Classification of levels of hypertension

Syndrome of systematically high blood pressure began to be investigated in the 20th century. Since then, the classification of arterial hypertension has changed more than once. As a result of the work, several directions were identified.

Many researchers, when determining the stages of pathology, stated its connection with numerous risk factors and some concomitant diseases. The result was that hypertension was divided into types depending on the causes and nature of development. This spawned even more proposals. As a result, more than fifty classifications of pathology were identified.

But many groups still continue to be controversial, some have not received recognition, others are not applied. So, one of the first methods of classification divided the disease, taking into account the appearance of the patient. She was offered a job by the German doctor F. Folgard. He argued that based on the type of patient, two types of hypertension can be distinguished: red and pale.

This doctor believed that with a pale form of pathology, a spasm of blood vessels occurs, as a result of which the skin becomes cold, acquires a pale shade. With red hypertension during an increase in pressure due to the expansion of the capillaries of the skin, the integuments turn red, become stained. Today, this theory is not used in medicine, but is simply a historical fact of scientific research.

Currently, hypertension is classified based on the following factors:

• the level of increase in systolic and diastolic indicators;
• stability of the increase in blood pressure;
• the course of the disease;
• the origin of the pathology;
• damage to organs due to pressure fluctuations.

Origin Classification

There are two degrees of hypertension: primary and secondary.

The primary form is actively researched today. Scientists have not been able to determine the exact cause of its occurrence. A combination of many factors leads to its appearance, which individually do not have a pronounced negative impact.

Primary hypertension, in turn, is divided into three degrees:

1. I degree. Pressure up to 159-99 mm Hg. Art., the indicators are not stable: either they return to acceptable values, or they rise much higher than expected. There is no organ damage yet, hypertensive crises practically do not occur.
2. II degree. Level up to 179 - 109 mm Hg. Art. Remission times are infrequent and short-lived.
3. III degree. Tonometer readings from 180-110 mm Hg. Art. and more. Often hypertension II and III degrees have complications such as vascular atherosclerosis, pulmonary edema, heart failure, asthma.

Secondary arterial hypertension includes an increase in blood pressure, pathogenetically associated with lesions of the internal organs involved in its regulation. Allocate renal, hemodynamic, endocrine, neurogenic type of secondary hypertension.

The most common is the pathology of renal etiology. It occurs as a result of pathology of the kidneys or their vessels. This disease is a consequence of the narrowing of the arteries due to organ diseases such as pyelonephritis, amyloidosis, and so on, or a genetic factor. The progression of renal hypertension depends on how quickly the blockage of the renal artery occurs. This disease does not respond well to antihypertensive drugs.

The endocrine form of hypertension appears due to pathologies of the endocrine glands. This type of hypertension appears in diseases such as thyrotoxicosis, pheochromocytoma, Itsenko-Cushing's, hyperthyroidism.

The hemodynamic type is one of the types of symptomatic hypertension. Pathology occurs as a result of impaired blood patency due to damage to the main arteries. One of the causes is coarctation of the aorta. With this pathology, the blood supply to the lower part of the body is carried out in an unnatural way, but mainly through dilated intercostal veins. As a result, the vessels of the upper body overflow with blood, and the veins of the lower extremities receive little of it.

With such a disease, a person suffers from dizziness, short-term fainting, partial loss of vision, and short-term loss of consciousness. Pathology is diagnosed by aortography.

A consequence of the neurogenic form of arterial hypertension may be a tumor, encephalitis, hemorrhage, ischemia, erythremia, inflammatory processes. A feature of this type of disease is that the level of pressure does not always correspond to the strength of the manifestation of the pain symptom. So, a strong pain syndrome can be observed both with high tonometer readings and slightly elevated ones.

Classification according to the complexity of the course

At the beginning of the last century, academician F. Lang identified two types of hypertension: benign (slowly developing) and malignant (rapidly progressing). In the first case, the disease has three stages. The second option is especially dangerous. According to statistics, about 80% of patients die due to the lack of medical treatment of a malignant form. Even at the present time, given the modern treatment options and the latest diagnostic methods, doctors are powerless against a rapidly progressing disease.

Most often, patients die from such consequences of the disease as hemorrhagic stroke, dissecting aneurysm of the aortic vessel, renal and chronic heart failure.

Classification by risk level

When diagnosing hypertension, in addition to the stage of the disease, the level of risk is established.

This item includes the following factors:

• age;
• bad habits;
• floor;
• the presence of similar diseases in close relatives;
• low mobility;
• organ damage.

Separate forms of hypertension

The most complex manifestation of arterial hypertension is a hypertensive crisis. It is characterized by a sharp rise in blood pressure to critical numbers. As a result, there is an excessive filling of the arteries of the brain with blood. Such a pathology manifests itself with headache, nausea, severe dizziness, gag reflex.

With an isolated type of hypertension, there is an increase in systolic indicators of more than 160 mm Hg. Art., and diastolic - continue to remain below 90 mm Hg. Art. Pathology is often accompanied by coronary heart disease, myocardial infarction.

The refractory form of hypertension (not subject to treatment) is established when drug therapy, even after the use of three or more drugs, is not able to lower blood pressure on the walls of blood vessels. But very often refractory hypertension is confused with other forms. This happens in some cases when the wrong type of hypertension was diagnosed during the diagnosis, medications were erroneously prescribed, or the doctor's instructions were violated directly to the patient.

New approaches to classification

To date, in Europe and America, the most common classification of hypertension according to the level of pressure. Many WHO randomized trials have been based on diastolic measurements. But the epidemiological developments of the present time have revealed that the level of systolic blood pressure is no less important when determining the class of hypertension. This is due to the fact that with its high rates, the possibility of complications of the cardiovascular system also increases significantly.

According to statistics, at the present time, the “mild” form of hypertension is most common (about 70%). According to the results of WHO in the United States of America, elevated blood pressure values ​​are established in 30% of the adult population. As for age, in people over 65, this manifestation occurs in more than 50% of fair-skinned and about 70% of dark-skinned patients. At the same time, in 90% of cases, primary hypertension is diagnosed. The rest of the patients during the examination were diagnosed with various secondary forms of hypertension.

At the same time, in more than half of the confirmed hypertensions, the diseases were caused by the pathology of the kidney parenchyma, that is, potentially incurable. Therapy of such ailments is similar to the treatment of other forms of hypertension. Therefore, in the majority of patients with hypertension, long-term drug treatment is carried out regardless of whether the exact cause of the pathology is established or not.

Since 1959, WHO has regularly issued recommendations regarding the classification and treatment of arterial hypertension. Since 1993, such proposals have been created by WHO staff with the MTF. In 1998, a joint conference between WHO and ITF was held in Japan. It approved new points regarding the treatment and classification of pathology, which are still valid today.

In them, arterial hypertension means a systolic pressure of more than 140 mm Hg. Art., diastolic - above 90 mm Hg. Art. in patients not taking antihypertensive drugs.

Also, the new WHO classification does not take into account the distinction between three stages of the course of hypertension. This item is due to the result of ten years of research, according to the results of which it was stated that the likelihood of developing pathological complications of the heart and blood vessels increases not only from an increase in blood pressure, organ damage, but also from many risk factors and other pathologies.

When choosing treatment, experts recommend considering the following risk factors:

• age (men over 65, women over 55);
• bad habits;
• cholesterol above 6.5 mmol/l;
• systolic and diastolic blood pressure indicators;
• hereditary possibility;
• revascularization of coronary vessels;
• nephropathy;
• diabetes;
• microalbuminuria;
• obesity;
• high fibrinogen level;
• social, economic and ethnic component;
• ventricular hypertrophy;
• proteinuria;
• atherosclerotic lesion;
• focal, generalized reduction of retinal vessels;

• stroke;
• heart attack;
• sedentary lifestyle;
• angina;
• renal, heart failure;
• dissecting aneurysm;
• exudates;
• swelling of the optic nerve.

The main goal in the treatment of hypertension, according to WHO, is the prevention of complications of the cardiovascular system. That is, therapy involves not only lowering high blood pressure, but also the elimination of risk factors that can be influenced, for example, smoking, therapy for the initial stage of diabetes, and so on.

Antihypertensive therapy, in addition, depends on the risk group to which the patient belongs. According to WHO studies, with the same degree of hypertension, the effectiveness of antihypertensive drugs in people with a high risk is greater than with a low one.

WHO also recommends lifestyle changes for all people with high blood pressure. Such a proposal is based on studies, the results of which have shown that non-drug influences not only lower blood pressure, but also significantly reduce the need for drugs, increase their effectiveness, and help to cope with almost all risk factors.

If arterial hypertension is not treated, the disease will progress, that is, its stages will acquire a more complex form. As a result, the possibility of developing hypertensive crises increases, which, if repeated, can lead to such irreversible consequences as a heart attack or stroke.