Stages of hypertension - stratification of risk in hypertension, methods of therapy, complications

What is hypertensive disease

This disease is a persistent increase in blood pressure above 140/90 mm Hg. Art. Such a pathology is typical for people over 55 years of age, but in the modern world young people also face it. Any person has two kinds of pressure:

• systolic or upper - reflects the force with which blood presses on large arterial vessels during compression of the heart;
• diastolic - shows the level of blood pressure on the walls of the vessels when the heart muscle relaxes.

Most patients are diagnosed with an increase in both pressure values, although isolated hypertension, systolic or diastolic, is sometimes noted. Primary arterial hypertension develops as an independent disease due to heredity, insufficient productivity of the kidneys, severe stress. The secondary form of hypertension is associated with pathologies of internal organs or external factors. Its main reasons are:

• psycho-emotional overload;
• of blood disease;
• kidney pathology;
• stroke;
instagram viewer
• heart failure;
• side effects of certain medicines;
• deviations in the work of the autonomic nervous system.

Stages of

The basic classification of hypertensive disease divides it into several stages depending on the degree of increase in pressure. On any of them, its values ​​will be more than 140/90 mm Hg. Art. Progressing, hypertensive disease causes the growth of systolic and diastolic indicators up to critical values ​​that threaten human life. Determine the stage of hypertension can be according to the following table:

Stage of arterial hypertension / Pressure indicator	Systolic, mm Hg. Art. Diastolic, mm Hg. Art.
First	140-159	90-99
Second	160-179	100-109
Third	180 and above	110 and above

Symptoms of

Classification of arterial hypertension by stages is necessary for the purpose of appropriate treatment. In addition, it helps doctors to guess how much the target organ is affected, and to determine the risk of serious complications. The main criteria for identifying the stages of hypertension are the pressure indicators. Confirm the diagnosis is helped by the symptoms of the disease. At each stage, certain manifestations of arterial hypertension are noted. It is also suspected of general signs of hypertension:

• dizziness;
• headache;
• numbness of the fingers;
• degradation of operability;
• irritability;
• tinnitus;
• sweating;
• pain in the heart;
• nasal bleeding;
• sleep disorders;
• vision impairment;
• peripheral edema.

These symptoms at a certain stage of hypertension are observed in different combinations. Vision disorders are manifested in the form of a shroud or "flies" before the eyes. Headache is more often noted at the end of the day, when the blood pressure level is at its peak. Often it appears and immediately after awakening. Because of this, the headache is sometimes attributed to the usual lack of sleep. Some distinguishing features of the pain syndrome:

• may be accompanied by a sensation of pressure or heaviness in the occiput;
• sometimes increases with tilting, turning the head, or with sudden movements;
• may cause swelling in the face;
• is not related to the level of blood pressure, but sometimes indicates its jump.

1st stage

Hypertensive disease of the first stage is diagnosed if the pressure is within 140 / 90-159 / 99 mm Hg. Art. It can persist at this level for several days or weeks in a row. Pressure is reduced to normal values ​​under favorable conditions, for example, after rest or stay in a sanatorium. Symptoms in the first stage of hypertension are practically absent. Patients have only complaints about:

• sleep disorders;
• pain in the head and heart;
• increase in the tone of the arteries of the fundus.

Stage 2

If the first stage of hypertension was not treated, then the pressure begins to rise even more and is already within 160 / 100-179 / 109 mm Hg. Art. The condition is not normalized without medicines even after rest. Among the symptoms of hypertension in the second stage appear:

• dyspnoea at a load;
• headache;
• dizziness;
• poor sleep;
• angina.

The hypertensive crisis is no longer as rare as in the first stage of hypertension. Because of this, the risk of stroke and other serious complications increases. In addition, stage 2 hypertension causes the first symptoms of damage to target organs, which are found on the ECG and ultrasound. During the diagnosis, the patient is found:

• protein in the urine;
• narrowing of arteries in the retina of the eye;
• increase in creatinine in urine;
• hypertrophy of the left ventricle.

Stage 3

Excess blood pressure level of 180/110 mm Hg. Art.speaks about the third stage of hypertensive disease. It is considered the most difficult of all - even taking tablets does not always give a positive result. Hypertensive disease at this stage causes the following symptoms:

• memory impairment;
• decreased vision;
• cardiac rhythm disturbance;
• headache;
• dyspnoea at physical exertion;
• angina;
• dizziness.

Strongly affected and target organs, especially the heart, brain, kidneys and eyes. The patient may develop heart or kidney failure. In addition, the contractility of the heart, the conductivity of impulses in the myocardium, decreases. Hypertensive crises occur frequently, so the risk of heart attack and stroke increases dramatically. To normalize the pressure, you sometimes have to take several medications at once.

Risk stratification in hypertension

In addition to stages, physicians also distinguish the degrees of hypertension. In this case, risk stratification is applied, i.e.their division into groups depending on the existing disorders in the body, changes in the work or structure of the target organs. For each degree of risk, certain complications of essential hypertension are typical:

1. First. This is a low-risk group in which hypertension is not determined. Infarction or stroke in the next 10 years arise only in 15% of patients.
2. Second. Group of average risk, in which a person has one external negative factor, for example, smoking. The likelihood of developing a stroke or heart attack is increased to 15-20%.
3. Third. High risk group, when the patient has a maximum of 3 negative factors. A heart attack or stroke is diagnosed in 20-30% of patients with essential hypertension.
4. Fourth. This is a very high risk, in which more than 3 negative factors affect the patient. Several pathogens are involved in the pathological process. A stroke or a heart attack occurs with a 30 percent probability.

To assess the degree of risk, the physician considers the number of negative factors available to the patient, target organ damage( POM), and associated clinical conditions( ACS).The latter include diseases of the cardiovascular system. Table for determining risk:

Type and number of available risk factors / Stage of hypertension	First	Second	Third
No risk factors, POM and ACS	Low risk	Medium	High
Less than 1-2 risk factors	Medium	High	Very high
3 or more factorsrisk, POM or ACS	High	High	Very high
ACS	Very high	Very high	Very high

Treatment

Therapist, cardiologist, neuropathologist can participate in the diagnosis of the disease. At the first stage, hypertension can be treated at home. For the normalization of pressure, it is recommended to eliminate negative external factors and a good rest, but it's also not worth lying on the couch all day. Regular walks will help strengthen the cardiovascular system. Drugs are not required here. Instead, the patient is recommended:

• normalize their weight;
• to abandon bad habits;
• eliminate experiences and stresses;
• comply with the work and rest regime;
• eat right.

Diet is an important condition for treating any stage of hypertension. To reduce the pressure should limit the intake of salt to 5-6 grams per day. Its excess causes an increase in the volume of circulating blood, which provokes a rise in pressure. As for the drinking regime, it is necessary to consume about 1.5 liters per day. The diet should include the following foods and dishes:

• egg white omelet and soft-boiled eggs;
• vegetable oils;
• salads from fresh vegetables;
• dried fruits;
• sour fruits and berries( gooseberries, apples, plums, figs);
• deciduous greens;
• jelly from fruit and berries;
• jujube;
• yesterday or dried bread;
• skim milk products;
• chicory;
• beans;
• low-fat fish, including pike perch, cod, pike, carp;Veal, beef, chicken, turkey.

With hypertension, all types of cooking are allowed, except frying. It is allowed to boil, bake, steaming. It is not recommended to extinguish foods very often. Eat up to 4-5 times a day in small portions weighing about 200 g. The food should not be too hot, as it excites the nervous system. The optimum temperature is 15-65 degrees. Prohibited products include:

• cream, fatty milk, cottage cheese and sour cream;
• fresh bread made from the highest grade flour;
• rich soups and soups based on them;
• spicy and fatty cheeses;
• margarine and culinary fat;
• jam, honey;
• alcohol;
• by-products;
• garlic, spinach, radish, daikon, turnip;
• sweets;
• horseradish, mustard, pepper;
• smoked meat;
• sausages;
• strong tea and coffee;
• eggs fried and hard boiled;
• oily fish;
• lamb, goose, pork, duck.

With hypertensive disease of the second stage cope already with the help of medication. The reason is that without medicines, the pressure does not return to normal. The main factors for hypertension are antihypertensives. These include drugs from different pharmacological groups. They reduce pressure, but in different ways. In hypertensive disease of Stage 2, the following drugs are used:

• Desaggregants: Aspirin, Clopidogrel, Ticlodipine, Dipyridamole. These are medicines that dilute blood flow. They are necessary to prevent thrombosis, the risk of which exists in hypertension.
• Lipidemic and hypoglycemic agents: Gliclazide, Levothyroxine sodium, Crestor. The first reduce the level of cholesterol, the second - glucose. Most often used if the cause of high blood pressure are overweight and diabetes.
• Calcium channel blockers: Amlodipine, Cordipine, Verapam, Dialtzem. They are calcium antagonists, cause an expansion of the lumen of blood vessels, due to which the pressure decreases.
• Diuretics: Furosemide, Veroshpiron, Indapamide. It is a diuretic that removes excess fluid from the body, thereby reducing the volume of circulating blood. As a result, blood pressure is reduced.

Acute attacks of hypertension of the third stage are treated in a hospital. Already at home the patient has to take medicines, sometimes several at once. Medications are selected individually for each patient. The doctor can prescribe:

• Alpha- and beta-blockers: Anaprilin, Bisoprolol, Terazozin, Clonidine. They inhibit alpha or beta receptors, which contributes to the relaxation of the vascular walls.
• Angiotensin 2 antagonists: Teveten, Mykardis, Atakand, Valsakor. Do not give this enzyme to provoke the tension of blood vessels, against which there are jumps of blood pressure.
• Angiotensin converting enzyme( ACE) inhibitors: Zocardis, Captopril, Prestarium. Block this substance, which eliminates the spasms of the vessels.
• Sedatives: Diazepam, Novo-Passit, Phenazepam. Used if the cause of hypertension are stress and psycho-emotional overload.

Possible complications and consequences

Hypertensive disease affects almost all organ systems, but the heart, kidneys and brain have a particularly severe negative effect. They are the first to attack when pressure rises. Possible complications of these organs include the following pathologies:

• myocardial infarction;
• left ventricular failure;
• ischemic or hemorrhagic stroke;
• hypertensive encephalopathy;
• glomerulonephritis;
• atherosclerosis of the arteries of the kidneys;
• kidney failure;
• nephrosclerosis;
• decreased visual acuity.

Video