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Arterial hypertension WHO. What is the classification for hypertension? Development of views on the classification of hypertension

In significant numbers cases of arterial hypertension preceded by the so-called “borderline arterial hypertension” (PAH), although not everyone causes the development of hypertension.

Diagnosis borderline arterial hypertension is established when the level of systolic blood pressure (BP) does not exceed 150 mm Hg. Art. diastolic - 94 mm Hg. Art. and with repeated measurements over a period of 2-3 weeks without the use of antihypertensive therapy, normal blood pressure values ​​are revealed.

When diagnosing essential arterial hypertension and an essential step is differentiation from secondary hypertension: renal, endocrine, cerebral origin. AH is established in the absence of these forms.

According to WHO classification stages of arterial hypertension are distinguished. The first stage is understood as an increase in blood pressure as such. The second stage is characterized not only by an increase in blood pressure, but also by damage to target organs (the presence of left ventricular hypertrophy, changes in the vessels of the fundus, kidneys). In the third stage, arteriolosclerosis of various organs is additionally added. In addition, arterial hypertension is divided according to the level of blood pressure: when the systolic blood pressure is not higher than 179 mm Hg. Art. and diastolic 105 mm Hg. Art. mild hypertension is diagnosed; with systolic blood pressure 180-499 mm Hg. Art. and diastolic 106-114 mm Hg, st. - moderate hypertension; with systolic blood pressure over 200 mm Hg. Art. and diastolic more than 115 mm Hg. Art. - high hypertension, with a systolic blood pressure value of more than 160 mm Hg. Art. and diastolic less than 90 mm Hg. Art. Isolated systolic hypertension is diagnosed.

WHO classification based on blood pressure levels has become widespread in Europe and the USA. It is taking into account the level of diastolic blood pressure that most randomized studies have been conducted. But epidemiological work in recent years has shown the importance of the value and level of systolic blood pressure. With its high numbers, the risk of cardiovascular complications in patients with hypertension is as great as with high diastolic blood pressure. It should be noted that the term “mild” hypertension does not at all correspond to the prognostic value of this condition. The share of mild hypertension is 70% among all forms of arterial essential hypertension. But it is mild hypertension that affects more than 60% of patients with cerebrovascular accidents (Arabidze G. G. 1995].

Arterial hypertension develops slowly, often over 10 years. In a small proportion of patients with hypertension, a transition to a malignant form is possible when fibrinous-necrotic changes develop in the arterioles. Heart and kidney failure develop, blindness and severe early disability occur. Life expectancy for this form is less than 5 years. Malignant hypertension, apparently, can also be the result of primary vasculitis.

Despite the predominance of complications in the late stage, even the presence of mild and moderate arterial hypertension. according to numerous long-term cooperative studies, it increases the incidence of major complications and atherosclerosis several times compared to normotension. This implies the need to treat even the mildest forms of hypertension.

New approaches to the classification and treatment of arterial hypertension. 1999 World Health Organization and International Society of Hypertension guidelines.

B.A.Sidorenko, D.V.Preobrazhensky, M.K.Peresypko

Medical Center of the Administration of the President of the Russian Federation, Moscow

Arterial hypertension (AH) is the most common cardiovascular syndrome in many countries of the world. For example, in the United States, high blood pressure (BP) is found in 20-40% of the adult population, and in age groups over 65 years, hypertension occurs in 50% of the white and 70% of the black race. More than 90-95% of all cases of hypertension are hypertension. In other patients, a thorough clinical and instrumental examination can diagnose a variety of secondary (symptomatic) hypertension. It should be taken into account that in 2/3 of cases, secondary hypertension is caused by damage to the kidney parenchyma (diffuse glomerulonephritis, diabetic nephropathy, polycystic kidney disease, etc.), and therefore is potentially incurable. Treatment of renal hypertension is generally no different from the treatment of hypertension.

Consequently, in the vast majority of patients with hypertension, long-term drug therapy is carried out regardless of whether the exact cause of high blood pressure is known or not.

The long-term prognosis in patients with hypertension depends on three factors: 1) the degree of increase in blood pressure, 2) damage to target organs and 3) concomitant diseases. These factors must be reflected in the diagnosis of a patient with hypertension.

Since 1959, experts from the World Health Organization (WHO) have periodically published recommendations for the diagnosis, classification and treatment of hypertension based on the results of epidemiological and clinical studies. Since 1993, such recommendations have been prepared by WHO experts together with the International Society of Hypertension (ISH). From September 29 to October 1, 1998, the 7th meeting of WHO and MTF experts took place in the Japanese city of Fukuoka, at which new recommendations for the treatment of hypertension were approved. These recommendations were published in February 1999. Therefore, in the literature, new recommendations for the treatment of hypertension are usually dated back to 1999 - 1999 WHO-ISH guidelines for the management of hypertension (1999 WHO-ISH guidelines for the treatment of hypertension).

In the 1999 WHO-IOG recommendations, hypertension is defined as a systolic blood pressure level of 140 mm Hg. Art. or more, and (or) a diastolic blood pressure level equal to 90 mm Hg. Art. or more, in people who are not receiving antihypertensive drugs. Given the significant spontaneous fluctuations in blood pressure, the diagnosis of hypertension should be based on the results of repeated blood pressure measurements during several visits to the doctor.

WHO-ITF experts proposed new approaches to the classification of hypertension. The new classification proposes to abandon the use of the terms “mild”, “moderate” and “severe” forms of hypertension, which were used, for example, in the 1993 WHO-IOG recommendations. To characterize the degree of increase in blood pressure in patients with hypertension, it is now recommended to use the following terms: as grade 1, grade 2 and grade 3 disease. It should be noted that the 1999 classification tightened the criteria for distinguishing between different degrees of severity of hypertension (Table 1).

Table 1. Comparison of criteria for the severity of hypertension in the classifications of WHO and MTF experts in 1993 (1996) and 1999.

Classification 1993(1996)

Hypertension. Classification of hypertension.

Diagnosis of hypertension(essential, primary arterial hypertension) is established by excluding secondary (symptomatic) arterial hypertension. The definition of “essential” means that persistently elevated blood pressure in hypertension is the essence (main content) of this arterial hypertension. No changes in other organs that could lead to arterial hypertension are found during routine examination.

Frequency of essential arterial hypertension accounts for 95% of all arterial hypertension (with a thorough examination of patients in specialized hospitals, this value decreases to 75%).

Genetic aspects.

- Family history. Allows you to identify hereditary predisposition to hypertension of a polygenic nature.

— There are many genetically determined disorders of the structure and function of cell membranes of both excitable and non-excitable types in relation to the transport of Na+ and Ca2+.

Etiology of hypertension.

— The main cause of hypertension: repeated, usually prolonged, psycho-emotional stress. The stress reaction is of a pronounced negative emotional nature.

— The main risk factors for hypertension (conditions contributing to the development of hypertension) are presented in the figure.

Factors involved in the development of hypertension

Excess Na+ causes (among other things) two important effects:

— Increased transport of fluid into cells and their swelling. Swelling of the cells of the walls of blood vessels leads to their thickening, narrowing of their lumen, increased vascular rigidity and a decrease in their ability to vasodilate.

— Increased sensitivity of myocytes of the walls of blood vessels and the heart to vasoconstrictor factors.

— Disorders of the functions of membrane receptors that perceive neurotransmitters and other biologically active substances that regulate blood pressure. This creates a condition for the dominance of the effects of hypertensive factors.

— Disturbances in the expression of genes that control the synthesis of vasodilatory agents (nitric oxide, prostacyclin, PgE) by endothelial cells.

Environmental factors. Occupational hazards are of greatest importance (for example, constant noise, the need for attention); living conditions (including utilities); intoxication (especially alcohol, nicotine, drugs); brain injuries (bruises, concussions, electrical trauma, etc.).

Individual characteristics of the body.

- Age. With age (especially after 40 years), hypertensive reactions mediated by the diencephalic-hypothalamic region of the brain (they are involved in the regulation of blood pressure) to various exo- and endogenous influences dominate.

- Increased body weight, high serum cholesterol, excess renin production.

— Features of the CVS reaction to stimuli. They consist in the dominance of hypertensive reactions to a variety of influences. Even minor emotional (especially negative) influences, as well as environmental factors, lead to a significant increase in blood pressure.

Classification of hypertension

In Russia, a classification of hypertension has been adopted (WHO classification, 1978), presented in the table

Table. Classification of hypertension

Stage I of hypertension - increased blood pressure more than 160/95 mm Hg. without organic changes in the cardiovascular system

Stage II of hypertension - increased blood pressure more than 160/95 mm Hg. in combination with changes in target organs (heart, kidneys, brain, fundus vessels) caused by arterial hypertension, but without disruption of their functions

Stage III of hypertension - arterial hypertension combined with damage to target organs (heart, kidneys, brain, fundus) with impairment of their functions

Forms of essential arterial hypertension.

- Borderline. A type of essential arterial hypertension observed in young and middle-aged people, characterized by fluctuations in blood pressure from normal to 140/90-159/94 mm Hg. Normalization of blood pressure occurs spontaneously. There are no signs of target organ damage typical for essential arterial hypertension. Borderline hypertension occurs in approximately 20-25% of individuals; In 20-25% of them, essential arterial hypertension then develops; in 30%, borderline arterial hypertension persists for many years or throughout life; in the rest, blood pressure normalizes over time.

- Hyperadrenergic. It is characterized by sinus tachycardia, unstable blood pressure with a predominance of the systolic component, sweating, facial flushing, anxiety, and throbbing headaches. It manifests itself in the initial period of the disease (in 15% of patients it persists in the future).

— Hyperhydration (sodium-, volume-dependent). Manifested by swelling of the face and paraorbital areas; fluctuations in diuresis with transient oliguria; when using sympatholytics - sodium and water retention; pale skin; constant bursting headaches.

- Malignant. A rapidly progressing disease with an increase in blood pressure to very high values ​​with visual impairment, the development of encephalopathy, pulmonary edema, and renal failure. Malignant essential arterial hypertension often develops with symptomatic arterial hypertension.

They call a disease that involves any persistent excess of blood pressure relative to standard normal figures (120/80 mm Hg). Based on diagnostic data, the doctor determines the type of hypertension and determines treatment tactics. The article describes in detail the classification of the disease.

Stages of arterial hypertension

The disease develops gradually, going through several stages. Typically, the patient consults a doctor in the later stages, when the symptoms already affect the quality of life. Therefore, it is necessary to pay attention to the first signs of the disease, when the prognosis for treatment is most favorable.

Stage 1

The blood pressure of a patient who has been diagnosed with stage 1 hypertension is noted to be within 159/99 mmHg. Art. If you do not take the necessary measures to reduce it, your blood pressure may remain elevated for a couple of days or even several weeks.

Stage one hypertension can be asymptomatic, which is where its danger lies, since, without feeling any special changes in their usual state, the patient is in no hurry to see a doctor. Rest can help reduce blood pressure at the initial stage of the disease; during this period it is better to avoid stressful situations.

If a higher stage of hypertension is diagnosed, medication is no longer necessary to reduce blood pressure.

The first stage of hypertension, as a rule, does not affect internal organs. General symptoms of the disease are:

  • insomnia,
  • pain in the heart.

At the first stage of hypertension, a change in the tone of blood vessels in the fundus can be detected. Rare ones are possible. Women aged during menopause are at risk. The risk of a hypertensive crisis in this group of patients is possible due to the body’s reaction to weather changes.

Stage 2

At this stage, the pressure can rise to 179/109 mmHg. Art. It is no longer possible to stabilize blood pressure in patients with the second stage without drug intervention. Arterial hypertension stage 2 is characterized by the following symptoms:

  • sleep disturbances,
  • dyspnea,

After conducting a series of tests, the doctor may detect protein in the urine, an increase in the amount of creatine in the blood plasma, and a significant narrowing of the blood vessels in the retina. A characteristic symptom of the development of stage 2 hypertension is hypertrophy of the left ventricle of the heart.

If you observe at least a few symptoms that characterize stage 2 hypertension, you should contact a specialist as soon as possible: simple rest and avoidance of stress will not get rid of this stage of the disease.

Ignoring the problem for a long time can lead to complications in the functioning of the kidneys, vision and brain. In addition, high blood pressure over a long period of time can provoke the manifestation of symptoms of coronary heart disease and even.

Stage 3

The third stage of the disease can be described as extremely severe. Hypertension at this stage provokes dysfunction of organs, disturbances in the functioning of which were noticed already at the second stage - these are the heart, brain and organs of vision. Blood pressure readings at stage 3 hypertension rarely fall below 180/110 mmHg. Art.

The consequences of the disease can be stroke, kidney failure,... A patient who has suffered a heart attack may experience sudden changes in pressure: from high to below normal. This phenomenon is called “decapitated hypertension.” Patients with the third stage of hypertension often complain of frequent migraine attacks and changes in skin color (blue or cyanosis).

Degrees of hypertension

The extent of the disease is determined by the severity of symptoms, and is often related to the stage of the disease.

1st degree

3rd degree

Considered severe. The pressure in this group can rise to 180/110 mm. Hg Art. The disease can be aggravated by the patient's addiction to cigarettes and alcohol, heavy physical activity, obesity, diabetes, and unhealthy diet. Signs of stage 3 disease include: cough with blood discharge, unsteady gait, arrhythmia, significant deterioration in visual function, paralysis. In addition, complications with grade 3 hypertension can provoke a number of problems with the functioning of internal organs.

Risks

Risks are assessed by the threat the disease poses to the normal functioning of other organs of the body and to human life in general.

Low, insignificant

The low risk group for patients with hypertension includes patients under 55 years of age who have been diagnosed with stage 1 disease. As a rule, in this group of patients there are no serious complications of the disease at all. However, you still need to visit a therapist regularly. It is not necessary to see a cardiologist for a low-risk group.

Average

The average risk group includes patients with first and second degrees of hypertension. The pressure in patients in this group remains at 179/110 mm. Hg Art. Patients at low risk may also be included here if they abuse smoking, fatty and spicy foods, do not get enough physical activity, or are overweight. Heredity plays an important role in the development of arterial hypertension with an average degree of risk.

High

The high-risk group includes patients with stage 2 and 3 hypertension in the presence of aggravating factors in the development of the disease, such as bad habits, heredity, etc.

As a rule, patients who are classified in this risk group have a 30% chance of developing complications of hypertension. In addition, patients at high risk may experience pathological changes in internal organs (kidneys, brain, endocrine system).

Very tall

The highest risk group includes patients with stage 3 arterial hypertension. Typically, treatment of these types of patients is carried out in a hospital setting. Complications are diagnosed in more than 30% of patients. Blood pressure in very high-risk patients exceeds 180 mmHg. Art.

Risk level 4 is characterized by symptoms:

  • sweating;
  • hyperemia of the skin;
  • decreased skin sensitivity;
  • visual impairment;
  • renal failure;
  • cardiac hypertrophy, heart failure;
  • decreased intelligence (vascular dementia).

To prevent hypertension or control its dynamics, representatives of all age groups need to pay more attention to their health, not neglect sports, give up or significantly limit bad habits, and immediately seek help from a specialist at the first symptoms of the disease.

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 the terms " hypertension" And " hypertension"practically none. As follows from the etymology, hyper - from Greek over, over - a prefix indicating excess of the norm; tensio - from Latin - tension; tonos - from Greek - tension. Thus, the terms "hypertension" and " "hypertension" essentially mean the same thing - "hypertension".

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".

Hypertension (HTN) is usually understood as a chronic disease, the main manifestation of which is arterial hypertension syndrome, not associated with the presence of pathological processes in which an increase in blood pressure (BP) is caused by known, in many cases remediable causes (“symptomatic arterial hypertension”) (WOK Recommendations, 2004).

Classification of arterial hypertension

I. Stages of hypertension:

  • Hypertension (HD) stage I assumes the absence of changes in “target organs”.
  • Hypertension (HD) stage II is established in the presence of changes on the part of one or more “target organs”.
  • Hypertension (HD) 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 Blood Pressure (BP) and diastolic Blood 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 determined in the case of newly diagnosed Arterial Hypertension (AH) and in patients not taking antihypertensive drugs.

Table No. 1. Determination and classification of blood pressure (BP) levels (mm Hg)

The classification is presented before 2017 and after 2017 (in brackets)
Blood pressure (BP) categories Systolic blood pressure (BP) Diastolic blood pressure (BP)
Optimal blood pressure < 120 < 80
Normal blood pressure 120-129 (< 120* ) 80-84 (< 80* )
High normal blood pressure 130-139 (120-129* ) 85-89 (< 80* )
1st degree hypertension (mild) 140-159 (130-139* ) 90-99 (80-89* )
2nd degree hypertension (moderate) 160-179 (140-159* ) 100-109 (90-99* )
AH of the 3rd degree of severity (severe) >= 180 (>= 160* ) >= 110 (>= 100* )
Isolated systolic hypertension >= 140
* - new classification of the degree of hypertension from 2017 (ACC/AHA Hypertension Guidelines).

III. Risk stratification criteria for 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)
LDL-C > 4.0 mmol/L (> 155 mg/dL)
HDL-C

c) (for women

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

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

e) :

- Sedentary lifestyle
- Increased fibrinogen

and) Diabetes mellitus:
- Fasting blood glucose > 7 mmol/L (126 mg/dL)
- Blood glucose after a meal or 2 hours after taking 75 g of 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/m2 for men and > 110 g/m2 for women
Rg-graphy of the chest - cardio-thoracic index>50%

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

V)

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

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

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

b) Dyslipidemia:
TC > 6.5 mmol/l (> 250 mg/dl)
or LDL-C > 4.0 mmol/L (> 155 mg/dL)
or HDL-C

V) Family history of early cardiovascular disease(in women

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

d) 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/m2 for men and > 110 g/m2 for women
Rg-graphy of the chest - cardio-thoracic index>50%

h) Ultrasound signs of thickening of the artery wall(carotid artery intima-media thickness >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

n) 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)

O) Peripheral artery disease:
Dissecting aortic aneurysm
Symptomatic peripheral artery disease

p) Hypertensive retinopathy:
Hemorrhages or exudates
Papilledema

Table No. 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 practically asymptomatic, but already at the second or third stage of hypertension, complications in the functioning of the kidneys, heart or brain are possible. In order to keep the disease under control, a person must change their lifestyle, strictly adhere to the doctor's recommendations and constantly monitor their blood pressure.

Definition of disease

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

  • constant stress;
  • alcohol;
  • smoking;
  • excess weight;
  • 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 high blood pressure.

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

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

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Classification of hypertension by stages

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

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Types of hypertension by level and stability of pressure

There are three stages of the disease depending on blood pressure readings.

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

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

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Classification of hypertension according to risk level

The classification of hypertension includes an additional clarifying diagnosis, which sounds like “degree of risk” - a concept that helps to find out what the possibility of damage to internal organs due to hypertension is. If there is a risk of 1 or 2, it means that the permissibility of damage to internal organs is at least 20%, and the factors influencing the aggravation of the disease are either less than three or not at all. If there is a risk of 3, the possibility of organ damage increases to 30%, and there are more than three factors in the history of hypertension that influence the course of the disease. When the diagnosis sounds like risk 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 are at risk for factors that influence the severity of hypertension are 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 diastolic pressure level

Increased diastolic pressure threatens stroke and myocardial infarction.

Usually, if hypertension is diagnosed, an increase in the levels of both upper and lower pressure is recorded, but there are cases when the upper pressure remains normal, while the lower pressure jumps. This pressure is called isolated diastolic - this is one of the types of hypertension. Increased diastolic pressure is recorded when the tonometer shows more than 90 mmHg. Art. When blood pressure increases by 5 points, the risk of hemorrhagic stroke increases threefold. The chance of having a myocardial infarction increases by more than 20%. When the tonometer rises by 10 divisions, the possibility of a stroke doubles, and a heart attack increases by 40%.

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Types of hypertension according to the degree of target organ damage

When pressure increases 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. Organ damage begins at stage 3, less often at late stage 2, of hypertension. If disorders appear 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

Consulting a doctor is mandatory in case of a benign course of the disease.

The classification of blood pressure includes the division into malignant and benign hypertension. With a benign variant of the development of hypertension, it slowly passes through all three stages of its development, affecting target organs. With a malignant course, the disease appears in childhood or adolescence, is severe, and immediately passes to stage 3 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, and also undergo an examination of the body and do an electrocardiogram, echocardiography, MRI of the head, conduct a fundus examination, 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 medications.

A patient with hypertension should avoid noisy places, stuffy rooms, drinking alcohol, fatty and salty foods. You need to strictly follow a daily routine, walk in the fresh air and stick to a diet, and also monitor your blood pressure - it needs to be measured twice a day. You should keep a diary where the tonometer readings will be noted, and there should also be a table that includes data on what medications the hypertensive person 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 widespread 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, there are various forms, degrees and stages of hypertension.

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

The disease manifests itself as high blood pressure, which is scientifically called arterial hypertension. The last term refers to any increase in blood pressure, regardless of the cause. As for hypertension, which is also called primary or essential hypertension, it is an independent disease of unknown etiology. It should be distinguished from secondary, or symptomatic, arterial hypertension, which develops as a sign of various diseases: heart, kidney, 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 disruption 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, and the nature of the course. Some of them have lost their relevance, others continue to be used by doctors today, most often this is a classification by degree and stage.

In recent years, the upper limits of normal blood pressure have changed. If recently the value was 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 considered to be 139/89 mm Hg. pillar Blood pressure 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 mmHg. pillar
  2. Normal ranges from 120/80–129/84.
  3. Border – 130/85–139/89.
  4. Stage 1 hypertension – 140/90–159/99.
  5. Stage 2 hypertension – 160/100–179/109.
  6. Stage 3 hypertension – from 180/110 and above.

Classification of hypertension is very important for 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. With the pale variety, the patient had an appropriate complexion and cold extremities due to spasms of small vessels. Red hypertension was characterized by dilation of blood vessels at the time of increased hypertension, as a result of which the patient’s face turned red and became covered with spots.

In the 1930s, two more types of the disease were identified, which differed in the nature of their 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. The course is usually severe: the pressure is constantly at high levels, and symptoms of encephalopathy are present.

Classification by origin 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 due to renal, cardiac, endocrine, neurological pathologies, as well as as a result of constant use of a number of medications.

Modern classification of hypertension

There is no unified systematization, but most often doctors use the classification that was recommended by WHO and the International Society of Hypertension (ISHA) in 1999. According to WHO, hypertension is classified primarily by the degree of increase in blood pressure, of which there are 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 - hypertension ranges 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 that distinguish 4 degrees of hypertension. In this case, the third form is characterized by pressure from 180/110 to 209/119 mm Hg. column, and the fourth is very heavy - from 210/110 mm Hg. pillar and above. The degree (mild, moderate, severe) indicates solely the level of pressure, but not the severity of the course and condition of the patient.

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

  1. Stage I. The increase in pressure is insignificant and inconsistent, the functioning of the cardiovascular system is not impaired. Patients usually have no complaints.
  2. Stage II. Blood pressure is high. There is an enlargement of the left ventricle. Usually there are no other changes, but local or generalized narrowing of the retinal vessels may be noted.
  3. Stage III. There are signs of organ damage:
    • heart failure, myocardial infarction, angina pectoris;
    • chronic renal failure;
    • stroke, hypertensive encephalopathy, transient cerebral circulatory disorders;
    • from the fundus of the eye: hemorrhages, exudates, swelling of the optic nerve;
    • lesions of peripheral arteries, aortic aneurysm.

When classifying hypertension, variants of increased blood pressure are also taken into account. The following forms are distinguished:

  • systolic – only the upper pressure is increased, the lower – less than 90 mm Hg. pillar;
  • diastolic – increased lower pressure, upper – from 140 mm Hg. pillar and below;
  • systolic-diastolic;
  • labile – blood pressure rises for a short time and normalizes on its own, without medications.

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 disrupted, intracranial pressure rises, and brain hyperemia 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. In the hyperkinetic form, the systolic pressure rises, in the hypokinetic form, the diastolic pressure rises; in the eukinetic crisis, both the upper and lower levels increase.

Refractory hypertension

In this case, we are talking about arterial hypertension, which cannot be treated 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 incorrect choice of medications, as well as due to the patient’s non-compliance 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 blood pressure measurement. This seemingly harmless phenomenon should not be ignored. According to doctors, a more dangerous stage of the disease may occur.

Features of stage 2 hypertension

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WHO classification of hypertension

Irina Evgenievna Chazova

At the end of the century, it is customary to sum up the development of mankind over the past century, evaluate the successes achieved and count the losses. At the end of the 20th century, the saddest outcome can be considered the epidemic of arterial hypertension (AH), with which we greeted the new millennium. The “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 the 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 do not persistently explain to patients the need for strict control over blood pressure and adherence to preventive recommendations to reduce the risk of such serious consequences of increased blood pressure as myocardial infarction and cerebral stroke, as well as patients who are accustomed to often 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 diastolic blood pressure by only 2 mm Hg. Art. leads to a reduction in the incidence of stroke by 15%, coronary heart disease (CHD) – by 6%. There is also a direct connection between blood pressure levels and the incidence of heart failure and kidney damage in hypertensive patients.

The main danger of high blood pressure is that it leads to the rapid development or progression of the atherosclerotic process, the occurrence of ischemic heart 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 mortality. Therefore, according to the WHO/IAS recommendations of 1999, “. 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, to treat patients with hypertension, it is not enough to simply reduce blood pressure to the required levels, but it is also necessary to influence other risk factors. In addition, the presence of such factors determines the tactics, or more precisely, the “aggression” of treatment of patients with hypertension.

At the All-Russian Congress of Cardiologists, held in Moscow in October 2001, “Recommendations for the prevention, diagnosis and treatment of arterial hypertension” were adopted, developed by experts of the All-Russian Scientific Society of Cardiologists based on the WHO/IAS recommendations of 1999 and domestic developments. The modern classification of hypertension involves determining the degree of increase in blood pressure (Table 1), the stage of hypertension (HT) and the risk group according to risk stratification criteria (Table 2).

Determination of the degree of blood pressure increase

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 headache

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

Stage I headache presupposes the absence of changes in target organs identified during functional, radiation and laboratory studies.

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

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

When making a diagnosis of hypertension, both the stage of the disease and the degree of risk should be indicated. In persons with newly diagnosed arterial hypertension and persons not receiving antihypertensive therapy, the degree of hypertension is indicated. In addition, it is recommended to detail the existing target organ lesions, risk factors and concomitant clinical conditions. Establishing stage III of the disease does not reflect the development of the disease over time and the cause-and-effect relationship between arterial hypertension and existing pathology (in particular, angina pectoris). The presence of associated conditions allows the patient to be classified in a more severe risk group and therefore requires the establishment of a higher stage of the disease, even if changes in a given organ are not, in the doctor’s opinion, a direct complication of hypertension.

Table 1. Definition and classification of blood pressure levels

Table 2. Risk stratification criteria

Identification of risk groups and treatment approaches

The prognosis of patients with hypertension and the decision on further tactics depend not only on blood pressure levels. The presence of associated risk factors, the involvement of target organs in the process, as well as the presence of associated clinical conditions is no less important than the degree of arterial hypertension, and therefore stratification of patients depending on the degree of risk has been introduced into the modern classification. To assess the total impact of several risk factors relative to the absolute risk of severe cardiovascular damage, WHO/IAS experts proposed 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 disease, as well as the risk of stroke and myocardial infarction (based on the results of the Framingham Study). To optimize therapy, it was proposed to divide all patients with hypertension according to the level of risk of cardiovascular complications (Table 3). The low-risk group includes men under 55 years of age and women under 65 years of age with grade 1 arterial hypertension (mild - with SBP 140–159 mm Hg and/or DBP 90–99 mm Hg) without any other risk factors. Among this category, the 10-year risk of cardiovascular disease is typically less than 15%. These patients rarely come to the attention of cardiologists; As a rule, local therapists are the first to encounter them. Patients at low risk of cardiovascular complications should be advised to make lifestyle changes for 6 months before considering medication. However, if after 6–12 months of non-drug treatment, blood pressure remains at the same level, drug therapy should be prescribed.

An exception to this rule are patients with 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 in order to lower blood pressure and reduce the risk of cardiovascular damage, he can continue measures related only to lifestyle changes.

The average risk group unites 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, increased total cholesterol levels over 6.5 mmol/l, impaired glucose tolerance, obesity, sedentary lifestyle, family history, etc. The risk of cardiovascular complications in this category of patients is higher than in the previous one and amounts to 15–20% over 10 years of observation. These patients are also more likely to be seen by primary care physicians rather than by cardiologists. For patients at average risk, it is advisable to continue lifestyle modification measures, and if necessary, accelerate them for at least 3 months before considering prescribing medications. However, if a decrease in blood pressure is not achieved within 6 months, drug therapy should be started.

Table 3. Distribution (stratification) by risk level

The next group is at 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 target organ damage, which include left ventricular hypertrophy and/or a slight increase in creatinine levels, atherosclerotic vascular disease, changes retinal vessels; The same group includes patients with 3rd degree arterial hypertension (severe - with SBP more than 180 mm Hg and/or DBP more than 110 mm Hg) in the absence of risk factors. Among these patients, the risk of cardiovascular disease over 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 sees a cardiologist or therapist for the first time, drug treatment should begin 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) are patients with stage 3 arterial hypertension and the presence of at least one risk factor, as well as patients with degrees 1 and 2 arterial hypertension. hypertension if they have 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 requires active drug treatment.

There is another group of patients that deserves special attention. These are patients with high normal blood pressure (SBP 130–139 mm Hg, DBP 85–89 mm Hg) who have diabetes mellitus and/or renal failure. They require early active drug therapy, since it has been shown that this type of treatment tactics prevents 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 methods to achieve it. Obviously, the higher the risk of cardiovascular complications, the more important it is to achieve the target blood pressure level and correct other risk factors.

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

Low risk less than 15% (level I)

Average risk 15–20% (level II)

High risk 20–30% (level III)

Very high risk 30% or higher (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 dysfunction of the corresponding target organs: heart, lungs, brain, nervous system, kidneys.

Hypertension (HD) or arterial hypertension develops as a result of a malfunction of higher centers that regulate the functions of the vascular system, neurohumoral and renal mechanisms.

Main clinical signs of headache:

  • Dizziness, ringing and noise in the ears;
  • Headaches;
  • Shortness of breath, suffocation;
  • Darkening and “stars” before the eyes;
  • Painful sensations in the chest, in the area 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 urine test.
  2. Doppler ultrasound of the arteries of the kidneys and neck.
  3. Electrocardiogram of the heart.
  4. EchoCG.
  5. Blood pressure monitoring.

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

Hypertension - definition and description

The main clinical signs of hypertension are sudden 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. Blood pressure decreases only after the patient takes antihypertensive drugs.

  • Systolic (upper) pressure – no higher than 140 mm. Hg Art.;
  • Diastolic (lower) pressure is not higher than 90 mm. Hg Art.

If during two medical examinations on different days the pressure was higher than the established norm, a diagnosis of arterial hypertension is made and adequate treatment is selected. Hypertension develops in both men and women with approximately the same frequency, mainly after the age of 40 years. But clinical signs of HD are also observed 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 becomes the cause of mortality among the young, working-age population.

According to the mechanism of development, according to WHO, we distinguish primary or essential hypertension, and secondary or symptomatic. The secondary form occurs in only 10% of cases. Essential arterial hypertension is diagnosed much more often. 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. Adrenal gland disorders – Itsenko-Cushing 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, it occurs slowly, with minor 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 blood pressure and maintain proper nutrition for hypertension.

Or malignant, when the pathology develops rapidly, the pressure rises sharply and remains at the same level, the patient’s condition can only be improved with the help of medications.

Pathogenesis of hypertension

An increase in pressure, which is the main cause and sign 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 medulla oblongata. As a result, disturbances in the tone of peripheral vessels appear, and spasm of arterioles occurs in the periphery - including the kidneys.

Dyskinetic and dyscirculatory syndrome develop, 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 disrupted. 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 elastofibrosis and arteriolosclerosis, which in turn provokes secondary changes in target organs.

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

Classification of hypertension by stage

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

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

At this stage of hypertension, the patient very rarely consults a doctor, since there is no sharp deterioration in the condition, only occasionally the blood pressure “goes through the roof.” However, if you do not see a doctor and start treatment at this stage of hypertension, there is a risk of rapid progression of the disease.

Stage II of hypertension is characterized by a steady increase in blood pressure. Disturbances in the heart and other target organs appear: the left ventricle becomes larger and thicker, and sometimes damage to the retina is observed. Treatment at this stage is almost always successful with the cooperation of the patient and the doctor.

At stage III of hypertension, damage to all target organs occurs. The blood pressure is consistently high, and the risk of myocardial infarction, stroke, and coronary heart disease is very high. If such a diagnosis is made, then, as a rule, a history of angina pectoris, renal failure, aneurysm, and hemorrhages in the fundus is already noted.

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

Classification of arterial hypertension by degree

This classification is currently considered more relevant and appropriate than by stage. The main indicator is the patient’s blood pressure, its level and stability.

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

Risk stratification for arterial hypertension

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

  1. Age indicators: for men it is over 55 years, for women – 65 years.
  2. Dyslipidemia is a condition in which the lipid spectrum of the blood is disrupted.
  3. Diabetes mellitus.
  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 has been noted that most often the cause of surges in blood pressure is nervous overstrain, increased intellectual work, especially at night, and chronic fatigue. This is the main negative factor according to WHO.

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

If more than two close relatives are being 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 monitor their diet.

Other risk factors, according to WHO, are:

  • Chronic diseases of the thyroid gland;
  • Atherosclerosis;
  • Chronic infectious diseases - for example, tonsillitis;
  • Menopause in women;
  • Pathologies of the kidneys and adrenal glands.

By comparing the factors listed above, the patient’s blood pressure indicators and their stability, the risk of developing such a pathology as arterial hypertension is stratified. If 1-2 unfavorable factors are identified in first-degree hypertension, then risk 1 is assigned, according to WHO recommendations.

If the unfavorable 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 WHO recommendations, if hypertension of the third degree is diagnosed and 2-3 unfavorable factors are noted, the risk is set to 3. Risk 4 implies a diagnosis of third-degree hypertension and the presence of more than three unfavorable factors.

Complications and risks of hypertension

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

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

  • Angina;
  • Myocardial infarction;
  • Ischemic stroke;
  • Hemorrhagic stroke;
  • Pulmonary edema;
  • Dissecting aortic aneurysm;
  • Retinal detachment;
  • Uremia.

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

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

But in other cases, especially if associated pathologies are added to hypertension, complete recovery is no longer possible. This does not mean that the patient should give up on himself and abandon treatment. The main measures are aimed at preventing sudden 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 and will help keep him active and productive until old age. Almost all forms of arterial hypertension allow you to play sports, lead a personal life and fully relax.

The exception is grades 2-3 with a risk of 3-4. But the patient has the power to prevent such a serious condition with the help of medications, folk remedies and a review of his habits. A specialist will talk about the classification of hypertension in the video in this article.

Almost everyone has experienced increased blood pressure at least once in their life and knows how much trouble it causes. However, hypertension is not as harmless as it might seem at first glance.

Serious fluctuations in pressure negatively affect the body, and a chronic disease, if left untreated, even leads to the most disastrous consequences. Today we will talk about how each stage differs and what risks it carries.

Stages of headache

Stage I

The pressure at stage 1 of hypertension does not exceed 159/99 mm. Hg Art. Blood pressure may remain in this elevated state for several days. Even ordinary rest and the exclusion of stressful situations significantly help to reduce its indicators. In more severe stages, it is no longer possible to normalize blood pressure so easily.

This stage of hypertension development is characterized by the absence of any signs that target organs are affected by high blood pressure, therefore, in many cases there is a practically asymptomatic course of the disease. Only occasionally do sleep disturbances, pain in the head or heart appear. Clinical examinations may reveal a slight increase in tone in the fundus of the arteries.

The group is distinguished by the appearance of the first signs from the internal organs. Often this form of damage has virtually no effect on their functions. There are also no obvious subjective symptoms that bother the patient. Most often, at stage 2 of the development of hypertension, the following are detected:

  • signs characteristic of left ventricular hypertrophy;
  • the amount of creatine in the blood increases;
  • narrowing of the arteries occurs in the retina;
  • Protein is found in the urine.

Hypertensive crises are not uncommon in stage 2 hypertension, which entails the threat of developing very serious complications, up to. In this case, it will no longer be possible to manage without constant drug therapy.

Stages of hypertension

Stage III

The last stage of hypertension has the most severe course and has the most extensive group of disorders in the functioning of a whole group of target organs. The kidneys, eyes, brain, blood vessels and heart suffer the most. Blood pressure is persistent, and it is quite difficult to normalize its level even if you take pills. Increases in blood pressure to 180/110 mm are not uncommon. Hg Art. and higher.

The symptoms of stage 3 of the disease are in many ways similar to those listed above, but they are also accompanied by quite dangerous signs from the affected organs (for example, kidney failure). Memory often deteriorates, severe heart rhythm disturbances occur, and vision decreases.

The most dangerous thing is that hypertension invariably affects the heart. The contractility and conductivity of the muscle is almost always impaired. Clinical studies also reveal many disorders in other organs.

Hypertension has not only stages 1, 2, 3, but also degrees 1, 2, 3, which we will talk about later.

Degrees

I degree

The first degree of severity refers to the mildest, in which periodic surges in blood pressure are observed. Another characteristic of it is that the pressure level is able to stabilize on its own. The most common cause of stage 1 headache is constant stress.

The video below will talk about the degrees of hypertension:

II degree

A moderate degree of hypertension is distinguished not only by the impossibility of independent stabilization of blood pressure, but also by the fact that periods of normal pressure are very short. The main manifestation is severe headaches.

If the disease develops very quickly, we can talk about a malignant course of hypertension. This form is very dangerous, since the disease can develop rapidly.

Degrees of hypertension

III degree

With grade 3 hypertension, the pressure always remains in a stable elevated state. If blood pressure decreases, the person is plagued by weakness, as well as a number of other symptoms from the internal organs. The changes that occur at this stage of the disease are already irreversible.

Also, the classification of hypertension includes, in addition to 1, 2, 3 degrees and stages, 1, 2, 3, 4 risks, which we will talk about later.

Risks

Low, insignificant

The lowest risk of complications is found in women under 65 years of age and men under 55 years of age who have developed stage 1 “mild” arterial hypertension. Over the next 10 years, only about 15% will develop vascular or cardiac pathologies that develop as a result of the disease. Such patients are often managed by general practitioners, since there is no point in serious treatment by a cardiologist.

If a minor risk is still present, patients need to try to significantly change their lifestyle in the near future (no more than 6 months). He can be observed by a doctor for some more time if the dynamics are positive. If such treatment does not bring results, and a decrease in blood pressure cannot be achieved, doctors may recommend a change in treatment tactics, which will entail the prescription of medications. However, doctors often insist on leading a healthy lifestyle, because such therapy will not have any negative consequences.

Average

This group includes patients with hypertension of both the second and first types. Their blood pressure usually does not exceed 179/110 mm. Hg Art. A patient in this category may have 1-2 risk factors:

  1. heredity,
  2. obesity,
  3. little physical activity,
  4. high cholesterol,
  5. impaired glucose tolerance.

Over 10 years of observation, the development of cardiovascular pathologies is possible in 20% of cases. Modification of normal lifestyle is necessarily included in the list of treatment measures. For 3-6 months, medications may not be prescribed to give the patient a chance to normalize their condition through life changes.

High

Patients with forms 1 and 2 of hypertension should also be included in the risk group with a high probability of detecting complications, but if they already have several predisposing factors described above. It is also customary to include any damage to target organs, diabetes mellitus, changes in retinal vessels, high creatinine levels, etc.

There may be no risk factors, but a patient with stage 3 arterial hypertension also belongs to this group of patients. All of them are already being observed by a cardiologist, since hypertension is mostly long-term. The probability of complications reaches 30%. Lifestyle changes can be used as an adjuvant strategy, but the main part of therapy is medication. The selection of medications must be carried out in a short time.

Risks hypertension

Very tall

Patients with the highest risk of complications in the functioning of the heart and blood vessels are a group of patients with stage 3 hypertension or stages 1 and 2 if the latter have any disorders of the target organs. This group is one of the smallest. The main treatment is carried out in a hospital. Drug therapy is carried out actively and often includes several groups of drugs.

The probability of developing complications is more than 30%.

The following video contains useful information about the stages and degrees of hypertension: