The classification of arterial hypertension is a system that is used to evaluate the gravity and development stage of arterial hypertension.
Attention!In the International Classification of Diseases of the Tenth Revision (ICD-10), Code i10 indicates the arterial hypertension of inorganic nature.
Hypertonic disease: definition, description and etiology
About 50% of people suffer from hypertension (GB).Approximately half of hypertension do 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 the mortality of patients with adult hypertension is the infarction of the brain or heart.
The prevalence of arterial hypertension increases with age and body weight.Men at an early age often suffer disease than women.Women in postmenopause often suffer 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, the modified and non -modified factors of disease formation are distinguished.These include:
- Obesity;
- Excess salt, alcohol in a diet;
- Smoking cohabitants (represent a danger, since the patient involuntarily becomes a passive smoker);
- Stress;
- Hypodinamia (lack of sport in patient's life);
- Smoking;
- Circulatory disorders (in a small or large circle);
- Elderly;
- Under social status.
Secondary (symptomatic) hypertension is due to another disease: apnea syndrome in a dream, aortic coarstation or aortic sclerosis.Neurogenic, psychogenic and could also know.The last form includes, among other things, Ovulation and NSAID inhibitors.Drugs and toxic substances, as well as the very high consumption of licorice can lead to a secondary form of hypertension.The renal hypertension caused by the stenosis of the renal artery, as well as hyperaldosteronism, pheochromocytoma, kushing disease or hyperthyroidism belong to the secondary forms of hypertension.
Another type of arterial hypertension occurs with the hypertensive disorder of pregnancy (GEC).Risk factors include the high age of the mother and multiple pregnancy.Several ways 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 spending or combinations of both.There are several adaptation mechanisms in this process, so blood pressure is constantly maintained at an increased level.To maintain heart expulsion, the heart is hypotrophia and can support a constant load under pressure.
The kidneys also play an important role in hypertension pathogenesis.Although renal blood flow and glomerular filtration rate remain constant, sodium excretion also increases.The influence of, for example, the secretion of renin or reabsorption changed sodium on the pressure is discussed.
Symptoms
Often, the symptoms of arterial hypertension occur too late.In most cases, the disease is asymptomatic.
Hypertension can be characterized by the following symptoms:
- Early pain in the morning;
- Sleep disturbances, dizziness;
- Epistaxis;
- Tinnitus;
- Nonspecific heart disorders;
- Headset tremor.
In the case of secondary hypertension, symptoms of the underlying disease are added.Special forms of hypertension are hidden hypertension (SG) and white tunic syndrome (SBC).
With SBC, blood pressure increases ≥140/90 mm Hg.Art.By measuring in the doctor's office.In the home and when monitoring blood pressure, normal blood pressure values are recorded.
With hidden hypertension, blood pressure values in 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 male 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 prevent pathological processes in the organs.Patients with this ailment require emergency help or take it to the clinic on their own.The lack of treatment can threaten the patient's life and cause irreversible consequences.The progression of blood pressure can be malignant, which will lead to unjustified risk.If any vascular symptoms occur, it is recommended to see a doctor immediately, since a crisis can cause a disability for life.
Classification of hypertension by grade
The stages of arterial hypertension were distinguished by an WHO.An increase in blood pressure, which occurs, for example, after physical stress, is not considered hypertension.
A disproportionately high level of blood pressure at low load is called labile hypertension.The dangerous form of arterial hypertension is associated with a diastolic blood pressure greater than 120 mm Hg.Art., Which decreases by less than 10% during the night.
New (2017) Classification of hypertension in stages and degrees: The table is provided below.
| AG stages | Systolic pressure in mm Hg.Art. | Diastolic pressure in mm Hg.Art. |
|---|---|---|
| Optimum | <120 | <75 |
| Normal | 120-125 | 75-79 |
| Normal high | 126-129 | 80-85 |
| First stage: initial hypertension | 130-150 | 85-99 |
| Stage 2: Moderate hypertension | 160-179 | 100-109 |
| Stage 3: severe hypertension | ≥180 | ≥110 |
| Isolated systolic hypertension | ≥130 | <90 |
Classification of arterial hypertension by grade
Hypertension can be classified depending on the 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 organs in the organs.Second, the target organs are affected and the atherosclerosis of the vessels are detected.With the third degree, obvious cardiovascular complications arise, cardiac and cerebral heart attack, transient ischemic attacks.
Risk stratification with pronounced arterial hypertension determines the probability of complications.Depending on the arterial hypertension stage, the risk can vary significantly.
Important!Only a doctor can determine the correct diagnosis, category of risk, to give certain types of recommendations for prevention and treatment.It is not recommended to independently calculate the risk in unsecked scales and try to treat the disease.The treatment of a child and a teenager can differ.A doctor chooses a variety of treatment based on medical history.
Complications
The problem of arterial hypertension is that it often remains without diagnosing for a long time or is poorly treated.The absence of symptoms forces patients not to seek medical help.This leads to complications that often appear in the heart, kidneys, central nerve systems and eyes or in the lower limb vessels.Often, atherosclerosis is developed.
Hearts and insufficiency, as well as coronary heart disease, are important consequences of the hypertension of the heart.The heart increases to resist an increase in load.The result is the Levo -Sntricular failure.
As a result of atherosclerotic changes in coronary arteries, the coronary reserve is so limited that even a slight increase in cardiac spending during stress can cause angina pectoralis, myocardial infarction or sudden coronary death.
Hypertonic nephropathy: kidney damage due to hypertension.It can occur as a result of endothelial damage.Years of exposure to high blood pressure can cause nephrosclerosis pronounced with renal failure of the last stage.
AG can lead to transient ischemic attacks (TIA), cerebral heart attack, hypertonic mass bleeding or acute encephalopathy.The risk of stroke can be significantly reduced by antihypertensive therapy.
Hypertonic retinopathy, as a rule, occurs as a result of the propagation of atherosclerosis in the blood vessels of the retina.Vascular diseases caused by hypertension are Ozpa, aneurysm of the abdominal aorta and aortic dissection.
Treatment method
Hypertension treatment begins with non -fragmentary intervention.The main therapy methods that are not funds for the disease:
- A decrease in body weight to 25 units according to the BMI;
- Transición a una dieta baja en sal de <5-6 g de NaCl por día (se recomienda seleccionar una dieta de tablero);
- Rejection of smoking, alcohol;
- Limit caffeine consumption.
It is also required to limit the use of hypertensive medications if there is hypertension.Patients are recommended in the type of end -to -stop training from 3 to 4 times per week, executing 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 objective values of blood pressure must be> 140/90 mm Hg.For patients under 80 years and> 150/90 mm Hg.- For elderly patients.
Medicine therapy begins with monotherapy with the medication of choice.AT values that deviate strongly from normal blood pressure values (> 20/10 mm HG) or primary combined therapy is carried out with concomitant diseases.
Choice preparations:
- Beta blockers;
- ECA inhibitors;
- Tiazide diuretics;
- AT1 receptor antagonists;
- Long action calcium blocks.
As a double combination, you can use a diuretic in combination with a beta blocker, prolonged action calcium antagonists, ECA inhibitors or AT1 receptor blockers.
Calcium antagonists of the non -hephidropyridine type should not be prescribed together with beta blockers, since they contribute to the development of bradycardia or atioventricular block.
Depending on concomitant disease, individual medications 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, you can also use beta blockers.
Regarding the use of individual medicines, factors such as side effects, individual tolerance and interaction with other medications used by the patient.Triple combinations are also possible if a double combination does not provide the desired effect.