This article describes the essence of hypertension, its classification according to various principles, characteristics diseases, 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 development 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.
• abnormality 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, constriction renal arteries, kidney inflammation.
• Dysfunction thyroid gland- hyperthyroidism.
• adrenal dysfunction - hypercortisolism syndrome, pheochromoblastoma.
• Atherosclerosis, coarctation of the aorta.

Important! An agronomist from Barnaul with 8 years of experience in hypertension found an old recipe, set up production and released a remedy that will once and for all save you from problems with pressure ...

Classification of hypertension by stages

1. I stage- increase in pressure, internal organs are not changed, their functionality is not impaired.
2. II stage- pressure increase accompanied by transformation internal organs: left ventricular hypertrophy, ischemic disease heart, 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 tends to be long high blood pressure. 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 understanding hypertension is 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.

sympathetic nervous system has a significant effect 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. First of all, you need to measure arterial pressure at rest. 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. Must pass general analysis blood, 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 carry out biochemical analysis blood.
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

staging 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:

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 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)

The classification before 2017 and after 2017 is presented (in brackets)

Categories of blood pressure (BP)	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* )
AH of the 1st degree of severity (mild)	140-159 (130-139* )	90-99 (80-89* )
Arterial hypertension of the 2nd degree of severity (moderate)	160-179 (140-159* )	100-109 (90-99* )
Arterial hypertension of the 3rd degree of severity (severe)	>= 180 (>= 160* )	>= 110 (>= 100* )
Isolated systolic hypertension	>= 140

* - new classification degrees of hypertension from 2017 (ACC / AHA Hypertension Guidelines).

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

g) 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 chest- cardio-thoracic index>50%

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

v)

G) microalbuminuria: 30-300 mg/day; urinary 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

v) 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(AG):
- Impaired glucose tolerance
- Sedentary lifestyle
- Increased fibrinogen

g) 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 disturbance cerebral circulation

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)

O) 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.

Hypertonic disease

Hypertonic disease (GB) -(Essential, primary arterial hypertension) is a chronic disease, the main manifestation of which is an increase in blood pressure (Arterial Hypertension). Essential arterial hypertension is not a manifestation of diseases in which an increase in blood pressure is one of the many symptoms (symptomatic hypertension).

HD classification (WHO)

Stage 1 - there is an increase in blood pressure without changes in internal organs.

Stage 2 - an increase in blood pressure, there are changes in internal organs without dysfunction (LVH, coronary artery disease, changes in the fundus). Presence of at least one of the following lesions

target organs:

Left ventricular hypertrophy (according to ECG data and echocardiography);

Generalized or local narrowing of the retinal arteries;

Proteinuria (20-200 mcg / min or 30-300 mg / l), creatinine more

130 mmol/l (1.5-2 mg/% or 1.2-2.0 mg/dl);

Ultrasound or angiographic features

atherosclerotic lesions of the aorta, coronary, carotid, iliac or

femoral arteries.

Stage 3 - increased blood pressure with changes in internal organs and violations of their functions.

Heart: angina pectoris, myocardial infarction, heart failure;

- Brain: transient cerebrovascular accident, stroke, hypertensive encephalopathy;

Fundus of the eye: hemorrhages and exudates with swelling of the nipple

optic nerve or without it;

Kidneys: signs of CKD (creatinine more than 2.0 mg/dl);

Vessels: dissecting aortic aneurysm, symptoms of occlusive lesions of peripheral arteries.

Classification of GB according to the level of blood pressure:

Optimal BP: DM<120 , ДД<80

Normal blood pressure: SD 120-129, DD 80-84

Elevated normal blood pressure: SD 130-139, DD 85-89

AG - 1 degree of increase SD 140-159, DD 90-99

AG - 2nd degree of increase SD 160-179, DD 100-109

AH - 3rd degree increase DM >180 (=180), DD >110 (=110)

Isolated systolic AH DM>140(=140), DD<90

If SBP and DBP fall into different categories, then the highest reading should be taken into account.

Clinical manifestations of GB

Subjective complaints of weakness, fatigue, headaches of various localization.

visual impairment

Instrumental Research

Rg - slight left ventricular hypertrophy (LVH)

Changes in the fundus of the eye: dilation of the veins and narrowing of the arteries - hypertensive angiopathy; with a change in the retina - angioretinopathy; in the most severe cases (swelling of the nipple of the optic nerve) - neuroretinopathy.

Kidneys - microalbuminuria, progressive glomerulosclerosis, secondarily wrinkled kidney.

Etiological causes of the disease:

1. Exogenous causes of the disease:

Psychological stress

Nicotine intoxication

Alcohol intoxication

Excess intake of NaCl

Hypodynamia

Binge eating

2. Endogenous causes of the disease:

Hereditary factors - as a rule, 50% of descendants fall ill with hypertension. Hypertension in this case proceeds more malignantly.

Disease pathogenesis:

Hemodynamic mechanisms

Cardiac output

Since about 80% of the blood is deposited in the venous bed, even a slight increase in tone leads to a significant increase in blood pressure, i.e. the most significant mechanism is an increase in total peripheral vascular resistance.

Dysregulation leading to the development of HD

Neurohormonal regulation in cardiovascular diseases:

A. Pressor, antidiuretic, proliferative link:

SAS (norepinephrine, adrenaline),

RAAS (AII, aldosterone),

arginine vasopressin,

Endothelin I,

growth factors,

cytokines,

Plasminogen activator inhibitors

B. Depressor, diuretic, antiproliferative link:

Natriuretic Peptide System

Prostaglandins

Bradykinin

Tissue plasminogen activator

Nitric oxide

Adrenomedullin

An increase in the tone of the sympathetic nervous system (sympathicotonia) plays an important role in the development of GB.

It is usually caused by exogenous factors. Mechanisms for the development of sympathicotonia:

facilitation of ganglionic transmission of nerve impulses

violation of the kinetics of norepinephrine at the level of synapses (violation of the reuptake of n / a)

change in sensitivity and / or number of adrenoreceptors

desensitization of baroreceptors

The effect of sympathicotonia on the body:

Increase in heart rate and contractility of the heart muscle.

An increase in vascular tone and, as a result, an increase in the total peripheral vascular resistance.

An increase in the tone of capacitive vessels - an increase in Venous return - An increase in blood pressure

Stimulates the synthesis and release of renin and ADH

Insulin resistance develops

The endothelium is damaged

Effect of insulin:

Increases Na reabsorption - Water retention - Increased blood pressure

Stimulates hypertrophy of the vascular wall (because it is a stimulator of the proliferation of smooth muscle cells)

The role of the kidneys in the regulation of blood pressure

Regulation of Na homeostasis

Regulation of water homeostasis

synthesis of depressor and pressor substances, at the beginning of GB both pressor and depressor systems work, but then the depressor systems are depleted.

The effect of Angiotensin II on the cardiovascular system:

Acts on the heart muscle and promotes its hypertrophy

Stimulates the development of cardiosclerosis

Causes vasoconstriction

Stimulates the synthesis of Aldosterone - increased Na reabsorption - increased blood pressure

Local factors in the pathogenesis of HD

Vasoconstriction and hypertrophy of the vascular wall under the influence of local biologically active substances (endothelin, thromboxane, etc...)

During GB, the influence of various factors changes, first neurohumoral factors prevail, then when the pressure stabilizes at high numbers, local factors predominantly act.

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Modern classification of arterial hypertension and approaches to treatment

Irina Evgenievna Chazova
Dr. honey. sciences, hands. otd. systemic hypertension Institute of Cardiology. A.L. Myasnikov RKNPK Ministry of Health of the Russian Federation

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 an 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 recommendations of the WHO / MOAG 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 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 determining 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 allows the patient to be attributed to a more severe risk group and therefore requires the establishment of a greater 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

Definition of risk group and approaches to treatment

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 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 initiated.

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; the same group 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 3rd degree arterial hypertension and the presence of at least one risk factor, as well as patients with 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)

What is the classification? Why is it extremely important to understand the danger of this pathology for a modern person. Some people believe that constantly elevated blood pressure numbers are not dangerous to health, and it is necessary to go to the hospital only when they "go off scale". This is a fundamentally erroneous opinion, therefore, knowing what classification exists today according to world organizations, what stages of the disease are distinguished and how it is treated will be a great help in preventing hypertension.

What is the essence of the problem

Hypertension is one of the most common cardiovascular diseases. Increasingly, new degrees and stages of hypertension are being classified.

Statistics say that in different countries, 10 to 20% of the active population suffers from hypertension. These figures are a worldwide trend. Half of all patients with this diagnosis are not treated. The danger of such a pathology is that it leads to a stroke or heart attack. The likelihood of developing the disease increases significantly with age. The disease leads to disability at a young age.

The latest data from the World Health Organization indicate that even adolescents begin to get sick with arterial hypertension. The most susceptible to pathology are people who are prone to frequent stress, negative emotions. According to the modern classification, different degrees of hypertension, forms, stages of the pathological process, its further complications are distinguished.

According to the recommendations of health care institutions, hypertension should be understood as an increase in blood pressure relative to the norm, regardless of the causes. Primary or essential hypertension is an independent pathology. To date, the reasons for its appearance have not yet been fully elucidated. Different stages of secondary hypertension develop against the background of already existing diseases of the heart, kidneys, endocrine glands.

The disease is chronic. It is characterized by a steady increase in pressure. This means that there is always an increased degree of risk for the heart and blood vessels, because they are working with an increased load all the time.

Development of views on the classification of hypertension

The disease has been studied by doctors for more than one century. During all this time, the classification of arterial hypertension by stages and types has undergone changes. Experts looked differently at the causes of its occurrence, clinical symptoms, blood pressure levels and characteristics of its stability, and more. Some of them have been out of date for a long time.

The most modern is the WHO classification in terms of blood pressure. It is customary to consider such indicators of blood pressure as normal and as deviations:

• 120/80 mm. rt. Art. - the best indicator;
• from 120/80 to 129/84 - indicators of the norm;
• border indicators - 130/85 - 139/89 mm. rt. st;
• from 140/90 to 159/99 mm. rt. Art. — evidence that the patient is developing grade 1 hypertension;
• with arterial hypertension of the 2nd degree, the tonometer indicator varies from 160/100 to 179/109 mm. rt. Art.;
• if a person has a pressure higher than 180/110 mm. rt. Art., he is diagnosed with hypertension degree 3.

Back in the 20s of the last century, doctors divided the pathology into “pale” and “red”. Its shape was determined depending on the patient's complexion. If he had cold extremities and a pale face, then he was diagnosed with the so-called pale type. On the contrary, with the expansion of blood vessels, the patient's face turned red, which means that he developed a "red" type of disease. Such a classification did not take into account the stage and degree of the disease, and the treatment was prescribed incorrectly.

From the 30s. distinguish between benign and malignant forms. Under benign understood such a variant of the course of the disease, when it progressed slowly. And if the disease developed quickly or began at a young age, then a malignant form was diagnosed.

In the future, the classification of hypertension was revised several times. Today, the stages are distinguished depending on the magnitude of the change in blood pressure and its stability. The WHO classification of arterial hypertension is as follows:

• borderline hypertension - its first degree (the tonometer reading does not exceed 159/99 mm);
• moderate (2nd degree) - pressure increase up to 179/109 mm;
• severe (3rd degree) - blood pressure rises more than 180/110 mm.

In some classifiers, the table is supplemented with a fourth stage. With her blood pressure is higher than 210/110 mm. rt. Art. This stage is considered very difficult.

Stages, forms of hypertension

Such a disease has not only degrees. Doctors also distinguish the stages of the disease process, depending on the damage to the organs of the body:

1. If a patient has stage 1 hypertension, he has a slight and short-term increase in blood pressure. There are no complaints. The work of the heart and blood vessels is not disturbed.
2. At the 2nd stage of arterial hypertension, there is a persistent increase in blood pressure. The left ventricle is getting bigger and bigger. A local narrowing of the vessels supplying the retina is diagnosed. No other pathological changes were recorded.
3. Arterial 3 is characterized by a pronounced lesion of all organs:

• heart failure, angina pectoris, heart attack;
• chronic disorders of the kidneys;
• acute disorders of cerebral circulation - stroke, hypertensive encephalopathy, other circulatory disorders;
• hemorrhages in the bottom of the eye, swelling of the nerve of the eye;
• damage to peripheral blood vessels;
• aortic aneurysms.

There is another classification of arterial hypertension, taking into account options for increasing blood pressure. In this regard, the following forms of pathology are distinguished:

• systolic (in this case, only the “upper” pressure rises, and diastolic pressure may be normal);
• diastolic (diastolic pressure increases, while the "upper" remains less than 140 mm Hg);
• systolic-diastolic (in such a patient, regardless of the degree of hypertension, both types of pressure are equally elevated);
• labile form (the patient's pressure rises only for a short time and passes quickly).

The above modern classification takes into account almost all aspects associated with an increase in the performance of the tonometer. Depending on which stage a particular patient has, appropriate treatment is prescribed. It does not take into account other nuances of the manifestation of hypertension.

Some manifestations of arterial hypertension

The WHO classification of arterial hypertension does not take into account other manifestations and forms of the disease. This means that they are "apart" from the above stages and forms of pathology. The table of manifestations of hypertension will be somewhat supplemented.

The most severe consequence of arterial hypertension is a hypertensive crisis. The pressure inside the arteries rises to critical values. Most often it happens if the patient is diagnosed with 3. Due to persistently high blood pressure, he develops such complications:

• the blood circulation of the brain is disturbed;
• sharply jumps intracranial pressure;
• oxygen starvation of the brain increases;
• there is dizziness and severe headache.

All this is accompanied by nausea and vomiting. With a hyperkinetic variety of the disease in humans, diastolic pressure is significantly increased. The hypokinetic form, on the contrary, is characterized by an increase in the “lower” pressure. If the patient develops a eukinetic form of the disease, both numbers on the tonometer simultaneously increase in him.

Some degrees of arterial hypertension can be complicated by the so-called refractory hypertension. In this case, the disease is not amenable to drug therapy. Sometimes the patient's condition does not improve, even if he took more than 3 drugs.

This form of the disease can be confused and due to an inaccurate diagnosis, drug therapy will be ineffective. Refractory hypertension stage 2 or 3 can also be observed if the patient does not comply with all doctor's prescriptions.

Finally, white coat hypertension is distinguished. In this case, high blood pressure in a person is observed when he is in the hospital during medical procedures. In this case, it is customary to assert an iatrogenic increase in pressure. It may seem harmless, but therein lies its cunning. Such a patient needs to pay attention to his way of life and undergo a medical examination.

Risk factors for arterial hypertension

Any stage of hypertension has certain risk factors. Their impact significantly increases the likelihood of a person developing dangerous complications. What are the main factors contributing to the development of arterial hypertension? This information should be taken into account by anyone who has had several episodes of high blood pressure, regardless of the causes:

1. Age (men over 55 and women over 65). With unfavorable heredity, special attention should be paid to men and up to 55 years.
2. Smoking. All cigarette users need to remember that their bad habit is the main factor in the development of the disease.
3. Increasing cholesterol levels. For all patients, the level of total cholesterol is more than 6.5 mmol / l. The same figures for CHSLDPNP over 4 mmol /, and HDLP over 1 mmol for male patients and 1.2 for female patients.
4. Poor family history of cardiovascular disease (especially for men under 55 and women under 65).
5. Obesity of the abdominal type (if the waist circumference is more than 102 cm in men or 88 cm in women).
6. Presence of C-reactive protein greater than 1 mg/dL.
7. Impaired sugar tolerance.
8. Physical inactivity.
9. An increase in the content of fibrinogen in the blood.

Such risk factors are especially relevant if the patient is diagnosed with grade 1 hypertension. If the disease has a second degree, then special attention should be paid to the following indicators:

• left ventricular hypertrophy;
• Ultrasound signs of the size of the artery wall or the presence of atherosclerotic growths;
• increase in serum creatinine - over 115 µmol/l in males and over 107 µmol/l in females;
• the presence of microalbuminuria from 30 to 300 mg per day.

Other risk factors for stage 3 hypertension are:

• age over 65 years for women and 55 years for men;
• dyslipidemia;
• unfavorable family history;
• cerebrovascular pathologies - stroke of an ischemic or hemorrhagic type, transient dysfunction of the blood circulation of the brain;
• myocardial infarction;
• kidney disease caused by diabetes;
• severe proteinuria;
• severe degree of renal failure;
• defeat of peripheral arteries;
• edema of the optic nerve.

Features of malignant hypertension

Hypertension degree 3-A or 3-B may have a malignant course. This is due to the way of life of the patient, psychological stress, unfavorable environmental situation. Malignant hypertension is a very dangerous disease, if left untreated, the complications it causes can be fatal.

The main characteristics of malignant hypertension are as follows:

1. Sharply increased pressure. Diastolic indicators can reach a value of 220 and even exceed it.
2. Changes in the fundus. This significantly impairs vision. In severe cases, complete blindness occurs.
3. Malfunctions of the kidneys.
4. Migraines develop.
5. Patients feel weakness, severe fatigue.
6. Sometimes there is a drop in weight, appetite.
7. Often there are fainting spells.
8. The work of the digestive system is disturbed - patients suffer from nausea, vomiting.
9. A sharp jump in blood pressure is recorded at night.

Malignant hypertension is caused by:

1. Pheochromocytoma. This is a pathological process in the adrenal cortex. As a result of inflammation, substances are formed in the body that provoke a sudden increase in blood pressure.
2. Parenchymal diseases.
3. Violation of the state of blood vessels in the kidneys. Because of this, the blood flow to this organ is significantly worsened, because of which the patient develops the so-called renovascular hypertension.

The risk factors for this hypertension are as follows:

• long-term smoking (at risk are patients who smoke more than a pack of cigarettes per day);
• alcohol abuse;
• endocrine disorders;
• pregnancy (against its background, pregnancy with a malignant course may develop);
• overwork and prolonged physical exertion;
• stress, emotional breakdowns.

Treatment of all these conditions should take place only under the supervision of a physician.

Renal hypertension

If a patient is diagnosed with arterial hypertension, the classification of all its varieties can be very difficult. This happens when high blood pressure is caused by malfunctioning of the kidneys. In some categories of patients, elevated systolic and diastolic blood pressure may be observed for a long time. Qualified assistance consists in the fact that the patient is given complex kidney treatment to stabilize all indicators.

Such a pathology develops with changes in the normal functioning of the excretory system. The most predisposed to this type of hypertension are those with a tendency to edema. Then decay products, salts and other substances are not removed from the blood.

Due to the complex processes that are triggered in the body due to chronic fluid retention, the patient narrows the lumen of the arteries that feed the kidneys. At the same time, the synthesis of prostaglandins decreases, the main function of which is to maintain the normal tone of the arteries. Therefore, in such patients, arterial pressure is stably elevated.

In the regulation of blood pressure, the normal function of the adrenal cortex is extremely important. If it functions intermittently, then the hormonal balance in the body is disturbed. And this leads to constantly high blood pressure.

Distinctive symptoms of such hypertension:

• young age;
• the patient's pressure rises suddenly, without dependence on previous emotional or physical stress;
• asymmetry of pressure increase;
• swelling of the legs;
• hyperemia of the vessels of the eyes (possibly hemorrhage in the retina of the eye);
• severe damage to the optic nerve.

Therapy of such a disease is associated with the treatment of the underlying disease. Medicines are prescribed that slow down the production of renin.

Hypertension has a rather complicated classification. This is due to the fact that the factors for the development of such a pathology are extremely diverse. Clinical manifestations, forms of manifestation of the disease depend on them and on pathogenesis. Regardless of the degree and stage of hypertension, a comprehensive diagnosis of the patient is prescribed before the start of therapy for the disease, and only after that can specially selected drugs be prescribed. For each patient, the complex intake of drugs will be individual, arterial hypertension in each proceeds in its own way.