The classification of hypertension is a system used to evaluate the severity and stage of the development of arterial hypertension.
Attention!In the International Classification of Diseases of the Tenth Review (ICD-10), Arterial Hypertension of Inorganic Nature is indicated by Code I10.
Hypertonic disease: definition, description and etiology
About 50% of people suffer from hypertension (GB).About half of hypertension does not know what suffers from the disease.More than 50% of patients with known hypertension are not treated or ineffective medications are received.The main cause of mortality from patients with adult hypertension is brain or heart infarction.
The prevalence of hypertension increases with age and body weight.Men at an early age usually suffer from illness than women.Post -female women suffer more often from hypertension than men.
Arterial hypertension can be divided into primary (essential) and secondary (organic).
The vast majority (> 90%) of hypertension has primary hypertension, defined as idiopathic.Primary hypertension is diagnosed excluding organic pathologies.
Some risk factors may increase the risk of developing the disease at an early age.In medicine, modified and unchanged factors from disease formation are distinguished.These include:
- Obesity;
- Excess salt, alcohol in a diet;
- Smoking cohabiting (they represent a danger, as the patient involuntarily becomes a passive smoker);
- Stress;
- Hypodinamia (lack of sport in the patient's life);
- Smoking;
- Circulatory disorders (in a small or large circle);
- Elderly age;
- Low social status.
Secondary (symptomatic) hypertension is due to another disease - Apnea syndrome in a dream, aortic coarctation or aortic sclerosis.Neurogenic, psychogenic and podogenic forms are also known.The last form includes, among other things, ovulation inhibitors and NSAIDs.Drugs and toxic substances, as well as very high consumption of licorice, can lead to a secondary form of hypertension.Renal hypertension caused by renal artery stenosis, as well as hyperaldosteronism, pheochromocytoma, kushing disease or hyperthyroidism belong to secondary forms of hypertension.
Another type of hypertension occurs with the hypertensive disorder of pregnancy (GEC).Risk factors include a high age of mother and multiple pregnancy.Several forms are known, including, for example, gestational hypertension with or without proteinuria.
Pathophysiology
Arterial hypertension occurs due to an increase in peripheral resistance, an increase in cardiac output or combinations of both.There are several adaptation mechanisms in this process, so blood pressure is constantly kept at an increased level.To maintain a cardiac ejection, the heart is hypertrophied and can withstand a constant load under pressure.
The kidneys also play a significant role in pathogenesis of hypertension.Although renal blood flow and glomerular filtration rate remain widely constant, sodium excretion also increases.The influence of, for example, renin secretion or altered reabsorption of sodium in pressure is discussed.
Symptoms
Often the symptoms of hypertension occur too late.In most cases the disease is asymptomatic.
Hypertension can be characterized by the following symptoms:
- Early morning pain in the head;
- Sleep disorders, dizziness;
- Epistaxis;
- Tinnitus;
- Nonspecific heart disorders;
- Atrial tremor.
In the case of secondary hypertension, symptoms of the underlying disease are added.Special forms of hypertension are hidden hypertension (SG) and white clothing syndrome (SBC).
With SBC, blood pressure increases ≥140/90 mm hg.Art.When measuring in the doctor's office.At home and by monitoring blood pressure, normal blood pressure values are recorded.
With hidden hypertension, blood pressure values at the doctor are in the normal range.House measurements or blood pressure monitoring show increased values of ≥140/90 mm hg.Art.This form can be associated with factors such as males and younger age, as well as smoking, drinking alcohol and stress.
With the hypertensive crisis, it is necessary to prescribe the correct treatment regime to avoid pathological processes in the organs.Patients with this disease need to cause emergency help or take it to the clinic on their own.Lack of treatment can threaten the patient's life and cause irreversible consequences.The progression of blood pressure can be evil, which will lead to an unjustified risk.If any vascular symptom occurs, it is recommended to consult a doctor immediately, as a crisis may result in lifelong disability.
Classification of hypertension by degree
The stages of arterial hypertension were distinguished by one who.Increased blood pressure, which occurs, for example, after physical stress, is not considered hypertension.
A disproportionately high level of low -load blood pressure is called Labin Hypertension.The dangerous form of arterial hypertension is associated with diastolic blood pressure above 120 mm Hg.Art., Which decreases at less than 10% at night.
Nova (2017) Classification of stages and degrees hypertension: The table is provided below.
| AG internships | Systolic pressure at mm hg.Art. | Diastolic pressure at mm Hg.Art. |
|---|---|---|
| Ideal | <120 | <75 |
| Normal | 120-125 | 75-79 |
| Normal | 126-129 | 80-85 |
| 1st Stage: Beginner Hypertension | 130-150 | 85-99 |
| Step 2: Moderate hypertension | 160-179 | 100-109 |
| Step 3: Severe hypertension | ≥180 | ≥110 |
| Isolated systolic hypertension | ≥130 | <90 |
Classification of arterial hypertension by degree
Hypertension can be classified, depending on damage to blood vessels, eyes, heart, kidneys.According to WHO recommendations, there are 3 degrees of hypertension.In the first degree, there are no clinical signs of organ damage.In the second degree, target organs are affected and vessel atherosclerosis is detected.With the third degree, obvious cardiovascular complications appear frog, heart and cerebral heart attack, transient ischemic attacks.
Risk stratification with pronounced arterial hypertension determines the likelihood of complications.Depending on the stage of hypertension, the risk may vary significantly.
Important!Only a doctor can determine the correct diagnosis, the risk category, to provide certain types of recommendations for prevention and treatment.It is not recommended to calculate independently the risk on unqualified scales and try to treat the disease.The treatment of a child and a teenager may differ.A variety of treatment is chosen by a doctor based on medical history.
Complications
The problem of arterial hypertension is that it usually remains without diagnosis for a long time or is poorly treated.The absence of symptoms forces patients not to seek medical help.This leads to complications that usually appear in the heart, kidneys, central nerve systems, and eyes or in the vessels of the lower ends.Frequently, pronounced atherosclerosis develops.
Hearts and insufficiency, as well as coronary heart disease, are important consequences of heart hypertension.The heart increases to support an increased load.The result is the ventricular failure of Levo.
As a result of atherosclerotic changes in the coronary arteries, coronary reserve is so limited that even a slight increase in cardiac output during stress can cause angina pectoris, myocardial infarction or sudden coronary death.
Hypertonic nephropathy - kidney damage due to hypertension.It can occur as a result of endothelial damage.Years of high blood pressure exposure can cause pronounced nephrosclerosis with renal failure of the last stage.
AG can lead to transient ischemic attacks (aunt), cerebral heart attack, hypertonic mass bleeding or acute encephalopathy.The risk of stroke can be significantly reduced by anti -hypertensive therapy.
Hypertonic retinopathy, as a rule, occurs as a result of the dissemination of atherosclerosis in retinal blood vessels.Vascular diseases caused by hypertension are OZPA, abdominal aortic aneurysm and aortic dissection.
Treatment method
Hypertension treatment begins with non -Drug intervention.The main methods of non -disease therapy for the disease:
- A decrease in body weight to 25 units according to the BMI;
- Transição para uma dieta com baixo sal de <5-6 g NaCl por dia (recomenda-se selecionar uma dieta de traço);
- Refusal to smoke, alcohol;
- Limiting caffeine consumption.
It is also necessary to limit the use of hypertensive medications if hypertension is.Patients are recommended to get involved in a type of cutting-edge training 3-4 times a week with cowardice or cycling.
In addition to these general measures, it is necessary to treat diseases that cause secondary hypertension.According to the European Hypertension Association, the target values of blood pressure should be> 140/90 mm Hg.For patients under 80 and> 150/90 mm hg.- For elderly patients.
Medical therapy begins with monotherapy with the drug of choice.In values that are strongly diverted from normal blood pressure values (> 20/10 mm Hg) or primary combined therapy is performed with concomitant diseases.
Preparations of choice:
- Betabloquers;
- ECA inhibitors;
- Thiazide diuretics;
- AT1 receptor antagonists;
- Longtime calcium blocks.
As a double combination, you can use a diuretic in combination with a beta blocker, prolonged action calcium antagonists, ACE inhibitors or AT1 receptor blockers.
Non -hefidropyridine calcium antagonists should not be prescribed along with beta -blockers, as they contribute to the development of bradycardia or atrioventricular block.
Depending on concomitant disease, individual drugs cannot be prescribed.Diuretics are recommended for hypertension in combination with heart failure.ECA inhibitors can be used for heart failure as well as diabetic nephropathy.In the presence of myocardial insufficiency, beta -blockers can also be used.
Regarding the use of individual medications, factors such as side effects, individual tolerance and interaction with other medications that patient use are added.Triple combinations are also possible if a double combination does not provide the desired effect.