Classification of arterial hypertension is a system used to evaluate the severity and stage of development of arterial hypertension.
Attention!In the international classification of 10th review diseases (ICD-10), arterial hypertension of inorganic nature is indicated by Code I10.
Hypertonic Disease: Definition, Description and Ethiology
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 either not treated or ineffective medication.The main cause of patients with increased hypertension patients is brain or heart stroke.
The prevalence of arterial hypertension increases with age and body weight.Men of young age often suffer from disease than women.Postmenopausal women more often suffer from hypertension than men.
Arterial hypertension can be divided into primary (essential) and secondary (organic).
The vast majority (> 90%) of hypertension have primary hypertension, defined as idiopathic.Primary hypertension is diagnosed by excluding organic pathologies.
Some risk factors can increase the risk of developing the disease at a young age.In medicine, modified and non -modified factors of the disease formation are distinguished.These include:
- Obesity;
- Excess salt, alcohol in a diet;
- Smoking cohabitants (they pose a risk, 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 coarction or aortic sclerosis.Neurogenic, psychogenic and podogenic forms are also known.The latter form includes, among other things, ovulation and NSAID inhibitors.Drugs and toxic substances, as well as very high consumption of licorice can lead to secondary hypertension form.Renal hypertension caused by renal artery stenosis, as well as hyperaldosteronism, fechromocytoma, Kushing disease or hyperthyroidism belong to secondary forms of hypertension.
Another type of arterial hypertension occurs with hypertensional pregnancy disorder (GEC).Risk factors include mother's high age and multiple pregnancy.Various 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 maintained at an elevated level.To maintain a heart extraction, the heart becomes hypertrophized and can resist a constant pressure under pressure.
The kidneys also play an important role in the pathogenesis of hypertension.Although renal blood flow and glomerular filtration rate remain largely constant, sodium secretion also increases.The impact of, for example, the secretion of renin or changed sodium reabsorption in pressure is discussed.
Symptoms
Often, the symptoms of arterial hypertension occur very late.In most cases, the disease is asymptomatic.
Hypertension may be characterized by the following symptoms:
- Early morning pain in the head;
- Sleep disturbances, dizziness;
- Epistaxis;
- Tinnitus in the ears;
- Nonspecific heart disorders;
- The vibration of the atrial.
In the case of secondary hypertension, symptoms of the underlying disease are added.Special forms of hypertension are hidden hypertension (SG) and white clothes syndrome (SBC).
With SBC, blood pressure increases ≥140/90 mm Hg.Art.When measuring in the doctor's office.At home and when monitoring blood pressure, normal blood pressure values are recorded.
With hidden hypertension, the blood pressure values to the doctor are in the normal interval.Home measurements or blood pressure monitoring show increased values of ≥140/90 mm Hg.Art.This form can be associated with factors such as male sex and younger age, as well as smoking, drinking alcohol and stress.
With hypertensive crisis, it is necessary to describe the appropriate treatment regimen in order to prevent pathological processes in organs.Patients with the disease seek to cause urgent help or take it to the clinic themselves.Lack of treatment can threaten the patient's life and cause irreversible consequences.The progress of blood pressure can be malignant, which will lead to unjustified risk.If any vascular symptoms appear, it is recommended to see a doctor immediately, as a crisis can result in lifelong disabilities.
Classification of hypertension by degree
The stages of arterial hypertension were distinguished by A Who.An increase in blood pressure, which occurs, for example, after physical stress, is not considered hypertension.
A high level disproportionately of low load blood pressure is called labile hypertension.The dangerous form of arterial hypertension is associated with diastolic blood pressure above 120 mm Hg.Art., Which decreases by less than 10% at night.
New classification (2017) of hypertension by stages and degrees: The table is given below.
| Stages ag | Systolic pressure in mm Hg.Art. | Diastolic pressure in mm Hg.Art. |
|---|---|---|
| optimum | <120 | <75 |
| Normal | 120-125 | 75-79 |
| High | 126-129 | 80-85 |
| Stage One: Initial Hypertension | 130-150 | 85-99 |
| Stage 2: moderate hypertension | 160-179 | 100-109 |
| Stage 3: Severe hypertension | ≥180 | ≥110 |
| Insulated systolic hypertension | ≥130 | <90 |
Classification of arterial hypertension by degree
Hypertension can be classified depending on damage to blood vessels, eyes, heart, kidneys.In accordance with WHO recommendations, there are 3 degrees of hypertension.In the first instance, there are no clinical signs of organ damage.In the second degree, the target organs are affected and vessel atherosclerosis is detected.With the third degree, obvious cardiovascular complications are born toad, cardiac and cerebral attack on the heart, transient ischemic attacks.
Stratification of risk with pronounced arterial hypertension determines the possibility of complications.Depending on the stage of arterial hypertension, the risk can vary significantly.
Important!Only a doctor can determine the correct diagnosis, the category of risk, to give certain types of recommendations for prevention and treatment.It is not recommended to independently calculate the risk of unused scales and try to treat the disease.Treating a child and a young man can change.A variety of treatment is chosen by a physician based on medical history.
Complications
The problem of arterial hypertension is that it often remains diagnosed for a long time or is treated poorly.Lack 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 extremities vessels.Often, pronounced atherosclerosis develops.
Hearts and insufficiency, as well as coronary heart disease, are important consequences of heart hypertension.The heart grows to withstand an increased load.The result is Levo -atcentricular failure.
As a result of atherosclerotic changes in the coronary arteries, the 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.Can occur as a result of endothelial damage.Years of exposure to high blood pressure can cause pronounced nephrosclerosis with renal failure of the last phase.
AG can lead to transitional ischemic attacks (TIA), cerebral attack on the heart, hypertonic bleeding or acute encephalopathy.The risk of stroke in the brain can be significantly reduced by antihypertensive therapy.
Hypertonic retinopathy, as a rule, occurs as a result of the spread of atherosclerosis in the blood vessels of the retina.Vascular diseases caused by hypertension are OZPA, abdominal aortic aneurysm and aortic dissection.
Treatment
Hypertension treatment begins with non -DRrug intervention.Main Methods Non -Drug of therapy for the disease:
- A decrease in body weight to 25 units according to BMI;
- Kalimi në një dietë me kripë të ulët nga <5-6 g NaCl në ditë (rekomandohet të zgjidhni një dietë dash);
- Rejection of smoking, alcohol;
- Limiting caffeine consumption.
It is also required to limit the use of hypertension if there is hypertension.Patients are recommended to be involved in the type of training from the bottom to the country 3-4 times a week, 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.
Medical therapy begins with monotherapy with the medicine of choice.In values that are strongly deviated from normal blood pressure values (> 20/10 mm Hg) or the combined primary therapy is performed with simultaneous disease.
Preparations of choice:
- Beta-blocker;
- ACE inhibitors;
- Thiazid diuretics;
- AT1 receptor antagonists;
- Calcium blocks of long action.
As a double combination, you can use a diuretic in combination with a beta-blocking, long-acting calcium antagonists, ACE inhibitors or AT1 receptor blockers.
Non-hefidropiridine calcium antagonists should not be described together with beta-blockers, as they contribute to the development of bradycardia or atrioventricular blockade.
Depending on the simultaneous disease, individual medicines cannot be prescribed.Diuretics are recommended for hypertension in combination with heart failure.ACE inhibitors can be used for heart failure as well as in diabetic nephropathy.In the presence of myocardial insufficiency, beta-blockers can also be used.
Regarding the use of individual medicines, factors such as side effects, individual tolerance and interaction with other medicines that patient use are added.Triple combinations are also possible if a double combination does not give the desired effect.