The classification of arterial hypertension is a system with which the severity and stage of the development of arterial hypertension are evaluated.
Attention!In the international classification of diseases of the tenth revision (ICD-10), arterial hypertension in nature is displayed by code i10.
Hypertonic disease: definition, description and etiology
About 50% of people suffer from high blood pressure (GB).About half of the high blood pressure do not know what suffers from the disease.More than 50% of patients with known high blood pressure are either not treated or ineffective medication are obtained.The main cause of mortality in adult hypertension patients is the infarction of the brain or the heart.
The prevalence of arterial hypertension increases with age and body weight.Men often suffer from diseases than women at a young age.Women in postmenopause suffer from high blood pressure more often than men.
Arterial hypertension can be divided into primarily (essential) and secondary (organically).
The vast majority (> 90%) Hyperture has primary hypertension, defined as idiopathic.The primary hypertension is diagnosed by excluding organic pathologies.
Some risk factors can increase the risk of developing the disease at a young age.In medicine, modified and unmodified factors of the formation of the disease are differentiated.This includes:
- Obesity;
- Salt surplus, alcohol in a diet;
- Smoking roommates (they are a danger because the patient involuntarily becomes a passive smoker);
- Stress;
- Hypodynamics (lack of sport in the patient's life);
- Smoke;
- Circulation disorders (in a small or large circle);
- Older age;
- Low social status.
Secondary (symptomatic) hypertension can be attributed to another disease -Apnea syndrome in a dream, aorta co -cardboard or aortic clerosis.Neurogens, psychogenic and podium forms are also known.The last form includes the ovulation inhibitors and NSAIDs.Medicines and toxic substances as well as a very high enjoyment of licorice can lead to a secondary form of high blood pressure.Renal hypertension through stenosis of renal artery as well as hyperaldosteronism, pheochromocytoma, kushing disease or hyperthyroidism are secondary forms of high blood pressure.
Another kind of arterial hypertension occurs in hypertensive pregnancy disorders (GEC).The risk factors include the old age of the mother and several pregnancy.Different forms are known, including pregnancy hypertension with or without proteinuria.
Pathophysiology
An arterial hypertension occurs due to an increase in peripheral resistance, an increase in cardiac volume or combinations of both.There are several adaptation mechanisms in this process, so that blood pressure is constantly kept at an increased level.In order to maintain a heart output, the heart is hypertrophied and can withstand constant stress under pressure.
The kidneys also play a significant role in the pathogenesis of high blood pressure.Although the kidney blood flow and the glomerular filtration rate remain largely constant, sodium excretion also increases.The influence of, for example, the secretion of Renin or the changed reabSorption of sodium is discussed on print.
Symptoms
Symptoms of arterial hypertension often occur too late.In most cases, the disease is asymptomatic.
Hypertension can be characterized by the following symptoms:
- Pain in the head early morning;
- Sleep disorders, dizziness;
- Epistaxis;
- Tinnitus;
- Unspecific heart disease;
- Trembling of the atrium.
In secondary hypertension, symptoms of the underlying disease are added.Special forms of high blood pressure are hidden hypertension (SG) and white robe syndrome (SBC).
With SBC, blood pressure ≥ 140/90 mm Hg increases.Art.When measuring in the doctor's office.Normal blood pressure values are recorded at home and monitoring blood pressure.
If high blood pressure hidden, the blood pressure values are on the doctor in the normal range.The measurements of the house or the monitoring of blood pressure show increased values of ≥ 140/90 mm Hg. Art.This form can be associated with factors such as the male gender and younger age as well as smoking, alcohol and stress.
In the case of hypertensive crisis, it is necessary to prescribe the correct treatment scheme to prevent pathological processes in the organs.Patients with this disease have to cause emergency aid or bring them to the clinic themselves.A lack of treatment can endanger the patient's life and have irreversible consequences.The progression of blood pressure can be malignant, which will lead to an unjustified risk.If vascular symptoms occur, it is recommended to see a doctor immediately because a crisis can lead to lifelong disability.
Classification of high blood pressure to degree
The stages of arterial hypertension were differentiated from a WHO.An increase in blood pressure that occurs, for example, after physical stress, is not regarded as high blood pressure.
A disproportionately high blood pressure mirror at low loads is called an unstable hypertension.The dangerous form of arterial hypertension is associated with diastolic blood pressure above 120 mm Hg.Art. That decreases by less than 10% during the night.
New (2017) Classification of high blood pressure through steps and degrees: The table is given below.
| Steps AG | Systolic pressure in mm ed. Art. | Diastolic pressure in mm ed. Art. |
|---|---|---|
| Optimal | <120 | <75 |
| Normal | 120-125 | 75-79 |
| High | 126-129 | 80-85 |
| 1. stage: start high blood pressure | 130-150 | 85-99 |
| Level 2: Moderate high blood pressure | 160-179 | 100-109 |
| Stage 3: Heavy high blood pressure | ≥ 180 | ≥110 |
| Isolated systolic hypertension | ≥130 | <90 |
Classification of arterial hypertension according to degree
Depending on the damage to blood vessels, eyes, heart and kidneys, hypertension can be classified.In accordance with WHO recommendations, there are 3 high blood pressure.There are no clinical signs of organs damage to the first degree.The target organs are affected in the second degree and atherosclerosis of the vessels is determined.With the third degree, there is obvious cardiovascular complications that occur cardiac and cerebral heart attacks and temporary ischemic attacks.
The stratification of the risk with pronounced arterial hypertension determines the likelihood of complications.Depending on the stage of arterial hypertension, the risk can vary considerably.
Important!Only one doctor can determine the correct diagnosis, category of risk to give certain types of recommendations for prevention and treatment.It is not recommended to calculate the risk of non -existent scales independently and to treat the disease.The treatment of a child and a teenager can differ.A large number of treatment is selected by a doctor based in the medical history.
Complications
The problem of arterial hypertension is that it often does not remain diagnosed for a long time or is treated poorly.The lack of symptoms forces patients not to seek medical help.This leads to complications that often occur in the heart, kidneys, central nervous systems and eyes or in the vessels of the lower extremities.Pronounced atherosclerosis often develops.
Hearts and insufficiency as well as coronary heart diseases are important consequences for the heart's hypertension.The heart increases and stood an increased burden.The result is Levo ventricular failure.
Due to atherosclerotic changes in the coronary arteries, the coronary reserve is so limited that even a minor increase in cardiac volume during the stress of angina pectorator, myocardial infarction or sudden coronary death can cause.
Hypertonic nephropathy - kidney damage due to high blood pressure.It can occur as a result of endothelial damage.Years of exposure to high blood pressure can cause pronounced nephrosclerosis with kidney failure of the last stage.
AG can lead to transient ischemic attacks (TIA), cerebral heart attack, hypertonic mass flood or acute encephalopathy.The risk of stroke can be significantly reduced by blood pressure -lowering therapy.
Hypertonic retinopathy usually occurs as a result of the spread of atherosclerosis in the blood vessels of the retina.Vascular diseases caused by high blood pressure are Ozpa, aneurysm of the abdominal aorta and aortic section.
Treatment method
Treatment of high blood pressure begins with non -displaced intervention.The most important therapy methods for the disease: therapy procedure:
- A decrease in body weight to 25 units according to BMI;
- Übergang zu einer niedrigen Salzdiät von <5-6 g NaCl pro Tag (es wird empfohlen, eine DASH-Diät auszuwählen);
- Rejection of smoking, alcohol;
- Restrict caffeine consumption.
It is also necessary to limit the use of hypertensive drugs in the event of high blood pressure.It is recommended that patients go through the type of training 3-4 times a week for swimming, ongoing cowardice or cycling.
In addition to these general measures, it is necessary to treat diseases that cause secondary hypertension.According to the European Hypertension Association, the target values of blood pressure> 140/90 mm Hg should be.For patients under 80 years and> 150/90 mm ed. - for older patients.
Medical therapy begins with monotherapy with the medication of choice.For values that are strongly carried out by normal blood pressure values (> 20/10 mm Hg) or a primary combined therapy with simultaneous diseases.
Preparations of the choice:
- Beta blocker;
- ACE inhibitors;
- Thiazidiuretics;
- AT1 receptor antagonist;
- Calcium blocks of a long effect.
As a double combination, you can use a diuretic in combination with a beta blocker, long-acting calcium antagonists, ACE inhibitors or AT1 receptor blockers.
Calcium antagonists of the type of non-Hephydropyridine should not be prescribed together with beta blockers because they contribute to the development of bradycardia or atrioventricular blockade.
Depending on the simultaneous disease, individual drugs cannot be prescribed.Diuretics are recommended for high blood pressure in combination with heart failure.ACE inhibitors can be used for both heart failure and diabetic nephropathy.Beta blockers can also be used in the presence of myocardial insufficiency.
With regard to the use of individual medicines, factors such as side effects, individual tolerance and interaction with other medication that the patient uses are added.Three -time combinations are also possible if a double combination does not provide the desired effect.