pressure can remain normal and increase only occasionally. It will be important to maintain pressure and maintain proper nutrition for hypertension.

Or malignant, when the pathology develops rapidly, the pressure rises sharply and remains at the same level, it is possible to improve the patient's condition only with the help of medications.

The pathogenesis of hypertension

An increase in pressure, which is the main cause and symptom of hypertension, occurs due to an increase in cardiac output of blood into the vascular bed and an increase in peripheral vascular resistance. Why is this happening?

There are certain stress factors that affect the higher centers of the brain - the hypothalamus and the medulla oblongata. As a result, there are violations of the tone of peripheral vessels, there is a spasm of arterioles in the periphery - including the kidney ones.

Dyskinetic and dyscirculatory syndrome develops, the production of Aldosterone increases - this is a neurohormone that participates in water-mineral metabolism and retains water and sodium in the vascular bed. Thus, the volume of blood circulating in the vessels increases even more, which contributes to an additional increase in pressure and swelling of the internal organs.

All these factors also affect blood viscosity. It becomes thicker, the nutrition of tissues and organs is disturbed. At the same time, the walls of the vessels become denser, the lumen becomes narrower - the risk of developing irreversible hypertension increases significantly, despite treatment. Over time, this leads to ellastofibrosis and arteriolosclerosis, which in turn provokes secondary changes in target organs.

The patient develops myocardial sclerosis, hypertensive encephalopathy, primary nephroangiosclerosis.

Classification of hypertension by stage

There are three stages of hypertension. It is this classification, according to WHO, that is considered traditional and was used until 1999. It is based on the degree of damage to target organs, which, as a rule, if treatment is not carried out and the doctor's recommendations are not followed, becomes more and more.

At stage I of hypertension, signs and manifestations are practically absent, therefore such a diagnosis is made very rarely. No target organ damage was noted.

At this stage of hypertension, the patient very rarely goes to the doctor, since there is no sharp deterioration in the condition, only occasionally the blood pressure "rolls over". However, if you do not consult a doctor and start treatment at this stage of hypertension, there is a risk of rapid progression of the disease.

II stage of hypertension is characterized by a steady increase in pressure. There are violations of the heart and other target organs: the left ventricle becomes larger and thicker, sometimes there are lesions of the retina. Treatment at this stage is almost always successful with the cooperation of the patient and the physician.

In stage III hypertension, all target organs are affected. The pressure is consistently high, the risk of myocardial infarction, stroke, coronary heart disease is very high. If such a diagnosis is made, then, as a rule, angina pectoris, renal failure, aneurysm, hemorrhages in the fundus are already noted in the anamnesis.

The risk of a sudden deterioration in the patient's condition is increased if the treatment is not carried out properly, the patient has stopped taking medication, abuses alcohol and cigarettes, or experiences psycho-emotional stress. In this case, a hypertensive crisis may develop.

Classification of arterial hypertension by degree

Such a classification is currently considered more relevant and appropriate than by stage. The main indicator is the patient's pressure, its level and stability.

1. Optimal - 120/80 mm. rt. Art. or below.
2. Normal - it is permissible to add no more than 10 units to the upper indicator, and no more than 5 units to the lower one.
3. Close to normal - indicators range from 130 to 140 mm. rt. Art. and from 85 to 90 mm. rt. Art.
4. Hypertension I degree - / 90-99 mm. rt. Art.
5. Hypertension II degree - / mm. rt. Art.
6. Hypertension III degree - 180/110 mm. rt. Art. and higher.

Hypertension of the III degree, as a rule, is accompanied by lesions of other organs, such indicators are characteristic of a hypertensive crisis and require hospitalization of the patient in order to carry out emergency treatment.

Risk stratification in arterial hypertension

There are risk factors that can lead to an increase in blood pressure and the development of pathology. The main ones are:

1. Age indicators: for men it is over 55 years old, for women - 65 years old.
2. Dyslipidemia is a condition in which the lipid spectrum of the blood is disturbed.
3. Diabetes.
4. Obesity.
5. Bad habits.
6. hereditary predisposition.

Risk factors are always taken into account by the doctor when examining a patient in order to make a correct diagnosis. It is noted that most often the cause of blood pressure surges is nervous overexertion, increased intellectual work, especially at night, and chronic overwork. This is the main negative factor according to WHO.

The second place is occupied by the abuse of salt. WHO notes - if you consume more than 5 grams daily. salt, the risk of developing arterial hypertension increases several times. The degree of risk increases if there are relatives in the family who suffer from high blood pressure.

If more than two close relatives are treated for hypertension, the risk becomes even higher, which means that the potential patient must strictly follow all the doctor's recommendations, avoid worries, give up bad habits and follow the diet.

Other risk factors, according to WHO, are:

• Chronic diseases of the thyroid gland;
• Atherosclerosis;
• Infectious diseases of a chronic course - for example, tonsillitis;
• The period of menopause in women;
• Pathology of the kidneys and adrenal glands.

Comparing the factors listed above, the patient's pressure indicators and their stability, the risk of developing such a pathology as arterial hypertension is stratified. If 1-2 adverse factors are identified in first-degree hypertension, then the risk is 1, according to the WHO recommendation.

If the adverse factors are the same, but hypertension is already of the second degree, then the risk from low becomes moderate and is designated as risk 2. Further, according to the WHO recommendation, if third-degree hypertension is diagnosed and 2-3 adverse factors are noted, risk 3 is established. Risk 4 implies a diagnosis of third-degree hypertension and the presence of more than three adverse factors.

Complications and risks of hypertension

The main danger of the disease is in the serious complications on the heart that it gives. For hypertension, combined with severe lesions of the heart muscle and left ventricle, there is a WHO definition - decapitated hypertension. The treatment is complex and lengthy, decapitated hypertension is always difficult, with frequent attacks, with this form of the disease, irreversible changes in blood vessels have already occurred.

By ignoring pressure surges, patients put themselves at risk of developing such pathologies:

• angina pectoris;
• myocardial infarction;
• Ischemic stroke;
• hemorrhagic stroke;
• Pulmonary edema;
• Dissecting aortic aneurysm;
• Detachment of the retina;
• Uremia.

If a hypertensive crisis occurs, the patient needs urgent help, otherwise he may die - according to WHO, it is this condition in hypertension that in most cases leads to death. The degree of risk is especially high for those people who live alone, and in the event of an attack, there is no one next to them.

It should be noted that it is impossible to completely cure arterial hypertension. If, with hypertension of the first degree, at the very initial stage, you begin to strictly control pressure and adjust your lifestyle, you can prevent the development of the disease and stop it.

But in other cases, especially if associated pathologies have joined hypertension, full recovery is no longer possible. This does not mean that the patient should give up on himself and abandon the treatment. The main measures are aimed at preventing sharp jumps in blood pressure and the development of a hypertensive crisis.

It is also important to cure all concomitant or associative diseases - this will significantly improve the patient's quality of life, help to keep him active and working until old age. Almost all forms of arterial hypertension allow you to play sports, lead a personal life and fully relax.

The exception is 2-3 degrees at a risk of 3-4. But it is in the power of the patient to prevent such a serious condition with the help of medicines, folk remedies and revision of their habits. A specialist will popularly tell about the classification of hypertension in the video in this article.

This article describes the essence of hypertension, its classification according to various principles, the characteristic features of the disease, the complications provoked by this disease.

What is hypertension?

Hypertension (AH) is a disease of the cardiovascular system of a chronic type, which is accompanied by an increase in blood pressure. leads to dysfunction of the heart, lungs, kidneys, brain, nervous system. Also called hypertension.

A number of factors contribute to the development of hypertension:

• person's age.
• his weight (the presence of excess weight).
• malnutrition: eating fatty, fried, salty foods.
• lack of vitamins and minerals.
• bad habits.
• psycho-emotional stress.
• wrong way of life.

A person is able to influence these factors, which means that he can prevent the development of hypertension, but there are factors that are due to nature, they cannot be influenced. These include: advanced age, genetic inheritance. With the aging of a person, the aging of his body occurs, the wear of organs and blood vessels. cholesterol plates accumulate on the walls of the vessels, which narrow the lumen of the vessels and lead to an increase in pressure (blood flow worsens).

Characteristic features of GB

According to the recommendations of the World Health Organization (WHO), normal pressure is with systolic (upper) pressure at the level of 120-140 mm Hg. and diastolic (lower) pressure of 80-90 mm Hg.

Men and women are equally susceptible to the development of this disease. Often, hypertension is accompanied by such a complication as, which mutually complicates the course of hypertension. Such a tandem is the cause of death for a person.

What doctors say about hypertension

Doctor of Medical Sciences, Professor Emelyanov G.V.:

I have been treating hypertension for many years. According to statistics, in 89% of cases, hypertension ends with a heart attack or stroke and the death of a person. Approximately two-thirds of patients now die within the first 5 years of disease progression.

The next fact is that it is possible and necessary to bring down the pressure, but this does not cure the disease itself. The only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension and is also used by cardiologists in their work is this. The drug acts on the cause of the disease, making it possible to completely get rid of hypertension. In addition, within the framework of the federal program, every resident of the Russian Federation can receive it IS FREE.

According to this principle, WHO divides hypertension into primary and secondary.

1. Primary- . A separate disease occurs due to dysfunction of the blood flow in the body.

Primary hypertension has five variants:

• Renal pathology: destruction of the vessels or membranes of the kidneys.
• Abnormalities of the endocrine system: diseases of the adrenal glands serve as an impetus for development.
• Accompanied destruction of the nervous system. ICP is the result of trauma, a brain tumor.
• hemodynamic: abnormality of the heart and blood vessels.
• Medication: poisoning due to an overdose of a drug.

1. Secondary- symptomatic hypertension. The disease manifests itself as a consequence of some other disease:

• Kidney dysfunction, narrowing of the renal arteries, inflammation of the kidneys.
• Thyroid dysfunction - hyperthyroidism.
• adrenal dysfunction - hypercortisolism syndrome, pheochromoblastoma.
• Atherosclerosis, coarctation of the aorta.

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Classification of hypertension by stages

1. I stage- increase in pressure, internal organs are not changed, their functionality is not impaired.
2. II stage- increased pressure accompanied by the transformation of internal organs: hypertrophy of the left ventricle of the heart, coronary heart disease, modification of the fundus.

At least one of the symptoms of organ dysfunction is present:

• Hypertrophy of the left ventricle of the heart.
• General or segmental angiopathy of the retina.
• A significant amount of protein in the urine, an increased content of creatinine.
• Examination of the vessels revealed symptoms of vascular atherosclerosis.

1. III stage- an increase in pressure, accompanied by a change in internal organs and their functionality. This stage can lead to the development of a hypertensive crisis.

Classification of GB according to the stages of its development

1. Initial stage. Belongs to the transient. The main symptom is an unstable increase in pressure during the day (sometimes a simple increase, sometimes jumps). at this stage, a person does not notice the disease, complains about weather conditions, etc. The person feels normal.
2. stable stage. She has high blood pressure for a long time. It is accompanied by poor health, blurred vision, pain in the head. Hypertension progresses gradually, affecting important organs and primarily the heart.
3. sclerotic stage. Vessels change into atherosclerotic ones, and other organs are also affected. The combination of these processes aggravates the overall picture of the disease.

Video

According to the nature of the disease, there is hypertonic disease:

• Benign or slow flowing. The disease is of a long-term nature of development, the symptoms tend to increase gradually. The patient is in good health. There are periods of exacerbation, which is of a short nature, and remissions. This type of GB is treatable.
• Malignant. The disease has a transience feature, proceeds with severe exacerbations and is life threatening. This species is difficult to control and difficult to treat.

Classification of GB according to the level of blood pressure

The presented classification is the most relevant and practical. Because the main thing for the understanding of hypertension are their changes.

Table

The last III degree of hypertension carries with it the development of a hypertensive crisis, which has deplorable consequences.

Risk factors

If we consider the causes of the appearance of hypertension, then they include the following:

• Age: men over 55, women over 65.
• Violation of the ratio of lipids in human blood.
• Diabetes.
• Overweight.
• Bad habits.
• Heredity.
• Nervous tension.
• Excessive consumption of salty, fried and fatty foods.

In accordance with the symptoms of manifestations of hypertension, their effect on the organs, they distinguish four types of risk namely:

1. Risk 1. Found 1-2 factors of manifestation, hypertension 1 degree. Other organs are not affected, the possible occurrence of death in the next ten years is minimal - 10%.
2. Risk 2. Hypertensive disease of the 2nd degree, the manifestation factors are unchanged. One of the target organs is affected, the possible onset of death in the next decade is 15-20%.
3. Risk 3. Hypertensive disease of the 3rd degree, 2-3 manifestation factors were found. There are complications that worsen the course of the disease. The probability of death is 25-30%.
4. Risk 4. Hypertensive disease of the 3rd degree, but there are more than three factors. All important target organs are affected, the probability of death is high - 35% or more.

The sympathetic nervous system has a significant influence on hypertension, namely the state of its tension. This complex of symptoms is called sympathicotonia, when the tone of the sympathetic nervous system exceeds the tone of the parasympathetic nervous system. Manifested due to excessive consumption of sodium, alcohol, smoking, etc.

Sympathicotonia increases heart rate, vascular tone and total peripheral vascular resistance. Increases the load on the vessels and increases the pressure.

What are the complications of hypertension?

The primary threat of hypertension is a complication in the work of the heart and blood vessels. According to WHO, decapitation hypertension is hypertension in combination with damage to the heart and left ventricle. This type of hypertension has irreversible consequences and difficult treatment.

If pressure drops are not treated, then pathology may occur in the work of any organ. May develop:

• Angina.
• Myocardial infarction.
• Brain infarction.
• Acute cerebrovascular accident with vascular rupture.
• Swelling of the lungs.
• Detachment of the retina.

Survey plan

1. The first step is to measure your resting blood pressure. The measurement must be taken at least twice with a break of a couple of minutes on each hand. One hour before the start of the procedure, you can not expose yourself to physical exertion, drink alcohol, coffee, smoke, take antihypertensive drugs. If this is the primary measurement, it is better to repeat the additional during the day in order to achieve the accuracy of the result. Patients under 20 years of age and over 50 years of age should additionally measure the pressure on each leg.
2. It is necessary to pass a general blood test, which is carried out in the morning on an empty stomach. If hypertension is prolonged, then the level of red blood cells, hemoglobin can be increased.
3. It is necessary to pass a general urine test in the morning.
4. Analysis of daily urine, which is collected every three hours in a separate jar.
5. It is necessary to conduct a biochemical blood test.
6. An ECG is performed to determine if the left ventricle is affected.
7. Echocardiography is performed to determine the presence of a hypertensive heart.
8. An examination of the fundus is carried out for the presence of changes in it.
9. Phonocardiography is performed to determine the tone of the heart. If hypertrophy develops, then the size of the oscillations of the first tone decreases. Heart failure is characterized by the third and fourth tone.
10. Rheoencephalography is performed to determine vascular tone.

Differential Diagnosis

A differential diagnosis is required to exclude a disease that is not suitable for certain symptoms and manifestations, in order to diagnose one suitable disease as a result.

There are many diseases that have common manifestations with HD, but also differ:

The syndrome of high blood pressure to the maximum permissible values ​​is defined as arterial hypertension. When the patient's blood pressure rises above 140/90 mm Hg, a hypertensive crisis, heart attack, stroke develops. The classification of the stages of hypertension occurs according to stages, forms, degrees, risks. How can a hypertensive person understand these terms?

Classification of arterial hypertension

With hypertension in a patient, the pressure rises pathologically in the range from 140/90 mm Hg. up to 220/110. The disease is accompanied by hypertensive crises, the risk of myocardial infarction and stroke. A common classification of arterial hypertension is by cause of occurrence. Depending on what became the impetus and the root cause of the increase in blood pressure (BP), there are:

• Primary hypertension is a disease, the cause of which cannot be identified as a result of instrumental (ultrasound of the heart, cardiogram) and laboratory (blood, urine, plasma) studies. Hypertension with an unexplained cause in history is defined as idiopathic, essential.

Hypertension with primary hypertension will have to maintain normal blood pressure (120/80) throughout life. Because there is always a risk that the disease will recur. Therefore, idiopathic arterial hypertension is classified as a chronic form. Chronic hypertension, in turn, is divided into health risks, degrees, stages.

• Secondary hypertension is a disease whose cause can be determined in the course of medical research. The classification of the disease originates from the pathology or factor that launched the process of increasing blood pressure.

Primary and secondary arterial hypertension is classified depending on the increase in blood pressure:

Classification according to the form of the course of the disease

It's important to know!

Vessels get dirty very quickly, especially in older people. To do this, you do not need to eat burgers or french fries all day long. It is enough to eat one sausage or scrambled eggs so that some amount of cholesterol is deposited in the vessels. Over time, pollution builds up...

Arterial hypertension occurs in the body in two forms - benign, malignant. Most often, a benign form, in the absence of adequate timely therapy, passes into a pathological malignant form.

With benign hypertension, a person begins to gradually increase blood pressure - systolic, diastolic. This process is slow. The cause must be sought in the pathologies of the body, as a result of which the work of the heart is disrupted. The patient's blood circulation is not disturbed, the volume of circulating blood is preserved, but the tone of the vessels, their elasticity are reduced. The process can take several years and persist throughout life.

The malignant form of hypertension progresses rapidly. Example: today the patient's blood pressure is 150/100 mmHg, after 7 days it is already 180/120 mmHg. At this moment, the patient's body is affected by a malignant pathology, which "makes" the heart beat ten times faster. The walls of blood vessels retain their tone and elasticity. But, myocardial tissues cannot cope with the increased rate of blood circulation. The cardiovascular system can not cope, the vessels spasm. The state of health of hypertensive patients deteriorates sharply, blood pressure rises to a maximum, the risk of myocardial infarction, cerebral stroke, paralysis, and coma increases.

With a malignant form of hypertension, blood pressure rises to 220/130 mm Hg. The internal organs and vital systems undergo serious changes: the fundus of the eye fills with blood, the retina swells, the optic nerve becomes inflamed, the vessels narrow. The heart, kidneys, brain tissues undergo necrosis. The patient complains of unbearable heart, headaches, loss of vision, dizziness, fainting.

Stages of arterial hypertension

Hypertension is divided into stages, which differ in blood pressure values, symptoms, risk, complications, disability. The classification of the stages of hypertension is as follows:

• Stage 1 hypertension proceeds with indicators of 140/90 mm Hg. and higher. You can normalize these values ​​without medication, with the help of rest, lack of stress, nervousness, intense physical exertion.

The disease is asymptomatic. A hypertensive person does not notice changes in health. Target organs at the 1st stage of the increase in blood pressure do not suffer. Rarely, there are violations of well-being under the guise of insomnia, heart, headaches.

Hypertensive crises can occur against the background of a change in the weather, after nervosa, stress, shock, physical activity. Treatment consists in maintaining a healthy lifestyle, drug therapy. The prognosis for recovery is favorable.

Hypertensive crisis leads to stroke, heart attack. The patient needs constant medical treatment. A hypertensive person can issue a disability group for health reasons.

• Stage 3 hypertension is difficult, the patient's blood pressure is 180/110 mm Hg. and higher. In hypertensive patients, target organs are affected: kidneys, eyes, hearts, blood vessels, brain, respiratory tract. Antihypertensive drugs do not always lower high blood pressure. A person is not able to serve himself on his own, he becomes disabled. An increase in blood pressure to 230/120 increases the risk of death.

The WHO classification of hypertension (given above) is necessary for a full scale assessment of the disease in order to choose the right treatment tactics. Optimally selected drug therapy is able to stabilize the well-being of a hypertensive patient, avoid hypertensive crises, the occurrence of risks of hypertension, and death.

IT'S IMPORTANT TO KNOW!

In 90-95% of people, high blood pressure develops regardless of lifestyle, being a risk factor for diseases of the brain, kidneys, heart, vision, AS WELL AS HEART HEART AND STROKE! In 2017, scientists discovered a relationship between the mechanisms of pressure increase and blood clotting factor.

Hypertension is divided according to the indications of blood pressure in degrees: from 1st to 3rd. To determine the tendency to hypertension, it is necessary to measure blood pressure in both arms. The difference is 10-15 mm Hg. between blood pressure measurements indicates cerebrovascular disease.

Vascular surgeon Korotkov introduced the method of sound, auscultatory measurement of blood pressure. The optimal pressure is considered to be 120/80 mm Hg, and normal - 129/89 (a state of prehypertension). There is a concept of high-normal blood pressure: 139/89. Directly the classification of hypertension itself by degree (in mmHg) is as follows:

• 1st degree: 140-159/85-99;
• 2nd degree: 160-179/100-109;
• 3rd degree: above 180/110.

The determination of the degree of hypertension occurs against the background of the complete absence of drug treatment with antihypertensive drugs. If the patient is forced to take medication for health reasons, then the measurement is carried out at the maximum reduction in their dosage.

In some medical sources, you can find a mention of arterial hypertension of the 4th degree (isolated systolic hypertension). The condition is characterized by an increase in upper pressure with a normal lower one - 140/90. The clinic is diagnosed in the elderly and patients with hormonal disorders (hyperthyroidism).

A hypertensive person in his diagnosis sees not only a disease, but also a degree of risk. What does risk mean in hypertension? Under the risk you need to understand the percentage of the likelihood of developing a stroke, heart attack, and other pathologies against the background of hypertension. Classification of hypertension according to the degree of risk:

• Low risk 1 is 15% that in the next 10 years a hypertensive person will develop a heart attack, cerebral stroke;
• Average risk of 2 implies a 20% chance of complications;
• High risk 3 is 30%;
• Very high risk 4 increases the likelihood of complications of well-being by 30-40% or more.

There are 3 main criteria for risk stratification for patients with hypertension: risk factors, the degree of damage to target organs (occurs with stage 2 hypertension), additional pathological clinical conditions (diagnosed at stage 3 of the disease).

Consider the main criteria, risk factors:

• The main ones: in women, men over 55 years old, in smokers;
• Dyslipidemia: total cholesterol more than 250 mgdl, low-density lipoprotein cholesterol (HLDL) more than 155 mg/dl; HDL (high density) more than 40 mg/dl;
• History of hereditary (hypertension in relatives in a straight line);
• C-reactive protein more than 1 mg/dl;
• Abdominal obesity - a condition when the waist circumference of women exceeds 88 cm, men - 102 cm;
• Hypodynamia;
• Impaired glucose tolerance;
• Excess of febrinogen in the blood;
• Diabetes.

At the second stage of the disease, damage to internal organs begins (under the influence of increased blood flow, spasm of blood vessels, oxygen and nutrient deficiency), the functioning of internal organs is disrupted. The clinical picture of stage 2 hypertension is as follows:

The last 2 indicators indicate kidney damage.

Concomitant clinical conditions (when determining the threat of arterial hypertension) are understood as:

• heart disease;
• Pathology of the kidneys;
• Physiological impact on the coronary arteries, veins, vessels;
• Inflammation of the optic nerve, bruising.

Risk 1 is set for elderly patients over 55 years of age without concomitant aggravating pathologies. Risk 2 is prescribed in the diagnosis of hypertensive patients with the presence of several of the factors described above. Risk 3 aggravates the disease in patients with diabetes mellitus, atherosclerosis, left gastric hypertrophy, renal failure, and damage to the organs of vision.

In conclusion, we remind you that arterial hypertension is considered an insidious, dangerous disease due to the absence of primary symptoms. The clinic of pathologies is most often benign. But, this does not mean that the disease will not pass from the first stage (with BP 140/90) to the second (BP 160/100 and above). If the 1st stage is stopped by medications, then the 2nd one brings the patient closer to disability, and the 3rd one brings the patient closer to lifelong disability. Hypertension in the absence of adequate timely treatment ends with damage to target organs, death. Do not risk your health, always keep a tonometer at hand!

Occurs in impressionable, emotional people.

The mechanism of origin and development of hypertension is quite complicated.

The main reason for the appearance of deviations are disorders that have arisen in the departments of the nervous and endocrine systems responsible for control.

As a rule, such manifestations are caused by a permanent one in which most modern people live. Staying in negatively affects the inhibitory and activating signals of the brain.

As a result, there is an increase in the activity of the sympathetic nervous system, which provokes vasospasm and associated negative changes, discomfort.

If left untreated, hypertension can worsen, gradually flowing into a chronic disease. If you start therapy when initial symptoms are detected, it is possible.

Disease classification

Since the symptoms have different intensities, experts have identified separate stages and degrees of hypertension.

This made it possible to determine treatment options that effectively eliminate symptoms of varying intensity and maintain the patient's health in a satisfactory condition.

Today, medicine uses the generally accepted classification of hypertension, which clearly defines blood pressure thresholds and symptoms that allow you to quickly diagnose the severity of the disease and choose the right set of therapeutic measures.

Data on the stages and degrees of the disease are in the public domain. But, even despite the availability of open data on the Web, you should not engage in self-diagnosis and self-treatment, since in such situations the probability of making an incorrect diagnosis is quite high.

In the case of hypertension, incorrectly taken measures can only aggravate the symptoms, provoke a further and more intensive development of the disease and lead to.

Today, when diagnosing and choosing therapeutic procedures that can improve the patient's condition, two options for systematizing symptoms are used.

The main classification of GB is due to the division of indicators into stages and degrees. Also in medical practice, separation according to is often used.

Classification of GB by stages

The stages of hypertension, a table with which was derived from data obtained in the course of research by the World Health Organization (WHO), is one of the basic sources of information that doctors use in the diagnostic process.

The classification is based mainly on symptoms, accompanied by certain sensations for each individual stage:

• 1 stage. This is characterized by an unstable, often slight increase in blood pressure. At the same time, dangerous or irreversible changes do not occur in the tissues of internal organs;
• 2 stage. This stage is characterized by a steady increase in blood pressure. At the second stage, changes are already taking place in the internal organs, but their functionality has not yet been affected. Possible simultaneous violations in the tissues of one or more organs: kidneys, heart, retina, pancreas and;
• 3 stage. There is a significant increase in pressure, accompanied by numerous severe symptoms and serious violations of the internal organs.

Possible consequences of stage 3 hypertension may include:

• retinal depletion;
• violation of blood circulation in the tissues of the brain;
• violation of the normal functioning of the kidneys and adrenal glands;
• atherosclerosis.

These effects can occur in combination or separately from each other. In any case, the classification of pathology by stages allows you to accurately determine the extent of the disease and correctly choose ways to deal with existing disorders.

Classification of arterial hypertension by degree

In addition, modern medicine also uses another classification of hypertension. These are degrees based on the level of blood pressure.

This system was introduced in 1999, and since then it has been successfully used alone or in combination with other classifications to determine the extent of the disease and the correct choice of treatment methods.

So, the following degrees of arterial hypertension are distinguished:

• . Doctors also call this degree of GB “mild”. At this stage, the pressure does not exceed 140-159 / 90-99 mm Hg;
• . Blood pressure in moderate hypertension reaches 160-179 / 100-109 mm Hg, but does not exceed the specified limits;
• . This is a severe form of the disease in which blood pressure reaches and may even exceed the specified limits.

In the second and third degree of GB, 1,2,3 and 4 risk groups are distinguished.

As a rule, the disease begins with the slightest organ damage and over time, the risk group grows due to an increase in the number of pathological changes in the tissues of the organs.

In this classification, there are also such concepts as normal and high. In the first case, the blood pressure indicator is 120/80 mm Hg, and in the second case it is in the range of 130-139/82-89 mm Hg.

High normal pressure is not dangerous to health and life, therefore, in 50% of cases, correction of the patient's condition is not required.

Risks and Complications

In itself, an increase in pressure for the body does not pose any danger. Harm to health is caused by risks, which, depending on the severity, can lead to a variety of consequences. In total, doctors distinguish 4 risk groups.

To clarify, doctors make a conclusion as follows: hypertension grade 2, risk 3. In order to determine the risk group during the examination, doctors take into account many factors.

So, the following groups of risks are distinguished:

• 1 group (small). The degree of risk of negative effects on the heart and blood vessels is extremely small;
• group 2 (medium). The risk of complications is 15-20%. At the same time, health problems due to GB occur after about 10-15 years;
• 3 group (high). The chance of complications with such symptoms is 20-30%;
• 4 group (very high). This is the most dangerous group, the risk of complications in which is at least 30%.

The high-risk group includes patients over 55 years of age and those with a hereditary predisposition to hypertension.

As a rule, hypertension of groups 3 and 4 most often occurs in those who have bad habits and increased.

Symptoms

Symptoms of hypertension can be very different. But often at the initial stage, patients do not take into account the alarming “bells” that the body gives them.

Most often, such general manifestations as excessive sweating, weakness, distracted attention, and shortness of breath are perceived by the patient as beriberi or overwork, so there is no question of measuring blood pressure. In fact, these signs are evidence of the initial stage of hypertension.

If we consider the symptoms in more detail, all the signs can be divided into groups, according to the stages of development of the disease:

• 1 stage. At this stage, the patient has not yet experienced changes in tissues and organs. The first stage of hypertension is easily eliminated. The main thing is a timely appeal to the doctor and constant. These measures will slow down the development of the disease;
• 2 stage. In the second stage, the main load falls on one of. It may increase in size. Accordingly, the patient feels. At the same time, other organs do not bother him;
• 3 stage. This degree significantly expands the range of affected organs. For this reason, the occurrence of heart attacks, strokes, heart failure. Also, in most cases, the development of renal failure and hemorrhage in the vessels of the eyeballs occurs.

Related videos

About how hypertension is classified in the video:

In order to minimize the consequences of hypertension and prevent irreversible consequences, it is recommended to seek medical help as soon as alarming symptoms are detected. Regular examinations and visits to specialists for preventive purposes are also possible.