Hypertension according to the American classification. Arterial hypertension WHO classification

Arterial hypertension is a chronic disease of the heart and blood vessels. It is characterized by an increase in pressure in the arteries above 140/90 mm Hg. The pathogenesis is based on a disorder of the neurohumoral and renal mechanisms, which lead to functional changes in the vascular wall. The following risk factors play a role in the development of hypertension:

• age;
• obesity;
• lack of physical activity;
• eating disorders: the use of a large amount of fast carbohydrates, a decrease in the diet of vegetables and fruits, an increased salt content in dishes;
• lack of vitamins and minerals;
• drinking and smoking;
• mental overload;
• low standard of living.

These factors are controllable, exposure to them can prevent or slow down the progression of the disease. However, there are also unmanageable risks that cannot be corrected. These include old age and hereditary predisposition. Elderly age- this is an uncontrollable risk factor, since over time a number of processes occur that predispose to the appearance of atherosclerosis plaques on the vessel wall, its narrowing and the appearance of a high level of pressure.

The world uses the same modern classification hypertension in terms of blood pressure. Its widespread introduction and use is based on data from studies conducted by the World Health Organization. Classification arterial hypertension necessary to determine further treatment and possible consequences for the patient. If we touch on statistics, then first-degree hypertension is most common. However, over time, an increase in the level of pressure increases, which occurs at the age of 60 years and more. Therefore, this category should receive increased attention.


The division into degrees basically contains different approaches to treatment. For example, in the treatment of mild hypertension, you can limit yourself to diet, exercise, and the exclusion of bad habits. While treatment of the third degree requires the use of antihypertensive drugs daily in significant doses.

Classification of blood pressure levels

1. Optimal level: pressure in systole less than 120 mm Hg, in diastole - less than 80 mm. Hg
2. Normal: SD in the range of 120 - 129, diastolic - from 80 to 84.
3. Elevated level: systolic pressure in the range of 130 - 139, diastolic - from 85 to 89.
4. The level of pressure related to arterial hypertension: SD above 140, DD above 90.
5. Isolated systolic variant - SD above 140 mm Hg, DD below 90.

Classification according to the degree of the disease:

• Arterial hypertension of the first degree - systolic pressure in the range of 140-159 mm Hg, diastolic - 90 - 99.
• Arterial hypertension of the second degree: SD from 160 to 169, pressure in diastole 100-109.
• Arterial hypertension of the third degree - systolic above 180 mm Hg, diastolic - above 110 mm Hg.

Origin Classification

According to the WHO classification of hypertension, the disease is divided into primary and secondary. Primary hypertension is characterized by a persistent increase in blood pressure, the etiology of which remains unknown. Secondary or symptomatic hypertension occurs in diseases that affect arterial system thus causing hypertension.

There are 5 variants of primary arterial hypertension:

1. Pathology of the kidneys: damage to the vessels or parenchyma of the kidneys.
2. Pathology of the endocrine system: develops in diseases of the adrenal glands.
3. The defeat of the nervous system, while there is a rise in intracranial pressure. Intracranial pressure may be the result of an injury, or a brain tumor. As a result of this, the parts of the brain involved in maintaining pressure in the blood vessels are injured.
4. Hemodynamic: in the pathology of the cardiovascular system.
5. Medicinal: characterized in poisoning the body with a large amount medicines, which trigger the mechanism of toxic effects on all systems, primarily the vascular bed.

Classification by stages of development of hypertension

Initial stage. Refers to transitory. An important characteristic of it is an unstable indicator of pressure increase throughout the day. At the same time, there are periods of increase in normal pressure figures and periods of its sharp jump. At this stage, the disease can be skipped, since the patient may not always clinically suspect an increase in pressure, referring to the weather, poor sleep and overexertion. There will be no target organ damage. The patient feels well.

stable stage. At the same time, the indicator is increased steadily and for a rather long period of time. With this patient will complain of feeling unwell, blurred eyes, headaches. During this stage, the disease begins to affect target organs, progressing over time. In this case, the heart suffers first of all.

sclerotic stage. It is characterized by sclerotic processes in the arterial wall, as well as damage to other organs. These processes aggravate each other, which further complicates the situation.

Classification by risk factors

Classification by risk factors is based on the symptoms of vascular and heart damage, as well as the involvement of target organs in the process, they are divided into 4 risks.

Risk 1: Characterized by the absence of involvement in the process of other organs, the probability of death in the next 10 years is about 10%.

Risk 2: The probability of death in the next decade is 15-20%, there is a defeat of one organ related to the target organ.

Risk 3: Risk of death in 25 - 30%, the presence of complications that aggravate the disease.

Risk 4: Life threatening due to involvement of all organs, risk of death over 35%.

Classification according to the nature of the disease

Along the course, hypertension is divided into slow-flowing (benign) and malignant hypertension. These two options differ not only in the course, but also in the positive response to treatment.

Benign hypertension proceeds for a long time with a gradual increase in symptoms. In this case, the person feels normal. There may be periods of exacerbations and remissions, but the period of exacerbation does not last long. This type of hypertension is successfully treated.

Malignant hypertension is a variant of the worst prognosis for life. It proceeds rapidly, sharply, with rapid development. The malignant form is difficult to control and difficult to treat.

According to WHO, arterial hypertension kills more than 70% of patients every year. The most common causes of death are dissecting aortic aneurysm, heart attack, renal and heart failure, and hemorrhagic stroke.

Even 20 years ago, arterial hypertension was a severe and difficult to treat disease that claimed the lives of a large number of people. Thanks to the latest diagnostic methods and modern drugs, it is possible to diagnose the early development of the disease and control its course, as well as prevent a number of complications.

With timely complex treatment you can reduce the risk of complications and prolong your life.

Complications of hypertension

Complications include involvement in the pathological process of the heart muscle, vascular bed, kidneys, eyeball and brain vessels. If the heart is damaged, a heart attack, pulmonary edema, cardiac aneurysm, angina pectoris, cardiac asthma can occur. When the eye is affected, retinal detachment occurs, resulting in blindness.

Hypertensive crises can also occur, which are acute conditions, without medical care which even the death of a person is possible. Provokes their stress, overexertion, prolonged physical exercise, change of weather and atmospheric pressure. In this state, headaches, vomiting, visual disturbances, dizziness, tachycardia are observed. The crisis develops acutely, loss of consciousness is possible. During a crisis, other acute conditions may develop, such as myocardial infarction, hemorrhagic stroke, and pulmonary edema.

Arterial hypertension is one of the most common and severe diseases. Every year the number of patients is steadily increasing. Most of these are elderly people, mostly men. The classification of hypertension is based on many principles that help to diagnose and treat the disease in a timely manner. However, it should be remembered that the disease is easier to prevent than to cure. It follows from this that disease prevention is one of the most easy way prevention of hypertension. Regular exercise, giving up bad habits, a balanced diet and healthy sleep can protect you from hypertension.

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Hypertonic disease(GB) is one of the most common diseases of the cardiovascular system, which, according to only approximate data, affects a third of the world's inhabitants. By the age of 60-65, more than half of the population has a diagnosis of hypertension. The disease is called the "silent killer", because its signs may be absent for a long time, while changes in the walls of blood vessels begin already in the asymptomatic stage, greatly increasing the risk of vascular accidents.

In Western literature, the disease is called. Domestic experts adopted this wording, although both “hypertension” and “hypertension” are still in common use.

Close attention to the problem of arterial hypertension is caused not so much by its clinical manifestations, how many complications in the form of acute vascular disorders in the brain, heart, kidneys. Their prevention is the main task of treatment aimed at maintaining normal numbers.

An important point is the definition of all possible risk factors, as well as elucidation of their role in the progression of the disease. The ratio of the degree of hypertension to the existing risk factors is displayed in the diagnosis, which simplifies the assessment of the patient's condition and prognosis.

For most patients, the numbers in the diagnosis after "AH" do not mean anything, although it is clear that the higher the degree and risk indicator, the worse the prognosis and the more serious the pathology. In this article, we will try to understand how and why this or that degree of hypertension is set and what underlies the determination of the risk of complications.

Causes and risk factors for hypertension

The causes of arterial hypertension are numerous. Gov yelling oh we and we mean the case when there is no specific previous disease or pathology internal organs. In other words, such hypertension occurs by itself, involving other organs in the pathological process. Primary hypertension accounts for more than 90% of cases of chronic hypertension.

The main cause of primary AH is considered stress and psycho-emotional overload, which contribute to the disruption of the central mechanisms of pressure regulation in the brain, then humoral mechanisms suffer, target organs (kidneys, heart, retina) are involved.

The third stage of hypertension occurs with an associated pathology, that is, associated with hypertension. Among the associated diseases, the most important for the prognosis are strokes, heart attack and nephropathy due to diabetes, kidney failure, retinopathy (retinal damage) due to hypertension.

So, the reader probably understands how even one can independently determine the degree of GB. This is not difficult, just measure the pressure. Next, you can think about the presence of certain risk factors, take into account age, gender, laboratory parameters, ECG data, ultrasound, etc. In general, everything that is listed above.

For example, in a patient, the pressure corresponds to grade 1 hypertension, but at the same time he had a stroke, which means that the risk will be maximum - 4, even if stroke is the only problem besides hypertension. If the pressure corresponds to the first or second degree, and of the risk factors, smoking and age can only be noted against the background. good health, then the risk will be moderate - GB 1 tbsp. (2 tbsp.), risk 2.

For clarity, understanding what the risk indicator in the diagnosis means, you can summarize everything in a small table. By determining your degree and "counting" the above factors, you can determine the risk of vascular accidents and complications of hypertension for a particular patient. 1 means low risk, 2 means moderate, 3 means high, 4 means very high risk complications.

Low risk means the probability of vascular accidents is not more than 15%, moderate - up to 20%, a high risk indicates the development of complications in a third of patients from this group; at a very high risk, more than 30% of patients are susceptible to complications.

Manifestations and complications of GB

Manifestations of hypertension are determined by the stage of the disease. In the preclinical period, the patient feels well, and only the indicators of the tonometer speak of a developing disease.

As the changes in the vessels and heart progress, symptoms appear in the form of headache, weakness, decreased performance, periodic dizziness, visual symptoms in the form of a weakening of visual acuity,. All these signs are not expressed with a stable course of pathology, but at the time of development, the clinic becomes brighter:

• Strong ;
• Noise, ringing in the head or ears;
• Darkening in the eyes;
• Pain in the region of the heart;
• Hyperemia of the face;
• Excitement and feeling of fear.

Hypertensive crises are provoked by psychotraumatic situations, overwork, stress, drinking coffee and alcoholic beverages, so patients with established diagnosis such influences must be avoided. On the background hypertensive crisis the likelihood of complications increases sharply, including life-threatening ones:

1. Hemorrhage or cerebral infarction;
2. Acute hypertensive encephalopathy, possibly with cerebral edema;
3. Pulmonary edema;
4. Acute renal failure;
5. Heart attack.

How to measure pressure correctly?

If there is reason to suspect high blood pressure, then the first thing a specialist will do is measure it. Until recently, it was believed that blood pressure numbers can normally differ on different hands, but, as practice has shown, even a difference of 10 mm Hg. Art. may occur due to the pathology of peripheral vessels, therefore, different pressures on the right and left hands should be treated with caution.

To obtain the most reliable figures, it is recommended to measure the pressure three times on each arm with small time intervals, fixing each result obtained. The most correct in most patients are the smallest values ​​obtained, however, in some cases, from measurement to measurement, the pressure increases, which does not always speak in favor of hypertension.

A large selection and availability of devices for measuring pressure make it possible to control it in a wide range of people at home. Usually, hypertensive patients have a tonometer at home, at hand, so that if they feel worse, they can immediately measure blood pressure. However, it should be noted that fluctuations are possible in absolutely healthy individuals without hypertension, therefore, a single excess of the norm should not be regarded as a disease, and in order to make a diagnosis of hypertension, pressure must be measured at different times, in different conditions and repeatedly.

When diagnosing hypertension, blood pressure numbers, electrocardiography data and the results of auscultation of the heart are considered fundamental. When listening, it is possible to determine noise, amplification of tones, arrhythmias. , starting from the second stage, will show signs of stress on the left side of the heart.

Treatment of hypertension

To correct high blood pressure, treatment regimens have been developed that include drugs of different groups and different mechanisms of action. Them the combination and dosage is chosen by the doctor individually taking into account the stage, comorbidity, response of hypertension to a specific drug. Once the diagnosis of HD has been established and prior to starting drug treatment, the doctor will suggest non-drug measures that greatly increase the effectiveness of pharmacological agents, and sometimes allow you to reduce the dose of drugs or refuse at least some of them.

First of all, it is recommended to normalize the regimen, eliminate stress, and ensure physical activity. The diet is aimed at reducing the intake of salt and liquid, the exclusion of alcohol, coffee and drinks and substances stimulating the nervous system. With a high weight, you should limit calories, give up fatty, floury, fried and spicy foods.

Non-drug measures for initial stage hypertension can give such a good effect that the need for prescribing drugs will disappear by itself. If these measures do not work, then the doctor prescribes the appropriate drugs.

The goal of treating hypertension is not only to reduce blood pressure, but also to eliminate, if possible, its cause.

The importance of choosing a treatment regimen is given to reducing the risk of vascular complications. So, it is noticed that some combinations have a more pronounced "protective" effect on the organs, while others allow better control of pressure. In such cases, experts prefer a combination of drugs that reduces the likelihood of complications, even if there will be some daily fluctuations in blood pressure.

In some cases, it is necessary to take into account comorbidity, which makes its own adjustments to the treatment regimens for GB. For example, men with prostate adenoma are prescribed alpha-blockers, which are not recommended for constant use to reduce pressure in other patients.

The most commonly used are ACE inhibitors, calcium channel blockers, which are prescribed for both young and elderly patients, with or without concomitant diseases, diuretics, sartans. The drugs of these groups are suitable for initial treatment, which can then be supplemented with a third drug of a different composition.

ACE inhibitors (captopril, lisinopril) reduce blood pressure and at the same time have a protective effect on the kidneys and myocardium. They are preferred in young patients, women taking hormonal contraceptives, indicated for diabetes, for age patients.

Diuretics no less popular. Effectively reduce blood pressure hydrochlorothiazide, chlorthalidone, torasemide, amiloride. To reduce adverse reactions, they are combined with ACE inhibitors, sometimes “in one tablet” (Enap, Berlipril).

Beta blockers(sotalol, propranolol, anaprilin) ​​are not a priority group for hypertension, but are effective in concomitant cardiac pathology - heart failure, tachycardia, coronary disease.

Calcium channel blockers often given in combination with an ACE inhibitor, they are especially good for bronchial asthma in combination with hypertension, as they do not cause bronchospasm (rhyodipine, nifedipine, amlodipine).

Angiotensin receptor antagonists(losartan, irbesartan) is the most prescribed group of drugs for hypertension. They effectively reduce pressure, do not cause cough like many ACE inhibitors. But in America, they are especially common due to a 40% reduction in the risk of Alzheimer's disease.

In the treatment of hypertension, it is important not only to choose an effective regimen, but also to take drugs for a long time, even for life. Many patients believe that when normal pressure figures are reached, treatment can be stopped, and tablets are already grabbed by the time of the crisis. It is known that the unsystematic use of antihypertensive drugs is even more harmful to health than the complete absence of treatment, therefore, informing the patient about the duration of treatment is one of the important tasks of the doctor.

Today, much is written and talked about hypertension (AH) and its impact on the quality of human life. This chronic illness it is really worth it to learn everything that modern medicine knows about it, because according to some estimates, about 40% of the adult population of the planet suffer from it.

The greatest concern is the fact that in recent years there has been a persistent trend towards the "rejuvenation" of this disease. Exacerbations of GB in the form of hypertensive crises today occur in 40-year-olds and even 30-year-old people. Since the problem concerns almost all age categories of adults, awareness of the pathology called hypertension seems to be relevant.

The term "hypertension" in everyday life replaces another concept - arterial hypertension (AH), but they are not quite equivalent. Although both represent pathological conditions, characterized by a rise in blood pressure (BP) above 140 mm in systolic (SBP) and above 90 mm in diastolic (DBP) indicators.

But in medical sources, hypertension is defined as hypertension that is not provoked by somatic diseases or other obvious causes that cause symptomatic hypertension.

Therefore, when asked what hypertension is, what it means, one should answer - it is primary, or (of uncertain etiology) arterial. The term has found widespread use in European and American medical circles, and the prevalence of the syndrome exceeds 90% of all hypertension diagnoses. For all other forms and the general definition of the syndrome, it is more correct to use the term arterial hypertension.

What can cause development in humans?

Despite the ambiguity of the pathogenesis (causes and mechanisms of origin) of hypertension, several provoking factors and aspects of its potentiation are known.

Risk factors

Normal blood pressure in a healthy vascular system is maintained through the interaction of complex vasoconstrictor and vasodilator mechanisms.

Hypertension is provoked by abnormal activity of vasoconstrictor factors or insufficient activity of vasodilating systems due to a violation of their mutually compensatory functioning.

The provocative aspects of hypertension are considered in two categories:

• neurogenic - due to a direct effect on the tone of arterioles through the sympathetic department of the nervous system;
• humoral (hormonal) - associated with intensive production of substances (renin, norepinephrine, hormones of the adrenal cortex), which have a vasopressor (vasoconstrictor) property.

Why exactly there is a failure in the regulation of blood pressure, resulting in hypertension, has not yet been established. But cardiologists call the risk factors for developing GB, identified in the process of many years of research:

• genetic predisposition to diseases of the heart and blood vessels;
• congenital pathology of cell membranes;
• unhealthy addictions - smoking, alcoholism;
• neuropsychic overload;
• low physical activity;
• excessive presence of salt in the menu;
• increased waist circumference, indicating metabolic disorders;
• high body mass index (BMI) > 30;
• high plasma cholesterol values ​​​​(more than 6.5 mmol / l according to the general indicator).

The list is not a complete list of everything that can cause hypertension in humans. These are just the main causes of pathology.

A threatening consequence of hypertension is a high probability of target organ damage (TOM), which causes its varieties such as hypertensive heart disease affecting this organ, renal hypertension and others.

Classification tables by stages and degrees

Since there are different clinical guidelines for choosing a therapeutic regimen for different forms of GB, the disease is classified according to stages and degrees of severity. The degrees are determined by the numbers of blood pressure, and the stages are determined by the scale of organic damage.

An experimentally developed classification of hypertension by stages and degrees is presented in the tables.

Table 1.Classification of hypertension by degrees.

The severity of hypertension is classified by a higher score, for example, if SBP is less than 180 and DBP is more than 110 mmHg, this is defined as grade 3 essential hypertension.

Table 2.Classification of hypertension by stages.

The abbreviation TPVR used in the table is total peripheral vascular resistance.

The presented tables would be incomplete without another summary list - the classification of GB by stages, degree and risk of complications from the heart and blood vessels (CVE).

Table 3Classification of the risk of cardiovascular complications in GB

Ascertaining the degrees and stages of GB is necessary for the timely selection of adequate antihypertensive therapy and the prevention of cerebral or cardiovascular accidents.

ICD code 10

The variety of variations of hypertension is also confirmed by the fact that in ICD 10 its codes are defined in the 4th heading from the I10th to the I13th positions:

• I10 - essential (primary) hypertension, this category of ICD 10 includes hypertension 1, 2, 3 tbsp. and malignant GB;
• I11 - hypertension with a predominance of heart damage (hypertensive heart disease);
• I12 - hypertensive disease with kidney damage;
• I13 is a hypertensive disease affecting the heart and kidneys.

The set of conditions manifested by the rise in blood pressure is represented by headings I10-I15, including symptomatic hypertension.

Today, antihypertensive therapy relies on 5 basic clusters of drugs for the treatment of hypertension:

• diuretics - medicines with a diuretic effect;
• sartans - angiotensin II receptor blockers, ARBs;
• CCB - calcium channel blockers;
• ACE inhibitors - angiotensin-converting enzyme inhibitors, ACE;
• BB - beta-blockers (subject to background AF or coronary artery disease).

The listed clusters of medications have passed randomized clinical trials and have shown high effectiveness in preventing the development of CVD.

Additional funds modern methods The treatment of hypertension is often treated with new generation medications - centrally acting alpha-adrenergic agonists, renin inhibitors, and I1-imidazoline receptor agonists. For these drug groups, in-depth studies have not been conducted, however, their observational study has given reason to consider them the drugs of choice for certain indications.

The best results are shown by combined therapeutic schemes with medications of different pharmacotherapeutic classes. The combination of ACE inhibitors and diuretics is considered the "gold" standard for the treatment of hypertension.

But treatment according to the standards, unfortunately, is not suitable for everyone. It is worth looking at the table of features of the use of drugs, taking into account contraindications and other aspects, in order to assess the difficulty of selecting an adequate drug treatment for hypertension individually for each patient.

Table 4. Groups of drugs used to treat hypertension (given in alphabetical order).

The selection of a suitable medication for the treatment of hypertension should be based on its classification, and taking into account parallel diseases and other nuances.

Lifestyle for hypertension

Consider which medications are relevant for hypertension aggravated by parallel diseases, damage to vulnerable organs, and in special pathological situations:

• in patients with microalbuminuria and renal dysfunction, sartans and ACE inhibitors are appropriate;
• with atherosclerotic changes - ACE inhibitors and CCBs;
• with left ventricular hypertrophy (often the consequences of GB) - sartans, BCC and ACE inhibitors;
• persons who have had a microstroke are shown any of the listed antihypertensive drugs;
• persons with a previous heart attack are prescribed ACE inhibitors, beta-blockers, sartans;
• concomitant CHF involves the use of aldosterone antagonists, diuretics, beta-blockers, sartans and ACE inhibitors in the treatment of hypertension;
• with and stable angina, CCBs and beta-blockers are recommended;
• with aortic aneurysm - beta-blockers;
• paroxysmal AF () requires the use of sartans, ACE inhibitors and beta-blockers or aldosterone antagonists (in the presence of CHF);
• GB with background AF of a permanent nature is treated with beta-blockers and non-dihydropyridine CCBs;
• in case of damage to peripheral arteries, CCB and ACE inhibitors are relevant;
• in the treatment of hypertension in those suffering from isolated systolic hypertension and in the elderly, it is recommended to use diuretics, CCBs and sartans;
• with metabolic syndrome - sartans, CCBs, ACE inhibitors and their combinations with diuretics;
• in case of hypertension diabetes- BKK, IAPF, sartans;
• pregnant women are allowed to treat GB with Nifedipine (CCB), Nebivolol or Bisoprolol (beta-blockers), Methyldopa (alpha-adrenergic agonist).

According to clinical guidelines, established by the results of the Congress of Cardiology, held in Barcelona in June 2018, beta-blockers were excluded from the list of 1st line drugs in the treatment of hypertension, where they were previously present. Now the use of beta-blockers is considered justified in concomitant or coronary artery disease.

The target values ​​of blood pressure in patients receiving antihypertensive therapy have also undergone changes:

• for patients younger than 65 years, the recommended SBP values ​​are 130 mm Hg. Art., if they are well tolerated;
• the target for DBP is 80 mmHg. for all patients.

To consolidate the results of antihypertensive therapy, it is necessary to combine drug treatment with non-drug methods - improvement of life, correction of the diet and physical activity.

Overweight and abdominal obesity, as a rule, indicating the presence of metabolic syndrome, are listed in the list of the main causes of hypertension. Removal of these risk factors will be a significant contribution to the treatment of HD.

The greatest efficiency shows a significant reduction in the amount of salt - up to 5 g per day. Nutrition for hypertension is also based on limiting fats and sugar, refusing to produce fast food, snacks and alcohol, and reducing the amount of drinks containing caffeine.

The diet for hypertension does not require a complete rejection of animal products. Be sure to use lean meats and fish, dairy products, cereals. A larger percentage of the diet should be given to vegetables, fruits, herbs and cereals. Carbonated drinks, sausages, smoked meats, canned food and pastries should be completely removed from the menu. Non-drug treatment based on a healthy diet is the main factor in the successful treatment of hypertension.

What effect does it have on the heart?

A common consequence of hypertension on the part of the heart is left ventricular hypertrophy - an abnormal increase in the size of the heart muscle in the LV region. Why is this happening? An increase in blood pressure is caused by a narrowing of the arteries, which is why the heart is forced to function in an enhanced mode to provide blood supply to the organs and its own. Work in increased load potentiates an increase in the size of the heart muscle, but the size of the vasculature in the myocardium (coronary vessels) does not grow at the same rate, so the myocardium experiences a lack of oxygen and nutrients.

The response of the central nervous system is the launch of compensation mechanisms that contribute to the acceleration of heart rate and vasoconstriction. This provokes the formation vicious circle, which often occurs with the progression of hypertension, because the longer elevated blood pressure persists, the sooner the heart muscle hypertrophies. The way out of this situation is the timely and adequate treatment of hypertension.

Prevention memo

It is useful to take preventive measures to prevent the development of hypertension not only for persons from a high-risk group (with hereditary factors, harmful working conditions, obesity), but also for all adults.

A memo on the prevention of hypertension contains the following items:

• the maximum amount of salt - no more than 5-6 g per day;
• organization and observance of the daily routine with a fixed time for getting up in the morning, eating and going to bed;
• increase in motor activity due to daily morning exercises, walking in the fresh air, feasible work in the garden, swimming or cycling;
• the norm of night sleep is 7-8 hours;
• maintaining a normal weight, with obesity - measures for weight loss;
• priority to foods rich in Ca, K and Mg - egg yolks, low-fat cottage cheese, legumes, parsley, baked potatoes, etc.;
• an indispensable condition - getting rid of addictions: alcohol, nicotine;

Measures for weight loss - careful calculation of calories consumed, control of fat intake (< 50-60 г в сутки), 2/3 которого должны быть растительного происхождения, сокращение количества цельномолочных продуктов в меню, сахара, меда, сдобы, шоколадных изделий, риса и манки.

In order to prevent hypertension, regular measurements of blood pressure levels, periodic medical examinations and timely treatment of detected pathological conditions are recommended.

Useful video

For more information about hypertension, see this video:

conclusions

1. The concept of hypertension in the medical literature is used for primary or essential arterial hypertension, that is, hypertension of unknown origin.
2. The prevalence of primary hypertension is 90% of all cases of hypertension.
3. Hypertension is a polyetiological disease, since it is caused by several provoking factors at the same time.

This article describes the essence of hypertension, its classification according to various principles, the characteristic features of the disease, the complications provoked by this disease.

What is hypertension?

Hypertension (AH) is a disease of the cardiovascular system of a chronic type, which is accompanied by an increase in blood pressure. leads to dysfunction of the heart, lungs, kidneys, brain, nervous system. Also called hypertension.

A number of factors contribute to the development of hypertension:

• person's age.
• his weight (the presence of excess weight).
• malnutrition: eating fatty, fried, salty foods.
• lack of vitamins and minerals.
• bad habits.
• psycho-emotional stress.
• wrong way of life.

A person is able to influence these factors, which means that he can prevent the development of hypertension, but there are factors that are due to nature, they cannot be influenced. These include: advanced age, genetic inheritance. With the aging of a person, the aging of his body occurs, the wear of organs and blood vessels. cholesterol plates accumulate on the walls of the vessels, which narrow the lumen of the vessels and lead to an increase in pressure (blood flow worsens).

Characteristic features of GB

According to the recommendations of the World Health Organization (WHO), normal pressure is with systolic (upper) pressure at the level of 120-140 mm Hg. and diastolic (lower) pressure of 80-90 mm Hg.

Men and women are equally susceptible to development this disease. Often, hypertension is accompanied by such a complication as, which mutually complicates the course of hypertension. Such a tandem is the cause of death for a person.

What doctors say about hypertension

Doctor of Medical Sciences, Professor Emelyanov G.V.:

I have been treating hypertension for many years. According to statistics, in 89% of cases, hypertension ends with a heart attack or stroke and the death of a person. Approximately two-thirds of patients now die within the first 5 years of disease progression.

The next fact is that it is possible and necessary to bring down the pressure, but this does not cure the disease itself. The only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension and is also used by cardiologists in their work is this. The drug acts on the cause of the disease, making it possible to completely get rid of hypertension. In addition, within the framework of the federal program, every resident of the Russian Federation can receive it IS FREE.

According to this principle, WHO divides hypertension into primary and secondary.

1. Primary- . A separate disease occurs due to dysfunction of the blood flow in the body.

Primary hypertension has five variants:

• Renal pathology: destruction of the vessels or membranes of the kidneys.
• Abnormalities of the endocrine system: diseases of the adrenal glands serve as an impetus for development.
• Accompanied destruction of the nervous system. ICP is the result of trauma, a brain tumor.
• hemodynamic: abnormality of the heart and blood vessels.
• Medication: poisoning due to an overdose of a drug.

1. Secondary- symptomatic hypertension. The disease manifests itself as a consequence of some other disease:

• Kidney dysfunction, narrowing of the renal arteries, inflammation of the kidneys.
• Dysfunction thyroid gland- hyperthyroidism.
• adrenal dysfunction - hypercortisolism syndrome, pheochromoblastoma.
• Atherosclerosis, coarctation of the aorta.

Important! An agronomist from Barnaul with 8 years of experience in hypertension found an old recipe, set up production and released a remedy that will once and for all save you from problems with pressure ...

Classification of hypertension by stages

1. I stage- increase in pressure, internal organs are not changed, their functionality is not impaired.
2. II stage- increased pressure accompanied by the transformation of internal organs: hypertrophy of the left ventricle of the heart, coronary heart disease, modification of the fundus.

At least one of the symptoms of organ dysfunction is present:

• Hypertrophy of the left ventricle of the heart.
• General or segmental angiopathy of the retina.
• A significant amount of protein in the urine, an increased content of creatinine.
• Examination of the vessels revealed symptoms of vascular atherosclerosis.

1. III stage- an increase in pressure, accompanied by a change in internal organs and their functionality. This stage can lead to the development of a hypertensive crisis.

Classification of GB according to the stages of its development

1. Initial stage. Belongs to the transient. The main symptom is an unstable increase in pressure during the day (sometimes a simple increase, sometimes jumps). at this stage, a person does not notice the disease, complains about weather conditions, etc. The person feels normal.
2. stable stage. She has high blood pressure for a long time. It is accompanied by poor health, blurred vision, pain in the head. Hypertension progresses gradually, affecting important organs and primarily the heart.
3. sclerotic stage. Vessels change into atherosclerotic ones, and other organs are also affected. The combination of these processes aggravates the overall picture of the disease.

Video

According to the nature of the disease, there is hypertonic disease:

• Benign or slow flowing. The disease is of a long-term nature of development, the symptoms tend to increase gradually. The patient is in good health. There are periods of exacerbation, which is of a short nature, and remissions. This type of GB is treatable.
• Malignant. The disease has a transience feature, proceeds with severe exacerbations and is life threatening. This species is difficult to control and difficult to treat.

Classification of GB according to the level of blood pressure

The presented classification is the most relevant and practical. Because the main thing for understanding hypertension is their changes.

table

The last III degree of hypertension carries with it the development of a hypertensive crisis, which has deplorable consequences.

Risk factors

If we consider the causes of the appearance of hypertension, then they include the following:

• Age: men over 55, women over 65.
• Violation of the ratio of lipids in human blood.
• Diabetes.
• Overweight.
• Bad habits.
• Heredity.
• Nervous strain.
• Excessive consumption of salty, fried and fatty foods.

In accordance with the symptoms of manifestations of hypertension, their effect on the organs, they distinguish four types of risk namely:

1. Risk 1. Found 1-2 factors of manifestation, hypertension 1 degree. Other organs are not affected, the possible occurrence of death in the next ten years is minimal - 10%.
2. Risk 2. Hypertensive disease of the 2nd degree, the manifestation factors are unchanged. One of the target organs is affected, the possible onset of death in the next decade is 15-20%.
3. Risk 3. Hypertensive disease of the 3rd degree, 2-3 manifestation factors were found. There are complications that worsen the course of the disease. The probability of death is 25-30%.
4. Risk 4. Hypertensive disease of the 3rd degree, but there are more than three factors. All important target organs are affected, the probability of death is high - 35% or more.

sympathetic nervous system has a significant effect on hypertension, namely the state of its tension. This complex of symptoms is called sympathicotonia, when the tone of the sympathetic nervous system exceeds the tone of the parasympathetic nervous system. Manifested due to excessive consumption of sodium, alcohol, smoking, etc.

Sympathicotonia increases heart rate, vascular tone and total peripheral vascular resistance. Increases the load on the vessels and increases the pressure.

What are the complications of hypertension?

The primary threat of hypertension is a complication in the work of the heart and blood vessels. According to WHO, decapitation hypertension is hypertension in combination with damage to the heart and left ventricle. This type of hypertension has irreversible consequences and difficult treatment.

If pressure drops are not treated, then pathology may occur in the work of any organ. May develop:

• Angina.
• Myocardial infarction.
• Brain infarction.
• Acute cerebrovascular accident with vascular rupture.
• Swelling of the lungs.
• Detachment of the retina.

Survey plan

1. First of all, you need to measure arterial pressure at rest. The measurement must be taken at least twice with a break of a couple of minutes on each hand. One hour before the start of the procedure, you can not expose yourself physical activity, drink alcohol, coffee, smoke, take antihypertensive drugs. If this is the primary measurement, it is better to repeat the additional during the day in order to achieve the accuracy of the result. Patients under 20 years of age and over 50 years of age should additionally measure the pressure on each leg.
2. Must pass general analysis blood, which is carried out in the morning on an empty stomach. If hypertension is prolonged, then the level of red blood cells, hemoglobin can be increased.
3. It is necessary to pass a general urine test in the morning.
4. Analysis of daily urine, which is collected every three hours in a separate jar.
5. It is necessary to conduct a biochemical blood test.
6. An ECG is performed to determine if the left ventricle is affected.
7. Echocardiography is performed to determine the presence of a hypertensive heart.
8. An examination of the fundus is carried out for the presence of changes in it.
9. Phonocardiography is performed to determine the tone of the heart. If hypertrophy develops, then the size of the oscillations of the first tone decreases. Heart failure is characterized by the third and fourth tone.
10. Rheoencephalography is performed to determine vascular tone.

Differential Diagnosis

A differential diagnosis is required to exclude a disease that is not suitable for certain symptoms and manifestations, in order to diagnose one suitable disease as a result.

There are many diseases that have common manifestations with HD, but also differ:

In a significant number cases of arterial hypertension preceded by the so-called "borderline arterial hypertension" (PAH), although not all of the latter causes the development of hypertension.

Diagnosis borderline arterial hypertension is established when the level of systolic blood pressure (BP) does not exceed 150 mm Hg. Art. diastolic - 94 mm Hg. Art. and with repeated measurements for 2-3 weeks without the use of antihypertensive therapy, normal blood pressure figures are also detected.

When diagnosing essential arterial hypertension and an essential step is differentiation with secondary AH: renal, endocrine, cerebral genesis. AG is established in the absence of these forms.

According to WHO classification allocate stages of arterial hypertension. The first stage is understood as an increase in blood pressure as such. The second stage is characterized not only by an increase in blood pressure, but also by damage to target organs (the presence of left ventricular hypertrophy, changes in the vessels of the fundus, kidneys). In the third stage, arteriolosclerosis of various organs is additionally added. In addition, arterial hypertension is subdivided according to the level of blood pressure: when the value of systolic blood pressure is not higher than 179 mm Hg. Art. and diastolic 105 mm Hg. Art. mild hypertension is diagnosed; with systolic blood pressure 180-499 mm Hg. Art. and diastolic and 106-114 mm Hg, Art. - moderate hypertension; with systolic blood pressure over 200 mm Hg. Art. and diastolic more than 115 mm Hg. Art. - high arterial hypertension, When the value of systolic blood pressure is more than 160 mm Hg. Art. and diastolic less than 90 mm Hg. Art. diagnosed with isolated systolic hypertension.

WHO classification in terms of blood pressure has become widespread in Europe and the United States. Most randomized trials have been conducted taking into account the level of diastolic blood pressure. But the epidemiological work of recent years has shown the importance of the value and level of systolic blood pressure. With its high figures, the risk of cardiovascular complications in patients with hypertension is as high as with high diastolic blood pressure. It should be noted that the term "mild" hypertension does not correspond to the prognostic value of this condition. The share of mild hypertension is 70% among all forms of arterial essential hypertension. But it is mild hypertension that affects more than 60% of patients with impaired cerebral circulation(Arabidze G. G. 1995].

arterial hypertension develops slowly, often over 10 years. In a small part of patients with hypertension, a transition to a malignant form is possible, when fibrinous-necrotic changes develop in the arterioles. Heart and kidney failure join, blindness sets in, severe early disability. Life expectancy in this form is less than 5 years. Malignant hypertension, apparently, can also be the result of primary vasculitis.

Despite the predominance of complications in the late stage, even the presence of mild and moderate arterial hypertension. according to numerous long-term cooperative studies, several times increases the frequency of major complications and atherosclerosis compared with normotonia. This implies the need to treat even the mildest forms of hypertension.

New approaches to the classification and treatment of arterial hypertension. 1999 World Health Organization and International Society of Hypertension recommendations.

B.A. Sidorenko, D.V. Preobrazhensky, M.K. Peresypko

Medical Center of the Office of the President of the Russian Federation, Moscow

Arterial hypertension (AH) is the most common cardiovascular syndrome in many countries of the world. For example, in the United States, high blood pressure (BP) is found in 20-40% of the adult population, and in the age groups over 65 years, hypertension occurs in 50% of the white and 70% of the black race. More than 90-95% of all cases of hypertension are hypertension. In other patients, a thorough clinical and instrumental examination can diagnose a variety of secondary (symptomatic) hypertension. It should be borne in mind that in 2/3 of cases, secondary AH is caused by damage to the kidney parenchyma (diffuse glomerulonephritis, diabetic nephropathy, polycystic kidney disease, etc.), and therefore, they are potentially incurable. Treatment of renal hypertension in general does not differ from the treatment of hypertension.

Therefore, in the vast majority of patients with hypertension, long-term drug therapy is carried out regardless of whether the exact cause of elevated blood pressure is known or not.

The long-term prognosis in patients with hypertension depends on three factors: 1) the degree of increase in blood pressure, 2) damage to target organs, and 3) concomitant diseases. These factors must be reflected in the diagnosis of a patient with hypertension.

Since 1959, experts from the World Health Organization (WHO) from time to time publish recommendations for the diagnosis, classification and treatment of hypertension based on the results of epidemiological and clinical studies. Since 1993, such recommendations have been prepared by WHO experts together with the International Society of Hypertension (International Society of Hypertension). From September 29 to October 1, 1998 in the Japanese city of Fukuoka, the 7th meeting of WHO and MTF experts took place, at which new recommendations for the treatment of hypertension were approved. These recommendations were published in February 1999. Therefore, in the literature, new recommendations for the treatment of hypertension are usually dated 1999 - 1999 WHO-ISH guidelines for the management of hypertension (WHO-ISH guidelines 1999).

In the 1999 WHO-IOH recommendations, hypertension refers to a systolic blood pressure level of 140 mm Hg. Art. or more, and (or) the level of diastolic blood pressure equal to 90 mm Hg. Art. or more in people who are not receiving antihypertensive drugs. Given the significant spontaneous fluctuations in blood pressure, the diagnosis of hypertension should be based on the results of repeated blood pressure measurements during several visits to the doctor.

WHO-IDG experts have proposed new approaches to the classification of hypertension. The new classification proposes to abandon the use of the terms "mild", "moderate" and "severe" forms of hypertension, which were used, for example, in the 1993 WHO-IOH recommendations. To characterize the degree of increase in blood pressure in patients with hypertension, it is now recommended to use such terms as as grade 1, grade 2 and grade 3 disease. It should be noted that the 1999 classification tightened the criteria for distinguishing between different degrees of severity of hypertension (Table 1).

Table 1. Comparison of AH severity criteria in the classifications of experts of WHO and MTF 1993 (1996) and 1999

Classification 1993 (1996)

Hypertonic disease. Classification of hypertension.

Diagnosis of hypertension(essential, primary arterial hypertension) is established by the method of excluding secondary (symptomatic) arterial hypertension. The definition of "essential" means that persistently elevated blood pressure in hypertension is the essence (main content) of this arterial hypertension. Any changes in other organs that could lead to arterial hypertension are not found during a routine examination.

Frequency of essential arterial hypertension accounts for 95% of all arterial hypertension (with a thorough examination of patients in specialized hospitals, this value is reduced to 75%).

Genetic aspects.

- Family history. Allows you to identify a hereditary predisposition to hypertension of a polygenic nature.

— There are many genetically determined disorders in the structure and function of cell membranes of both excitable and non-excitable types in relation to the transport of Na+ and Ca2+.

Etiology of hypertension.

- The main cause of hypertension: repeated, as a rule, prolonged psycho-emotional stress. The stress reaction has a pronounced negative emotional character.

- The main risk factors for hypertension (conditions that contribute to the development of hypertension) are shown in the figure.

Factors involved in the development of hypertension

An excess of Na+ causes (among other things) two important effects:

- Increased transport of fluid into cells and their swelling. Swelling of the cells of the walls of blood vessels leads to their thickening, narrowing of their lumen, increased rigidity of the vessels and a decrease in their ability to vasodilate.

- Increased sensitivity of myocytes of the walls of blood vessels and the heart to vasoconstrictor factors.

- Disorders of the functions of membrane receptors that perceive neurotransmitters and other biologically active substances that regulate blood pressure. This creates a condition for the dominance of the effects of hypertensive factors.

- Violations in the expression of genes that control the synthesis of endothelial cells of vasodilators (nitric oxide, prostacyclin, PgE).

environmental factors. Occupational hazards are of the greatest importance (for example, constant noise, the need to strain attention); living conditions (including utilities); intoxication (especially alcohol, nicotine, drugs); brain injuries (bruises, concussions, electrical trauma, etc.).

individual characteristics of the body.

- Age. With age (especially after 40 years), mediated by the diencephalic-hypothalamic region of the brain (they are involved in the regulation of blood pressure) hypertensive reactions to various exogenous and endogenous influences dominate.

- Increased body weight, high serum cholesterol levels, excessive renin production.

- Features of the CCC reaction to stimuli. They consist in the dominance of hypertensive reactions to a variety of influences. Even minor emotional (especially negative) influences, as well as environmental factors, lead to a significant increase in blood pressure.

Classification of hypertension

In Russia, a classification of hypertension has been adopted (WHO classification, 1978), presented in the table

Table. Classification of hypertension

I stage of hypertension - an increase in blood pressure over 160/95 mm Hg. without organic changes in the cardiovascular system

II stage of hypertension - increased blood pressure over 160/95 mm Hg. in combination with changes in target organs (heart, kidneys, brain, fundus vessels) caused by arterial hypertension, but without disruption of their functions

III stage of hypertension - arterial hypertension, combined with damage to target organs (heart, kidneys, brain, fundus) with a violation of their functions

Forms of essential arterial hypertension.

- Borderline. A kind of essential arterial hypertension, observed in young and middle-aged people, characterized by fluctuations in blood pressure from normal to 140/90-159/94 mm Hg. Normalization of blood pressure occurs spontaneously. There are no signs of target organ damage typical of essential arterial hypertension. Borderline arterial hypertension occurs in approximately 20-25% of individuals; 20-25% of them then develop essential arterial hypertension, 30% have borderline arterial hypertension for many years or a lifetime, and the rest of the blood pressure normalizes over time.

- Hyperdrenergic. Characterized by sinus tachycardia, unstable blood pressure with a predominance of the systolic component, sweating, flushing of the face, anxiety, throbbing headaches. It manifests itself in the initial period of the disease (in 15% of patients it persists in the future).

- Hyperhydration (sodium-, volume-dependent). Manifested by swelling of the face, paraorbital areas; fluctuations in diuresis with transient oliguria; when using sympatholytics - sodium and water retention; pale skin; constant bursting headaches.

- Malignant. A rapidly progressive disease with an increase in blood pressure to very high values ​​with visual impairment, the development of encephalopathy, pulmonary edema, kidney failure. Malignant essential arterial hypertension often develops with symptomatic arterial hypertension.