The classification of arterial 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 revision (ICD-10), the arterial hypertension of inorganic nature is indicated by the i10 code.
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 received or ineffective medicines.The main cause of patients' mortality with adult hypertension is brain or heart infarction.
The prevalence of arterial hypertension increases with age and body weight.Men at a young age often suffer from a disease compared to women.Postmenopausal women suffer more often than 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 disease at an early age.In medicine, modified and not modified factors of the formation of the disease are distinguished.These include:
- Obesity;
- Excess of salt, alcohol in a diet;
- Smoking living together (they represent a danger, since the patient involuntarily becomes a passive smoker);
- Stress;
- Hypodynamia (lack of sport in the patient's life);
- Smoke;
- Circulatory disorders (in a small or large circle);
- Elderly age;
- Low social state.
Secondary (symptomatic) hypertension is due to another apnea syndrome in a dream, aorta coartation or aortic sclerosis.There are also known neurogenic, psychogenic and running forms.The latest form includes, among other things, ovulation and fans inhibitors.Drugs and toxic substances, as well as a very high consumption of licorice can lead to a secondary form of hypertension.Renal hypertension caused by renal artery stenosis, as well as hyperaldosteronism, feocromocytoma, kushing disease or hyperthyroidism belong to the secondary forms of hypertension.
Another type of arterial hypertension occurs with hypertensive pregnancy disorder (GEC).Risk factors include the elevated age of the mother and multiple pregnancy.Various forms are known, including, for example, gestational hypertension with or without proteinuria.
Patophysiology
Arterial hypertension occurs due to an increase in peripheral resistance, an increase in cardiac range or combinations of both.There are several adaptation mechanisms in this process, therefore blood pressure is constantly maintained at an increased level.To maintain a cardiac expulsion, the heart becomes hypertrophic and can resist a constant load under pressure.
The kidneys also play a significant role in the pathogenesis of hypertension.Although the renal blood flow and the glomerular filtration rate remain largely constant, the sodium excretion also increases.The influence of, for example, is discussed the secretion of Renina or the change of reabsorption of the sodium on the pressure.
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:
- Morning head pain;
- Sleep disturbances, dizziness;
- Epistaxis;
- Tinnitus;
- Non -specific heart disorders;
- Tremature of the atrial.
In the case of secondary hypertension, the symptoms of the underlying disease are added.The special forms of hypertension are hidden hypertension (SG) and white clothes syndrome (SBC).
With SBC, blood pressure increases ≥140/90 mm hg.Art.When measurement in the doctor's office.At home and in the monitoring of blood pressure, normal blood pressure values are recorded.
With hidden hypertension, the values of blood pressure to the doctor are in the normal interval.The measurements of the house or the monitoring of blood pressure show increases ≥140/90 mm hg values.Art.This form can be associated with factors such as male and younger age, as well as smoking, drink alcohol and stress.
With the hypertensive crisis, it is necessary to prescribe the correct treatment regime in order to prevent pathological processes in the bodies.Patients with this disorder requires to cause emergency help or take it to the clinic alone.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 an unjustified risk.If vascular symptoms occur, it is recommended to see a doctor immediately, since a crisis can cause permanent disabilities.
Classification of hypertension by degree
The stages of arterial hypertension were distinct from a Who.An increase in blood pressure, which occurs, for example, after physical stress, is not considered hypertension.
A disproportionately high level of low -load blood pressure is called lapable hypertension.The dangerous form of arterial hypertension is associated with diastolic blood pressure greater than 120 mm hg.Art., Which decreases less than 10% during the night.
New (2017) Classification of hypertension for phases and degrees: the table is reported below.
| Stages Ag | Systolic pressure in mm hg.Art. | Diastolic pressure in mm hg.Art. |
|---|---|---|
| Optimal | <120 | <75 |
| Normal | 120-125 | 75-79 |
| High normal | 126-129 | 80-85 |
| 1st stadium: initial hypertension | 130-150 | 85-99 |
| Phase 2: moderate hypertension | 160-179 | 100-109 |
| Phase 3: severe hypertension | ≥180 | ≥110 |
| Isolated systolic hypertension | ≥130 | <90 |
Classification of arterial hypertension per degree
Hypertension can be classified according to the damage to blood vessels, eyes, heart, kidneys.In accordance with WHO recommendations, there are 3 degrees of hypertension.At the first degree, there are no clinical signs of damage to the organs.In the second degree, the target organs are interested and the atherosclerosis of the vessels is detected.With the third degree, obvious cardiovascular complications arise toad that more, heart attack and cerebral cardiac, transient ischemic attacks.
The stratification of the risk with the pronounced arterial hypertension determines the probability of complications.Depending on the stadium of arterial hypertension, the risk may vary significantly.
Important!Only a doctor can determine the correct diagnosis, a risk category, to provide certain types of recommendations for prevention and treatment.It is not recommended to independently calculate the risk on ungotted stairs and try to treat the disease.The treatment of a child and a teenager can differ.A variety of care is chosen by a doctor based on medical history.
Complications
The problem of arterial hypertension is that it often remains not diagnosed for a long time or is not very treated.The absence of symptoms forces patients not to look for medical assistance.This leads to complications that often appear in the heart, in the kidneys, in the central nervous system and in the eyes or in the vessels of the lower limbs.Often pronounced atherosclerosis develops.
Hearts and insufficiency, as well as coronary heart disease, are important consequences of the hypertension of the heart.The heart increases to resist an increased load.The result is the insufficiency of levo -ventricular.
Due to atherosclerotic changes in coronary arteries, the coronary reserve is very limited that even a slight increase in the cardiac range during stress can cause angina pectis angina, myocardial infarction or sudden coronary death.
Hypertonic nephropathy - renal damage due to hypertension.It can occur due to endothelial damage.Years of high blood pressure exposure can cause nephrosclerosis pronounced with renal failure of the last stadium.
AG can lead to transient ischemic attacks (Tia), brain infarction, hypertonic mass bleeding or acute encephalopathy.The risk of stroke can be significantly reduced by antihypertensive therapy.
Hypertonic retinopathy, as a rule, occurs following the spread of the atherosclerosis in the blood vessels of the retina.Vascular diseases caused by hypertension are Ozpa, abdominal aorta aneurysm and aortic dissection.
Treatment method
The treatment of hypertension begins with a non -drug intervention.The main methods of non -pharmacological therapy for the disease:
- A decrease in body weight to 25 units according to the IMC;
- Transizione a una dieta a basso contenuto di sale da <5-6 g di NaCl al giorno (si consiglia di selezionare una dieta trattista);
- Refusal of smoke, alcohol;
- Limit the consumption of caffeine.
It is also necessary to limit the use of hypertensive drugs if there is hypertension.Patients are recommended to engage in a type of end-to-stay training 3-4 times per week of swimming, running cowards 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 the age of 80 and> 150/90 mm hg.- For elderly patients.
Medicine therapy begins with monotherapy with your favorite drug.At values that are strongly deviated by the normal blood pressure values (> 20/10 mm hg) or the primary combined therapy is carried out with concomitant diseases.
Prepare of choice:
- Beta-blockers;
- ACE inhibitors;
- Thiazidic diuretics;
- AT1 receptor antagonists;
- Long -lasting football blocks.
As a double combination, it is possible to use a diuretic in combination with a beta-blocker, long-lasting football antagonists, ACE inhibitors or AT1 receptors blocking.
The non-ephropyridine calcium antagonists must not be prescribed together with beta-blockers, since they contribute to the development of bradycardia or atrioventricular blocking.
Depending on the concomitant disease, the individual drugs cannot be prescribed.Diuretics are recommended for hypertension in combination with heart failure.ACE -Inbiters can be used for heart failure, as well as in diabetic nephropathy.In the presence of myocardial insufficiency, beta-blockers can also be used.
As for the use of individual drugs, factors such as side effects, individual tolerance and interaction with other drugs that are added the use of the patient.Triple combinations are also possible if a double combination does not provide the desired effect.