Classification of blood pressure table. Degrees and stages of arterial hypertension

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Hypertension is one of the most common pathologies of cardio-vascular system and is widespread throughout the world, especially in civilized countries. It is most susceptible to active people whose lives are full of actions and emotions. According to the classification, there are various forms, degrees and stages of hypertension.

Treatment of hypertension - lifestyle changes

The basis for achieving good control blood pressure is not pharmacotherapy, but an action that the patient can introduce into his daily life. Eating 6 grams less of salt throughout the day can reduce systolic blood pressure by 2-4 mmHg. Mediterranean diet. When lowering blood pressure, it is useful to eat large amounts of vegetables, fruits and fish and reduce the amount of animal fats. Regular physical activity. Just half an hour of brisk walking, practiced on most days of the week, reduces systolic pressure by 4-9 mmHg. Limit your alcohol intake. Consuming no more than two standard drinks of alcohol in men reduces systolic blood pressure by 2-4 mmHg. Quit smoking. Avoid stress, relaxing training.

Reduce obesity.
Diastolic pressure decreases by 5-20 mmHg.
For every 10 kg of weight loss.
Limiting salt intake.

The effectiveness of hypertension therapy is largely determined by the cooperation of the patient and the doctor.

According to statistics, from 10 to 20% of adults in the world are sick. It is believed that half do not know about their disease: hypertension can occur without any symptoms. Half of the patients diagnosed with this condition are not treated, and of those who are treated, only 50% do it correctly. The disease develops equally often in both men and women, and occurs even in teenage children. Most people get sick after 40 years of age. Half of all older people have been diagnosed with this condition. Hypertension often leads to stroke and heart attack and is common cause death, including people of working age.

This applies to both health monitoring, in which the patient must actively participate by performing daily blood pressure measurements and the treatment itself. There are currently many drugs available to lower blood pressure, creating a variety of therapeutic options.

The decision to make about this drug must include factors such as patient tolerance, adverse events, and patient financial capabilities in addition to the pharmacological mechanism of action. Also, the recommended dosage regimen should be clear and easy to remember; This is especially true for older people.

The disease manifests itself as high blood pressure, which is scientifically called arterial hypertension. The last term refers to any increase in blood pressure, regardless of the cause. As for hypertension, which is also called primary or, it is an independent disease of unknown etiology. It should be distinguished from secondary, or, which develops as a sign of various diseases: heart, kidney, endocrine and others.

Hypertension is a chronic disease that often does not cause any obvious symptoms for many years. However, patients should be aware that consistent treatment is the only way to avoid serious complications, including premature death.

The risk of developing this condition increases with age. On the contrary, in young people, hypertension can be the result of other ailments. When measuring blood pressure, we read the systolic blood pressure, which is given first, and the diastolic blood pressure, which is given as the second value.

Hypertension is characterized by a chronic course, a persistent and prolonged increase in pressure, not associated with pathologies of any organs or systems. This is a disruption of the heart and the regulation of vascular tone.

Classifications of hypertension

Over the entire period of studying the disease, more than one classification of hypertension has been developed: according to appearance the patient, the reasons for the increase in pressure, etiology, the level of pressure and its stability, the degree of organ damage, the nature of the course. Some of them have lost their relevance, while others continue to be used by doctors today, most often this is a classification by degree and stage.

The causes of hypertension depend on the type of hypertension. Diseases that increase the risk of hypertension: Cushing's syndrome - with increased level steroid hormones in the blood, chronic disease kidneys, high intraocular pressure, Conn's syndrome, characterized by excessive production of adrenal aldosterone, pheochromocytoma - usually benign tumor The adrenal gland secretes adrenaline and norepinephrine, obstructive sleep apnea, aortic stenosis. Primary hypertension - this occurs without a specific cause. . In addition, there are factors that increase the risk of hypertension, including:

IN last years The upper limits of normal blood pressure have changed. If recently the value was 160/90 mm Hg. column was considered normal for an elderly person, today this figure has changed. According to WHO for all ages upper limit The norm is considered to be 139/89 mm Hg. pillar Blood pressure equal to 140/90 mm Hg. pillar, is initial stage hypertension.

Inadequate lifestyle, obesity, smoking, overweight, physical inactivity, excessive salt intake, high alcohol consumption, genetics. The development of hypertension is actually a long-term and complex process that depends not only on the environment, but also on genetic factors over which we have no influence. Therefore, it is better to prevent than to cure, that is, to minimize the risk of hypertension in the future.

In many patients, hypertension does not cause any symptoms, especially in the early stages of the disease, when pressure abnormalities are not so high. Severe symptoms appear when additional complications occur, such as left ventricular hypertrophy or atherosclerosis. This increases the risk of heart attack or stroke. Secondary hypertension is characterized by very high blood pressure, and the patient may not respond to treatment alone.

The classification of pressure by level is of practical importance:

The optimal is 120/80 mmHg. pillar
Normal ranges from 120/80–129/84.
Border – 130/85–139/89.
Stage 1 hypertension – 140/90–159/99.
Stage 2 hypertension – 160/100–179/109.
Stage 3 hypertension – from 180/110 and above.

Classification of hypertension is very important for correct diagnosis and choice of treatment depending on the form and stage.

Many patients may experience minor symptoms such as: Shortness of breath, headaches, dizziness, insomnia, palpitations, sweating, hot flashes, facial flushing, poor physical and mental fitness. As hypertension develops, other symptoms appear that are the result of organ damage due to poor blood pressure. Then the patient can.

Abnormal kidney function, problems with normal sensation and movement, vision problems, less intellectual ability, tired limbs, swelling of the limbs. What does blood pressure depend on? This is influenced by several factors, including:

According to the very first classification, which was adopted at the beginning of the 20th century, hypertension was divided into pale and red. The form of pathology was determined by the type of patient. With the pale variety, the patient had an appropriate complexion and cold extremities due to spasms of small vessels. Red hypertension was characterized by dilation of blood vessels at the time of increased hypertension, as a result of which the patient’s face turned red and became covered with spots.

Beats per minute, heart strength, stress, work, blood volume in the body. We talk about hypertension when at least two separate measurements of systolic blood pressure exceed 140 and diastolic 90 mmHg. In children, special so-called diagrams are used to determine hypertension. centil mesh. In adults, the cause of the disease is most often unknown, with only one in ten suffering from secondary hypertension; Children, on the other hand, are exactly the opposite.

Diseases and situations in which hypertension occurs and which should be excluded during diagnosis and before treatment include: Kidney diseases and blood vessels which supply the kidneys. Numerous endocrine diseases. Use of certain medications and addictive substances.

In the 1930s, two more types of the disease were identified, which differed in the nature of their course:

The benign form is a slowly progressive disease, in which three stages were distinguished according to the degree of stability of pressure changes and the severity pathological processes in organs.
Malignant arterial hypertension progresses rapidly and often begins to develop at a young age. As a rule, it is secondary and has an endocrine origin. The course is usually severe: the pressure is constantly at high levels, and symptoms of encephalopathy are present.

Classification by origin is very important. It is necessary to distinguish primary (idiopathic) hypertension, which is called hypertension, from the secondary (symptomatic) form. If the first occurs for no apparent reason, then the second is a sign of other diseases and accounts for about 10% of all hypertension. Most often, there is an increase in blood pressure due to renal, cardiac, endocrine, neurological pathologies, as well as as a result of constant use of a number of medications.

There are also situations where the patient's office shows elevated values in the doctor's office, with very good self-measurements at home. This is the so-called. white coat hypertension. Diagnostic methods, used in the diagnosis of hypertension. Before starting testing, the doctor must interview the patient and rule out factors that may interfere with the normal outcome, for example, stress, cigarette smoking. The patient should be rested before taking the measurement; It is very useful to measure the patient's blood pressure at home. It can record the values - it not only helps to recognize hypertension, but also select the appropriate treatment method and exclude the patient due to organ damage - diagnose hypertension in the patient. Pressure measurement - of course, do not offer any measurement! . When treating hypertension, the most important thing is.

Modern classification of hypertension

There is no uniform systematization, but most often doctors use the classification that was recommended by WHO and the International Society of Hypertension (ISHA) in 1999. According to WHO, hypertension is classified primarily by the degree of increase in blood pressure, of which there are three:

Lifestyle changes, minimizing risk factors for hypertension, taking antihypertensive medications. Various antihypertensive drugs are used alone or in combination. Simultaneous with or even before pharmacological therapy, lifestyle changes are extremely important, such as increased physical activity, smoking cessation, weight loss, limiting salt and alcohol intake, and introducing a Mediterranean diet. Treatment is chronic and requires patient commitment and persistence, which is often difficult, especially in the context of long-term asymptomatic conditions.

The first degree - mild (borderline hypertension) - is characterized by pressure from 140/90 to 159/99 mm Hg. pillar
In the second degree of hypertension - moderate - hypertension ranges from 160/100 to 179/109 mm Hg. pillar
In the third degree - severe - the pressure is 180/110 mm Hg. pillar and above.

You can find classifiers that distinguish 4 degrees of hypertension. In this case, the third form is characterized by pressure from 180/110 to 209/119 mm Hg. column, and the fourth is very heavy - from 210/110 mm Hg. pillar and above. The degree (mild, moderate, severe) indicates solely the level of pressure, but not the severity of the course and condition of the patient.

Medicines used to treat hypertension. Beta blockers reduce sympathetic tension, calcium channel blockers, aldosterone, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers lower blood pressure. However, a carefully conducted therapeutic treatment brings tangible benefits. This allows you to avoid or significantly slow down the occurrence of complications of hypertension, which include.

Development in the arteries of the heart, neck, kidneys and lower limbs, left ventricular hypertrophy with subsequent damage, visual impairment and renal function. Diagnosis of hypertension in a pregnant woman requires a separate diagnosis and treatment. Pregnant women are characterized by the following types of hypertension.

In addition, doctors distinguish three stages of hypertension, which characterize the degree of organ damage. Classification by stages:

Stage I. The increase in pressure is insignificant and inconsistent, the functioning of the cardiovascular system is not impaired. Patients usually have no complaints.
Stage II. Blood pressure is high. There is an enlargement of the left ventricle. Usually there are no other changes, but local or generalized narrowing of the retinal vessels may be noted.
Stage III. There are signs of organ damage:
- heart failure, myocardial infarction, angina pectoris;
- chronic renal failure;
- stroke, transient cerebral circulatory disorders;
- from the fundus of the eye: hemorrhages, exudates, swelling of the optic nerve;
- lesions of peripheral arteries, aortic aneurysm.

When classifying hypertension, variants of increased pressure are also taken into account. The following forms are distinguished:

Hypertensive pregnancy - occurs after 20 weeks of pregnancy and disappears a few days after the birth of the child. This is called preeclampsia and is dangerous because it results in a risky condition for both mother and baby. Hypertension not classified before birth - occurs when hypertension is diagnosed after 20 weeks of pregnancy and is not measured before pregnancy or in the first weeks of pregnancy. Recognizing that a woman has hypertension before pregnancy will require changes in her treatment, as many medications for this condition can harm the fetus.

systolic – only the upper pressure is increased, the lower – less than 90 mm Hg. pillar;
diastolic – increased lower pressure, upper – from 140 mm Hg. pillar and below;
systolic-diastolic;
labile - pressure increases by a short time and normalizes on its own, without drugs.

Certain types of hypertension

Some varieties and stages of the disease are not reflected in the classification and stand apart.

How to correctly measure blood pressure at home?

Measure your blood pressure while sitting, after at least five minutes of rest. Smoking, drinking coffee and physical activity half an hour before measurement interfere with the result. The forearm of the non-dominant hand is best placed on a flat surface, at the level of the heart.

The back should be straight. Feet should be on the floor. Take 2 or 3 measurements at a time, one minute at a time, and take the average of them. Don't forget to save your pressure measurements on the sheet. The Site is intended to enhance, and not replace, the contact between a service user and their doctor. The service is for informational and educational purposes only. Consult with your physician before requesting a specialist consultation, especially a medical consultation included in our Service.

Hypertensive crises

This is the most severe manifestation arterial hypertension, at which the pressure rises to critical levels. As a result, cerebral circulation is disrupted, intracranial pressure rises, and brain hyperemia occurs. The patient experiences severe headaches and dizziness, accompanied by nausea or vomiting.
in turn, they are divided according to the mechanism of pressure increase. In the hyperkinetic form, the systolic pressure rises, in the hypokinetic form, the diastolic pressure rises; in the eukinetic crisis, both the upper and lower levels increase.

The Administrator does not bear any consequences as a result of using the information contained in the Service. What are the blood pressure standards? Hypertension can be recognized if the average pressure values, calculated from a minimum of two measurements taken during at least two medical visits, are ≥ 140 mmHg. systolic pressure and 90 mm Hg. diastolic blood pressure. Hypertension, depending on its severity, is divided into degrees. The third stage, i.e. severe hypertension, diagnosed when systolic blood pressure ≥ 180 mm Hg.

Refractory hypertension

In this case, we are talking about arterial hypertension, which cannot be treated with medications, that is, the pressure does not decrease even when using three or more drugs. This form of hypertension is easily confused with those cases where treatment is ineffective due to an incorrect diagnosis and incorrect choice of medications, as well as due to the patient’s non-compliance with doctor’s prescriptions.

And diastolic blood ≥ 110 mm Hg. Special type non-arterial hypertension is the so-called portal hypertension, manifested by an increase in blood pressure in the portal vein above 12 mm Hg. The development of portal hypertension is associated with an increase in portal resistance and blood stasis.

The most common cause of portal hypertension is liver block caused by cirrhosis of the liver, damage to medicine or indirectly for other diseases. Hypertensive drugs are used in the pharmacotherapy of hypertension. Medicines for hypertension include, but are not limited to, diuretics, especially thiazides such as hydrochlorothiazide and indapamide or chlorthalidone. Their antihypertensive effect is to reduce the volume of plasma and extracellular fluid, which leads to a decrease in cardiac output and a decrease in peripheral vascular resistance.

White coat hypertension

This term in medicine means a condition in which an increase in pressure occurs only in medical institution during pressure measurement. This seemingly harmless phenomenon should not be ignored. According to doctors, a more dangerous stage of the disease may occur.

A syndrome such as high blood pressure occurs in most cases for unknown reasons. This is the so-called essential, that is, primary, hypertension. The primary form is most often diagnosed after 50 years of age; if left untreated, hypertension can cause quite serious complications. Secondary hypertension, or symptomatic, is caused by an underlying disease, that is, it is necessary to treat the cause of hypertension. In addition, there are various degrees arterial hypertension, classification by stages is used.

Forms of hypertension

Hypertension is usually divided into different forms according to the clinical course of the disease:

Transistor, which is characterized by increased blood pressure with periods of attacks from a couple of hours to several days. After the attack, the blood pressure returns to normal, medications not required. Most often, this form is observed during the initial development of hypertension.
Labile, in which an increase in blood pressure is associated with various provoking factors, for example, physical activity, stress. To relieve an attack, drug treatment is required. Usually this is grade 1 hypertension; if the increase in pressure is persistent, then maintenance therapy, giving up bad habits, and diet are necessary.
Stable hypertension– a condition in which there is a persistent increase in blood pressure, general state getting worse. In this case, serious treatment and constant monitoring are required.
Malignant form characterized by a serious increase in blood pressure to very high values. The disease develops quickly, serious complications appear, which in most cases end in the death of the patient if the prescribed course of treatment is not followed.
Crisis– sharp rises in pressure levels, which can be observed against the background of normal blood pressure or its slight increase. Typically, such crises appear when stage 2 hypertension is diagnosed; in the first stage, sudden changes in pressure are very rare.

Degrees of hypertension

Hypertension is classified into three main degrees, which differ in the severity of the disease and blood pressure level.

Hypertension 1 degree characterized by not very strong increases in blood pressure, target organs such as the brain, kidneys, and heart are not affected, and there are almost no crises. The symptoms are also mild; this initial form is often detected only during routine examinations.

Hypertension 2 degrees manifests itself in the form of serious increases in blood pressure, frequent crises appear, and damage to target organs is diagnosed, for example, an increase in the heart muscle.

Hypertension 3 degrees characterized by a strong increase in blood pressure, this is accompanied by renal and heart failure. Target organs are severely affected, complications are often observed, and the general state of health is critical.

In many cases, slight increases in blood pressure are almost asymptomatic; the disease is diagnosed only during routine examinations or during studies of completely other diseases. Enough severe symptoms diseases generally manifest themselves in advanced states, when hypertension is accompanied by damage to blood vessels or the heart. This final stages arterial hypertension, requiring constant medical monitoring and serious therapy.

Classification of hypertension

Since 2004, according to the recommendations of the GFOC, a classification has been adopted based on increased blood pressure, existing risk and other factors. Using this classification, you can immediately determine the degree of the disease, the presence of complications, the risk group for health and life, and other indicators.

Depending on the specified values, the WHO classification from 1996 and the GFCI from 2004 suggests the following division:

Stage 1 hypertension, that is, the presence of hypertension syndrome, but the absence of objective signs of the disease;
Stage 2 with bright pronounced syndrome hypertension, the presence of at least one type of target organ damage (for example, renal failure);
Stage 3, in which organ damage and severe deterioration in health are observed.

The 1st stage is the mildest, it is asymptomatic, it can only be detected during the study of an external disease or during a routine medical examination. It does not require drug treatment; only diet and lowering levels are recommended. physical activity, exclusion of stressful situations. But stage 2 hypertension is already characterized by the following lesions:

ventricular hypertrophy, which is detected on the ECG;
proteinuria, creatininemia;
atherosclerosis;
narrowing (focal, generalized) of the retinal arteries.

At the 3rd stage, severe damage to organs is observed, the following serious processes are diagnosed:

renal hypertension;
symptomatic neurogenic hypertension;
endocrine hypertension;
Hypertension due to arterial lesions;
Arterial hypertension while taking medications.

The greatest risk is observed precisely at the third stage, when the blood pressure level increases very strongly and is maintained for a long time. According to the GFCI classification, the following stages can be distinguished by risk group and blood pressure level:

optimal pressure: SBP up to 120, DBP up to 80 mm Hg;
normal – SBP – 120(129), DBP – up to 80(84);
normal high – SBP – up to 130(139), DBP – up to 85(89);
1st degree of hypertension – SBP – up to 140(159), DBP – up to 90(99);
borderline hypertension – SBP – up to 140(149), DBP – up to 90(94);
2nd degree hypertension – SBP – up to 160(179), DBP – up to 100(109);
3rd degree hypertension – SBP – more than 180, DBP – more than 110;
systolic isolated hypertension - SBP - more than 140, DBP - more than 90.

Today, a disease such as hypertension is observed in approximately 90% of the population; in 20-40% the disease is caused by genetic factors. Drug treatment is prescribed in 21-46% of cases, but its effectiveness is only about 17%, since it is usually prescribed in the later stages. About half of patients do not know about the problem, since the disease occurs without visible signs. Dizziness or temporary shortness of breath are rarely perceived as a threatening factor, although their frequent repetition should be alarming.