home Analyzes Arterial hypertension WHO classification. What is the classification for hypertension? Hypertension according to American classification

Arterial hypertension WHO classification. What is the classification for hypertension? Hypertension according to American classification

The syndrome of increased blood pressure to the maximum permissible values is defined as arterial hypertension. When a patient’s blood pressure rises above 140/90 mmHg, a hypertensive crisis, heart attack, or stroke develops. Classification of the stages of hypertension occurs according to stages, forms, degrees, risks. How can a hypertensive patient understand these terms?

Classification of arterial hypertension

With hypertension, the patient's blood pressure increases pathologically in the range of 140/90 mmHg. up to 220/110. The disease is accompanied by hypertensive crises, the risk of myocardial infarction and stroke. A common classification of arterial hypertension is by reason of occurrence. Depending on what became the impetus and the root cause of the increase in blood pressure (BP), there are:

Primary hypertension is a disease the cause of which cannot be identified as a result of instrumental (ultrasound of the heart, cardiogram) and laboratory studies (blood, urine, plasma tests). Hypertension with an unknown cause in history is defined as idiopathic, essential.

Hypertensive patients with primary hypertension will have to maintain normal blood pressure (120/80) throughout their lives. Because there is always a risk that the disease will recur. Therefore, idiopathic arterial hypertension is classified as a chronic form. Chronic hypertension, in turn, is divided according to health risks, degrees, and stages.

Secondary hypertension is a disease whose cause can be determined through medical research. The classification of the disease originates from the pathology or factor that triggered the process of increasing blood pressure.

Primary and secondary arterial hypertension are classified depending on the increase in blood pressure:

Classification according to the form of the disease

It is important to know!

Vessels become dirty very quickly, especially in older people. To do this, you don’t need to eat burgers or fries all day long. It is enough to eat one sausage or scrambled egg for some amount of cholesterol to be deposited in the blood vessels. Over time, pollution accumulates...

Arterial hypertension occurs in the body in two forms - benign and malignant. Most often, the benign form, in the absence of adequate timely therapy, turns into a pathological malignant form.

With benign hypertension, a person’s blood pressure begins to gradually increase - systolic, diastolic. This process is slow. The cause must be sought in pathologies of the body, as a result of which the functioning of the heart is disrupted. The patient's blood circulation is not impaired, the volume of circulating blood is maintained, but the tone of the blood vessels and their elasticity are reduced. The process can last several years and persist throughout life.

The malignant form of hypertension progresses rapidly. Example: today a patient’s blood pressure is 150/100 mmHg, after 7 days it is already 180/120 mmHg. At this moment, the patient’s body is affected by a malignant pathology, which “forces” the heart to beat tens of times faster. The walls of blood vessels retain their tone and elasticity. But myocardial tissue cannot cope with the increased rate of blood circulation. The cardiovascular system cannot cope, the blood vessels spasm. The health of a hypertensive patient sharply worsens, blood pressure rises to the maximum, and the risk of myocardial infarction, cerebral stroke, paralysis, and coma increases.

In the malignant form of hypertension, blood pressure rises to 220/130 mmHg. Internal organs and vital systems undergo serious changes: the fundus of the eye becomes filled with blood, the retina swells, the optic nerve becomes inflamed, and the blood vessels narrow. The heart, kidneys, and brain tissue undergo necrosis. The patient complains of unbearable heart pain, headaches, loss of vision, dizziness, and fainting.

Stages of arterial hypertension

Hypertension is divided into stages, which differ in blood pressure values, symptoms, degree of risk, complications, and disability. The classification of the stages of hypertension looks like this:

Stage 1 hypertension occurs with readings of 140/90 mmHg. and higher. These values can be normalized without medications, with the help of rest, lack of stress, nervousness, and intense physical activity.

The disease is asymptomatic. Hypertensive patients do not notice changes in health. At the 1st stage of increased blood pressure, target organs are not affected. Disorders of well-being in the form of insomnia, heart pain, and headaches are rarely observed.

Hypertensive crises can occur against the background of changes in weather, after nervousness, stress, shock, or physical exertion. Treatment consists of maintaining a healthy lifestyle and drug therapy. The prognosis for recovery is favorable.

Hypertensive crisis leads to stroke and heart attack. The patient requires constant drug treatment. A person with hypertension can apply for a disability group based on health reasons.

Stage 3 hypertension is severe, the patient’s blood pressure is 180/110 mmHg. and higher. In hypertensive patients, target organs are affected: kidneys, eyes, hearts, blood vessels, brain, respiratory tract. Antihypertensive drugs do not always lower high blood pressure. A person is unable to care for himself, he becomes disabled. An increase in blood pressure to 230/120 increases the risk of death.

The WHO classification of hypertension (given above) is necessary for a full-scale, large-scale assessment of the disease in order to select the correct treatment tactics. Optimally selected drug therapy can stabilize the well-being of a hypertensive patient, avoid hypertensive crises, the risk of hypertension, and death.

IT IS IMPORTANT TO KNOW!

In 90-95% of people, high blood pressure develops regardless of lifestyle, being a risk factor for diseases of the brain, kidneys, heart, vision, AS WELL AS HEART ATTACKS AND STROKES! In 2017, scientists discovered a relationship between the mechanisms of increasing blood pressure and blood clotting factor.

Hypertension is divided according to blood pressure readings into degrees: from 1st to 3rd. To determine the tendency to hypertension, it is necessary to measure blood pressure in both arms. The difference is 10-15 mmHg. between blood pressure measurements indicates cerebrovascular disease.

Vascular surgeon Korotkov introduced a method of sound, auscultation measurement of blood pressure. The optimal pressure is considered to be 120/80 mmHg, and normal is 129/89 (pre-hypertension state). There is a concept of high-normal blood pressure: 139/89. The classification of hypertension itself by degree (in mmHg) is as follows:

1st degree: 140-159/85-99;
2nd degree: 160-179/100-109;
3rd degree: above 180/110.

Determination of the degree of hypertension occurs against the background of the complete absence of drug treatment with antihypertensive drugs. If the patient is forced to take medications for health reasons, then the measurement is carried out at the maximum reduction in their dosage.

In some medical sources you can find mention of grade 4 arterial hypertension (isolated systolic hypertension). The condition is characterized by an increase in upper pressure with normal lower pressure - 140/90. The clinic is diagnosed in elderly people and patients with hormonal disorders (hyperthyroidism).

A hypertensive patient sees in his diagnosis not only the disease, but also the degree of risk. What does risk mean for hypertension? By risk we mean the percentage of probability of developing a stroke, heart attack, or other pathologies against the background of hypertension. Classification of hypertension according to risk levels:

Low risk 1 is 15% that in the next 10 years a hypertensive patient will develop a heart attack or cerebral stroke;
An average risk of 2 implies a 20% chance of complications;
High risk 3 is 30%;
A very high risk of 4 increases the likelihood of health complications by 30-40% or more.

There are 3 main criteria for hazard stratification for patients with hypertension: risk factors, the degree of target organ damage (occurs in stage 2 hypertension), additional pathological clinical conditions (diagnosed at stage 3 of the disease).

Let's consider the main criteria and risk factors:

Main: in women, men over 55 years of age, in smokers;
Dyslipidemia: total cholesterol more than 250 mgdl, low-density lipoprotein cholesterol (LDL) more than 155 mg/dl; HDL-C (high density) more than 40 mg/dl;
Hereditary history (hypertension in direct relatives);
C-reactive protein level more than 1 mg/dl;
Abdominal obesity is a condition when the waist circumference of women exceeds 88 cm, men - 102 cm;
Physical inactivity;
Impaired glucose tolerance;
Excess febrinogen in the blood;
Diabetes.

At the second stage of the disease, damage to internal organs begins (under the influence of increased blood flow, spasm of blood vessels, lack of oxygen and nutrients), and the functioning of internal organs is disrupted. The clinical picture of stage 2 hypertension is as follows:

The last 2 indicators indicate kidney damage.

Concomitant clinical conditions (when determining the threat of arterial hypertension) mean:

Heart diseases;
Kidney pathologies;
Physiological impact on the coronary arteries, veins, vessels;
Inflammation of the optic nerve, bruising.

Risk 1 is established for elderly patients over 55 years of age without concomitant aggravating pathologies. Risk 2 is prescribed in the diagnosis for hypertensive patients with the presence of several factors described above. Risk 3 aggravates the disease of patients with diabetes mellitus, atherosclerosis, left gastric hypertrophy, renal failure, and damage to the organs of vision.

In conclusion, we remind you that arterial hypertension is considered an insidious, dangerous disease due to the absence of primary symptoms. Clinical pathologies are most often benign. But this does not mean that the disease will not move from the first stage (with blood pressure 140/90) to the second (blood pressure 160/100 and above). If the 1st stage is treated with medications, then the 2nd stage brings the patient closer to disability, and the 3rd stage brings the patient closer to lifelong disability. Hypertension in the absence of adequate timely treatment ends in target organ damage and death. Don't risk your health, always keep a blood pressure monitor at hand!

A person may not even feel the onset of the disease - it is practically asymptomatic, but already in the second or third stage of hypertension, complications in the functioning of the kidneys, heart or brain are possible. In order to keep the disease under control, a person must change their lifestyle, strictly adhere to the doctor's recommendations and constantly monitor their blood pressure.

Definition of disease

Doctors diagnose hypertension when a patient has persistently high blood pressure. The cause of hypertension is poor circulation in the body. The walls of the vessels thicken, complicating the passage of blood flow. Narrower vessels force the heart to spend more energy pumping blood, and this leads to rapid wear and tear of the myocardium. The narrowing of blood flow passages is influenced by many factors, including:

Frequent headaches in the temporal part of the head are one of the first signs of high blood pressure.

At the initial stage of the disease, with a correct diagnosis and following the doctor’s recommendations, you can get rid of it, and at more advanced stages, you can keep the disease under control. It should also be remembered that each person is an individual organism that chooses for itself the pressure that suits it. However, when the first symptoms of hypertension appear, you should consult a doctor. Doctors include signs of hypertension:

Return to contents

Classification of hypertension by stages

Normally, the upper or systolic pressure should be 120 mmHg. Art., and the lower, diastolic, equals 80 mm Hg. The WHO classification of hypertension says that arterial hypertension occurs when the tonometer needle rises by 20 divisions, when the pressure is 140/90 mm Hg. Art. - the first degree of hypertension occurs. Note that the WHO classification includes the division of hypertension into stages. The types of hypertension regarding stages are presented in the table.

Return to contents

Types of hypertension by level and stability of pressure

There are three stages of the disease depending on blood pressure readings.

Hypertension is an insidious disease in which the first two stages can be asymptomatic, and in the third, due to neglect, irreversible changes already occur in the body. The WHO classification of hypertension also includes the following stages of disease development. For doctors, this division makes it possible to more accurately determine the stage of progression of hypertension.

Soft - the pressure is unstable, ranging from 140/60 mm Hg. Art. up to 159/99 mm Hg. Art.
Moderate - the tonometer scale almost always remains at a level of 160/100 mm Hg. Art. up to 179/109 mm Hg.
Severe - pressure is consistently high from 180/110 mm Hg. Art. and higher.

Return to contents

Classification of hypertension according to risk level

The classification of hypertension includes an additional clarifying diagnosis, which sounds like “degree of risk” - a concept that helps to find out what the possibility of damage to internal organs due to hypertension is. If there is a risk of 1 or 2, it means that the permissibility of damage to internal organs is at least 20%, and the factors influencing the aggravation of the disease are either less than three or not at all. If there is a risk of 3, the possibility of organ damage increases to 30%, and there are more than three factors in the history of hypertension that influence the course of the disease. When the diagnosis sounds like risk 4, then most likely one of the target organs is already affected, or the likelihood of problems with the heart, kidneys or brain is about 40%. Those at risk for factors that influence the aggravation of hypertension are those who:

Return to contents

Type of hypertension according to diastolic pressure level

Increased diastolic pressure threatens stroke and myocardial infarction.

Usually, if hypertension is diagnosed, an increase in the levels of both upper and lower pressure is recorded, but there are cases when the upper pressure remains normal, while the lower pressure jumps. This pressure is called isolated diastolic - this is one of the types of hypertension. Increased diastolic pressure is recorded when the tonometer shows more than 90 mmHg. Art. When blood pressure increases by 5 points, the risk of hemorrhagic stroke increases threefold. The chance of having a myocardial infarction increases by more than 20%. When the tonometer rises by 10 divisions, the possibility of a stroke doubles, and a heart attack increases by 40%.

Return to contents

Types of hypertension according to the degree of target organ damage

When pressure increases by several points, the possibility of diseases of internal organs increases by the same percentage. Arterial hypertension has chosen several internal organs as targets and affects them. Organ damage begins at stage 3, less often at late stage 2, of hypertension. If disorders appear in the target organs, they will not work without failures, but you can minimize the risks by taking the right medications.

Return to contents

Other classifications of hypertension

Consulting a doctor is mandatory in case of a benign course of the disease.

The classification of blood pressure includes the division into malignant and benign hypertension. With a benign variant of the development of hypertension, it slowly passes through all three stages of its development, affecting the target organs. With a malignant course, the disease appears in childhood or adolescence, is severe, and immediately passes to stage 3 of development, affecting the brain and heart muscle. But this type of hypertension is rare.

Return to contents

Diagnosis and treatment of hypertension

At the first signs of arterial hypertension, you should visit a doctor to establish an accurate diagnosis, and also undergo an examination of the body and do an electrocardiogram, echocardiography, MRI of the head, conduct a fundus examination, and take a urine test for protein. In order for the treatment of hypertension to be successful, the patient must follow a diet, daily routine and take medications.

A patient with hypertension should avoid noisy places, stuffy rooms, drinking alcohol, fatty and salty foods. You need to strictly follow a daily routine, walk in the fresh air and stick to a diet, and also monitor your blood pressure - it needs to be measured twice a day. You should keep a diary where the tonometer readings will be noted, and there should also be a table that includes data on what medications the hypertensive person takes, how he sleeps and what he eats.

Classification of hypertension by degrees and stages

Classifications of hypertension
Modern classification
Certain types of hypertension

Hypertension is one of the most common pathologies of the cardiovascular 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.

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 a common cause of death, including in people of working age.

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 essential hypertension, it is an independent disease of unknown etiology. It should be distinguished from secondary, or symptomatic, arterial hypertension, which develops as a sign of various diseases: heart, kidney, endocrine and others.

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 the appearance of the patient, the reasons for the increase in pressure, etiology, the level of pressure and its stability, the degree of organ damage, and 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.

In recent 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, the upper limit of normal is considered to be 139/89 mm Hg. pillar Blood pressure equal to 140/90 mm Hg. column, is the initial stage of hypertension.

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.

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.

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 of pathological processes in the 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.

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:

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.

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, hypertensive encephalopathy, 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:

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

Certain types of hypertension

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

Hypertensive crises

This is the most severe manifestation of arterial hypertension, in 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.

Hypertensive crises, in turn, 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.

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.

White coat hypertension

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

Features of stage 2 hypertension

Please note that all information posted on the site is for reference only and

not intended for self-diagnosis and treatment of diseases!

Copying of materials is permitted only with an active link to the source.

WHO classification of hypertension

Irina Evgenievna Chazova

At the end of the century, it is customary to sum up the development of mankind over the past century, evaluate the successes achieved and count the losses. At the end of the 20th century, the saddest outcome can be considered the epidemic of arterial hypertension (AH), with which we greeted the new millennium. The “civilized” lifestyle has led to the fact that 39.2% of men and 41.1% of women in our country have high blood pressure (BP).

At the same time, 37.1 and 58.0%, respectively, know that they have the disease, only 21.6 and 45.7% are treated, and only 5.7 and 17.5% are treated effectively. Obviously, this is the fault of both doctors who do not persistently explain to patients the need for strict control over blood pressure and adherence to preventive recommendations to reduce the risk of such serious consequences of increased blood pressure as myocardial infarction and cerebral stroke, as well as patients who are accustomed to often neglecting their health who are not fully aware of the danger of uncontrolled hypertension, which often does not manifest itself subjectively. At the same time, it has been proven that a decrease in diastolic blood pressure by only 2 mm Hg. Art. leads to a reduction in the incidence of stroke by 15%, coronary heart disease (CHD) – by 6%. There is also a direct connection between blood pressure levels and the incidence of heart failure and kidney damage in hypertensive patients.

The main danger of high blood pressure is that it leads to the rapid development or progression of the atherosclerotic process, the occurrence of ischemic heart disease, strokes (both hemorrhagic and ischemic), the development of heart failure, and kidney damage.

All these complications of hypertension lead to a significant increase in overall mortality, and especially cardiovascular mortality. Therefore, according to the WHO/IAS recommendations of 1999, “. The main goal of treating a patient with hypertension is to achieve the maximum reduction in the risk of cardiovascular morbidity and mortality.” This means that now, to treat patients with hypertension, it is not enough to simply reduce blood pressure to the required levels, but it is also necessary to influence other risk factors. In addition, the presence of such factors determines the tactics, or more precisely, the “aggression” of treatment of patients with hypertension.

At the All-Russian Congress of Cardiologists, held in Moscow in October 2001, “Recommendations for the prevention, diagnosis and treatment of arterial hypertension” were adopted, developed by experts of the All-Russian Scientific Society of Cardiologists based on the WHO/IAS recommendations of 1999 and domestic developments. The modern classification of hypertension involves determining the degree of increase in blood pressure (Table 1), the stage of essential hypertension (HT) and the risk group according to risk stratification criteria (Table 2).

Determination of the degree of blood pressure increase

The classification of blood pressure levels in adults over 18 years of age is presented in Table. 1. The term “degree” is preferable to the term “stage”, since the concept of “stage” implies progression over time. If the values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) fall into different categories, then a higher degree of arterial hypertension is established. The degree of arterial hypertension is established in the case of a newly diagnosed increase in blood pressure and in patients not receiving antihypertensive drugs.

Determining the stage of headache

In the Russian Federation, the use of a three-stage classification of hypertension is still relevant, especially when formulating a diagnostic conclusion (WHO, 1993).

Stage I headache presupposes the absence of changes in target organs identified during functional, radiation and laboratory studies.

Stage II hypertension presupposes the presence of one or more changes in target organs (Table 2).

Stage III headache is established in the presence of one or more associated (concomitant) conditions (Table 2).

When making a diagnosis of hypertension, both the stage of the disease and the degree of risk should be indicated. In persons with newly diagnosed arterial hypertension and persons not receiving antihypertensive therapy, the degree of hypertension is indicated. In addition, it is recommended to detail the existing target organ lesions, risk factors and concomitant clinical conditions. Establishing stage III of the disease does not reflect the development of the disease over time and the cause-and-effect relationship between arterial hypertension and existing pathology (in particular, angina pectoris). The presence of associated conditions allows the patient to be classified in a more severe risk group and therefore requires the establishment of a higher stage of the disease, even if changes in a given organ are not, in the doctor’s opinion, a direct complication of hypertension.

Table 1. Definition and classification of blood pressure levels

Table 2. Risk stratification criteria

Identification of risk groups and treatment approaches

The prognosis of patients with hypertension and the decision on further tactics depend not only on blood pressure levels. The presence of associated risk factors, the involvement of target organs in the process, as well as the presence of associated clinical conditions is no less important than the degree of arterial hypertension, and therefore stratification of patients depending on the degree of risk has been introduced into the modern classification. To assess the total impact of several risk factors relative to the absolute risk of severe cardiovascular damage, WHO/IAS experts proposed risk stratification into four categories (low, medium, high and very high risk - Table 3). The risk in each category is calculated based on the 10-year average risk of death from cardiovascular disease, as well as the risk of stroke and myocardial infarction (based on the results of the Framingham Study). To optimize therapy, it was proposed to divide all patients with hypertension according to the level of risk of cardiovascular complications (Table 3). The low-risk group includes men under 55 years of age and women under 65 years of age with grade 1 arterial hypertension (mild - with SBP 140–159 mm Hg and/or DBP 90–99 mm Hg) without any other risk factors. Among this category, the 10-year risk of cardiovascular disease is typically less than 15%. These patients rarely come to the attention of cardiologists; As a rule, local therapists are the first to encounter them. Patients at low risk of cardiovascular complications should be advised to make lifestyle changes for 6 months before considering medication. However, if after 6–12 months of non-drug treatment, blood pressure remains at the same level, drug therapy should be prescribed.

An exception to this rule are patients with so-called borderline arterial hypertension - with SBP from 140 to 149 mm Hg. Art. and DBP from 90 to 94 mm Hg. Art. In this case, the doctor, after a conversation with the patient, may suggest that in order to lower blood pressure and reduce the risk of cardiovascular damage, he can continue measures related only to lifestyle changes.

The average risk group unites patients with 1st and 2nd degrees of arterial hypertension (moderate - with SBP 160–179 mm Hg and/or DBP 100–109 mm Hg) in the presence of 1–2 risk factors, which include smoking, increased total cholesterol levels over 6.5 mmol/l, impaired glucose tolerance, obesity, sedentary lifestyle, family history, etc. The risk of cardiovascular complications in this category of patients is higher than in the previous one and amounts to 15–20% over 10 years of observation. These patients are also more likely to be seen by primary care physicians rather than by cardiologists. For patients at average risk, it is advisable to continue measures related to lifestyle modification, and if necessary, then accelerate them for at least 3 months before raising the question of prescribing medications. However, if a decrease in blood pressure is not achieved within 6 months, drug therapy should be started.

Table 3. Distribution (stratification) by risk level

The next group is at high risk of cardiovascular complications. It includes patients with 1st and 2nd degrees of arterial hypertension in the presence of three or more risk factors, diabetes mellitus or target organ damage, which include left ventricular hypertrophy and/or a slight increase in creatinine levels, atherosclerotic vascular disease, changes retinal vessels; The same group includes patients with 3rd degree arterial hypertension (severe - with SBP more than 180 mm Hg and/or DBP more than 110 mm Hg) in the absence of risk factors. Among these patients, the risk of cardiovascular disease over the next 10 years is 20–30%. As a rule, representatives of this group are “experienced hypertensive patients” who are under the supervision of a cardiologist. If such a patient sees a cardiologist or therapist for the first time, drug treatment should begin within a few days - as soon as repeated measurements confirm the presence of elevated blood pressure.

The group of patients with a very high risk of cardiovascular complications (more than 30% within 10 years) are patients with stage 3 arterial hypertension and the presence of at least one risk factor, as well as patients with degrees 1 and 2 arterial hypertension. hypertension if they have such cardiovascular complications as cerebrovascular accident, ischemic heart disease, diabetic nephropathy, dissecting aortic aneurysm. This is a relatively small group of patients with hypertension - usually cardiologists, often hospitalized in specialized hospitals. Undoubtedly, this category of patients requires active drug treatment.

There is another group of patients that deserves special attention. These are patients with high normal blood pressure (SBP 130–139 mm Hg, DBP 85–89 mm Hg) who have diabetes mellitus and/or renal failure. They require early active drug therapy, since it has been shown that this type of treatment tactics prevents the progression of renal failure in this group of patients. It should be noted that the distribution of patients into groups based on the total risk of cardiovascular complications is useful not only for determining the threshold from which treatment with antihypertensive drugs should be started. It also makes sense for setting the level of blood pressure that should be achieved and choosing the intensity of methods to achieve it. Obviously, the higher the risk of cardiovascular complications, the more important it is to achieve the target blood pressure level and correct other risk factors.

Risk levels (risk of stroke or myocardial infarction in the next 10 years after the examination):

Low risk less than 15% (level I)

Average risk 15–20% (level II)

High risk 20–30% (level III)

Very high risk 30% or higher (level IV)

Classification of hypertension by stages and degrees: table

Hypertension is a pathology of the cardiovascular system, in which persistent high blood pressure is noted, which leads to dysfunction of the corresponding target organs: heart, lungs, brain, nervous system, kidneys.

Hypertension (HD) or arterial hypertension develops as a result of a malfunction of higher centers that regulate the functions of the vascular system, neurohumoral and renal mechanisms.

Main clinical signs of headache:

Dizziness, ringing and noise in the ears;
Headache;
Shortness of breath, suffocation;
Darkening and “stars” before the eyes;
Painful sensations in the chest, in the area of the heart.

There are different stages of hypertension. Determination of the degree of hypertension is carried out using the following methods and studies:

Biochemical blood test and urine test.
Doppler ultrasound of the arteries of the kidneys and neck.
Electrocardiogram of the heart.
EchoCG.
Blood pressure monitoring.

Taking into account risk factors and the degree of target organ damage, a diagnosis is made and treatment is prescribed using medications and other techniques.

Hypertension - definition and description

The main clinical signs of hypertension are sudden and persistent jumps in blood pressure, while blood pressure is consistently high, even if there is no physical activity and the patient’s emotional state is normal. Blood pressure decreases only after the patient takes antihypertensive drugs.

Systolic (upper) pressure – no higher than 140 mm. rt. Art.;
Diastolic (lower) pressure is not higher than 90 mm. rt. Art.

If during two medical examinations on different days the pressure was higher than the established norm, a diagnosis of arterial hypertension is made and adequate treatment is selected. Hypertension develops in both men and women with approximately the same frequency, mainly after the age of 40 years. But clinical signs of HD are also observed in young people.

Arterial hypertension is often accompanied by atherosclerosis. One pathology complicates the course of another. Diseases that occur against the background of hypertension are called associated or concomitant. It is the combination of atherosclerosis and hypertension that becomes the cause of mortality among the young, working-age population.

According to the mechanism of development, according to WHO, we distinguish primary or essential hypertension, and secondary or symptomatic. The secondary form occurs in only 10% of cases. Essential arterial hypertension is diagnosed much more often. As a rule, secondary hypertension is a consequence of such diseases:

Various kidney pathologies, renal artery stenosis, pyelonephritis, hydronephrosis tuberculosis.
Thyroid dysfunction – thyrotoxicosis.
Adrenal gland disorders – Itsenko-Cushing syndrome, pheochromocytoma.
Atherosclerosis of the aorta and coarctation.

Primary hypertension develops as an independent disease associated with impaired regulation of blood circulation in the body.

In addition, hypertension can be benign - that is, it occurs slowly, with minor deterioration in the patient’s condition over a long period of time; the pressure can remain normal and increase only occasionally. It will be important to maintain blood pressure and maintain proper nutrition for hypertension.

Or malignant, when the pathology develops rapidly, the pressure rises sharply and remains at the same level, the patient’s condition can only be improved with the help of medications.

Pathogenesis of hypertension

An increase in pressure, which is the main cause and sign of hypertension, occurs due to an increase in cardiac output of blood into the vascular bed and an increase in peripheral vascular resistance. Why is this happening?

There are certain stress factors that affect the higher centers of the brain - the hypothalamus and medulla oblongata. As a result, disturbances in the tone of peripheral vessels appear, and spasm of arterioles occurs in the periphery - including the kidneys.

Dyskinetic and dyscirculatory syndrome develop, the production of Aldosterone increases - this is a neurohormone that participates in water-mineral metabolism and retains water and sodium in the vascular bed. Thus, the volume of blood circulating in the vessels increases even more, which contributes to an additional increase in pressure and swelling of the internal organs.

All these factors also affect blood viscosity. It becomes thicker, the nutrition of tissues and organs is disrupted. At the same time, the walls of the vessels become denser, the lumen becomes narrower - the risk of developing irreversible hypertension increases significantly, despite treatment. Over time, this leads to elastofibrosis and arteriolosclerosis, which in turn provokes secondary changes in target organs.

The patient develops myocardial sclerosis, hypertensive encephalopathy, and primary nephroangiosclerosis.

Classification of hypertension by stage

There are three stages of hypertension. This classification, according to WHO, is considered traditional and was used until 1999. It is based on the degree of damage to the target organs, which, as a rule, if treatment is not carried out and the doctor’s recommendations are not followed, becomes greater and greater.

In stage I hypertension, signs and manifestations are practically absent, therefore such a diagnosis is made very rarely. No target organ damage is noted.

At this stage of hypertension, the patient very rarely consults a doctor, since there is no sharp deterioration in the condition, only occasionally the blood pressure “goes through the roof.” However, if you do not see a doctor and start treatment at this stage of hypertension, there is a risk of rapid progression of the disease.

Stage II of hypertension is characterized by a steady increase in blood pressure. Disturbances in the heart and other target organs appear: the left ventricle becomes larger and thicker, and sometimes damage to the retina is observed. Treatment at this stage is almost always successful with the cooperation of the patient and the doctor.

In stage III hypertension, damage to all target organs occurs. The blood pressure is consistently high, and the risk of myocardial infarction, stroke, and coronary heart disease is very high. If such a diagnosis is made, then, as a rule, a history of angina pectoris, renal failure, aneurysm, and hemorrhages in the fundus is already noted.

The risk of sudden deterioration of the patient's condition increases if treatment is not carried out properly, the patient has stopped taking medications, abuses alcohol and cigarettes, or experiences psycho-emotional stress. In this case, a hypertensive crisis may develop.

Classification of arterial hypertension by degree

This classification is currently considered more relevant and appropriate than by stage. The main indicator is the patient’s blood pressure, its level and stability.

Optimal – 120/80 mm. rt. Art. or lower.
Normal - it is permissible to add no more than 10 units to the upper indicator, and no more than 5 to the lower indicator.
Close to normal - indicators range from 130 to 140 mm. rt. Art. and from 85 to 90 mm. rt. Art.
Stage I hypertension –/90-99 mm. rt. Art.
Hypertension II degree –/mm. rt. Art.
Hypertension III degree – 180/110 mm. rt. Art. and higher.

Hypertension of the third degree, as a rule, is accompanied by lesions of other organs; such indicators are characteristic of a hypertensive crisis and require hospitalization of the patient for emergency treatment.

Risk stratification for arterial hypertension

There are risk factors that can lead to increased blood pressure and the development of pathology. The main ones:

Age indicators: for men it is over 55 years, for women – 65 years.
Dyslipidemia is a condition in which the lipid spectrum of the blood is disrupted.
Diabetes.
Obesity.
Bad habits.
Hereditary predisposition.

Risk factors are always taken into account by the doctor when examining a patient in order to make a correct diagnosis. It has been noted that most often the cause of surges in blood pressure is nervous overstrain, increased intellectual work, especially at night, and chronic fatigue. This is the main negative factor according to WHO.

The second place goes to salt abuse. WHO notes that if you consume more than 5 grams daily. table salt, the risk of developing arterial hypertension increases several times. The risk increases if there are relatives in the family who suffer from high blood pressure.

If more than two close relatives are being treated for hypertension, the risk becomes even higher, which means that the potential patient must strictly follow all the doctor’s recommendations, avoid worries, give up bad habits and monitor their diet.

Other risk factors, according to WHO, are:

Chronic diseases of the thyroid gland;
Atherosclerosis;
Chronic infectious diseases - for example, tonsillitis;
Menopause in women;
Pathologies of the kidneys and adrenal glands.

By comparing the factors listed above, the patient’s blood pressure indicators and their stability, the risk of developing such a pathology as arterial hypertension is stratified. If 1-2 unfavorable factors are identified in first-degree hypertension, then risk 1 is assigned, according to WHO recommendations.

If the unfavorable factors are the same, but hypertension is already of the second degree, then the risk from low becomes moderate and is designated as risk 2. Further, according to WHO recommendations, if hypertension of the third degree is diagnosed and 2-3 unfavorable factors are noted, the risk is set to 3. Risk 4 implies a diagnosis of third-degree hypertension and the presence of more than three unfavorable factors.

Complications and risks of hypertension

The main danger of the disease is the serious heart complications it causes. For hypertension combined with severe damage to the heart muscle and left ventricle, there is a WHO definition - decapitated hypertension. Treatment is complex and lengthy; decapitated hypertension is always difficult, with frequent attacks; with this form of the disease, irreversible changes in the blood vessels have already occurred.

By ignoring pressure surges, patients put themselves at risk of developing the following pathologies:

If a hypertensive crisis occurs, the patient needs urgent help, otherwise he may die - according to WHO, this condition in hypertension leads in most cases to death. The risk is especially high for those people who live alone, and in the event of an attack there is no one near them.

It should be noted that it is impossible to completely cure arterial hypertension. If, in case of hypertension of the first degree, at the very initial stage, you begin to strictly control your blood pressure and adjust your lifestyle, you can prevent the development of the disease and stop it.

But in other cases, especially if associated pathologies are added to hypertension, complete recovery is no longer possible. This does not mean that the patient should give up on himself and abandon treatment. The main measures are aimed at preventing sudden jumps in blood pressure and the development of a hypertensive crisis.

It is also important to cure all concomitant or associative diseases - this will significantly improve the patient’s quality of life and will help keep him active and productive until old age. Almost all forms of arterial hypertension allow you to play sports, lead a personal life and fully relax.

The exception is grades 2-3 with a risk of 3-4. But the patient has the power to prevent such a serious condition with the help of medications, folk remedies and a review of his habits. A specialist will talk about the classification of hypertension in the video in this article.

For quotation: Preobrazhensky D.V. NEW APPROACHES TO THE TREATMENT OF ARTERIAL HYPERTENSION // Breast Cancer. 1999. No. 9. S. 2

Since 1959, World Health Organization (WHO) experts have published recommendations for the diagnosis, classification and treatment of arterial 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. In the Japanese city of Fukuoka, from September 29 to October 1, 1998, the 7th meeting of WHO and the International Society of Hypertension (ISH) experts was held, at which new recommendations for the treatment of arterial hypertension were approved. These recommendations were published in February 1999 (1999 WHO-ISH guidelines for the management of hypertension). Below we provide a brief summary of their main provisions.

WITH 1959 World Health Organization (WHO) experts publish recommendations for the diagnosis, classification and treatment of arterial 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 (Intern a tional Society of Hypertension). In the Japanese city of Fukuoka, from September 29 to October 1, 1998, the 7th meeting of WHO and the International Society of Hypertension (ISH) experts was held, at which new recommendations for the treatment of arterial hypertension were approved. These recommendations were published in February 1999 (1999 WHO-ISH guidelines for the management of hypertension). Below we provide a brief summary of their main provisions.

Definition and classification of arterial hypertension

In the 1999 WHO-IOG recommendations, arterial hypertension is defined as a systolic blood pressure (BP) level of 140 mmHg. Art. or more, and/or a diastolic blood pressure level equal to 90 mmHg. 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.
Table 1. Classification of blood pressure

AD class*	Blood pressure, mmHg Art.
AD class*	systolic	diastolic
Optimal blood pressure	< 120	< 80
Normal blood pressure	< 130	< 85
Increased normal blood pressure	130-139	85-89
Arterial hypertension
1st degree ("soft")	140-159	90-99
Subgroup: borderline	140-149	90-94
2nd degree ("moderate")	160-179	100-109
3rd degree ("severe")	i 180	і 110
Isolated c istolic hypertension	і 140	< 90
Subgroup: borderline	140-149	< 90
* If systolic and diastolic blood pressure are in different classes, the patient’s blood pressure level is assigned to a higher class.

Depending on the level of systolic and diastolic blood pressure, three degrees of arterial hypertension are distinguished ( ). In the 1999 WHO-ITF classification, grades 1, 2, and 3 arterial hypertension correspond to the terms “mild,” “moderate,” and “severe” hypertension, which were used, for example, in the 1993 WHO-ITF guidelines.
In contrast to the 1993 guidelines, the new guidelines state that approaches to the treatment of hypertension in the elderly and isolated systolic hypertension should be the same as approaches to the treatment of classical hypertension in middle-aged individuals.

Long-term prognosis assessment

In 1962, WHO expert recommendations first proposed distinguishing three stages of arterial hypertension depending on the presence and severity of target organ damage. For many years it was believed that in patients with target organ damage, antihypertensive therapy should be more intensive than in patients without damage to such organs.
The new classification of arterial hypertension by WHO-IOG experts does not provide for the identification of stages in the course of hypertension. The authors of the new recommendations draw attention to the results of the Framingham study, which showed that in patients with arterial hypertension, the risk of developing cardiovascular complications over a 10-year observation period depended not only on the degree of increase in blood pressure and the severity of target organ damage, but also on other factors risk and associated diseases. After all, it is known that clinical conditions such as diabetes mellitus, angina pectoris or congestive heart failure have a more unfavorable effect on the prognosis of patients with arterial hypertension than the degree of increase in blood pressure or left ventricular hypertrophy.
When choosing therapy in patients with arterial hypertension, it is recommended to take into account all factors that may affect the prognosis ().
Before initiating therapy, each patient with hypertension must be assessed for their absolute risk of cardiovascular complications and assigned to one of four risk categories depending on the presence or absence of cardiovascular risk factors, end-organ damage, and comorbidities ( ).

Goal of antihypertensive therapy

The goal of treating a patient with arterial hypertension is to reduce the risk of cardiovascular complications as much as possible. This means that it is necessary not only to reduce high blood pressure, but also to act on all other reversible risk factors (smoking, hypercholesterolemia, diabetes mellitus), as well as treat concomitant diseases. In young and middle-aged patients, as well as in patients with diabetes, if possible, blood pressure should be maintained at an “optimal” or “normal” level (up to 130/85 mm Hg). In elderly patients, blood pressure should be reduced to at least an “elevated normal” level (up to 140/90 mm Hg; see).
Table 2. Prognostic factors for arterial hypertension

A. Risk factors for cardiovascular disease
I. Used for risk assessment
. Levels of systolic and diastolic blood pressure (arterial hypertension of the 1st - 3rd degree)
. Men over 55 years old
. Women over 65 years old
. Smoking
. Serum total cholesterol level more than 6.5 mmol/l(250 mg/dl)
. Diabetes
. Indications of premature development of cardiovascular disease in a family history
II. Other factors that have an adverse effect for forecast
. Reduced levels of high lipoprotein cholesterol density
. Elevated lipoprotein cholesterol levels
low density
. Microalbuminuria (30 - 300 mg/day) in diabetes mellitus
. Impaired glucose tolerance
. Obesity
. Passive lifestyle
. Elevated fibrinogen levels
. High risk socioeconomic group
. High risk ethnic group
. High risk geographic region
B. Target organ damage
. Left ventricular hypertrophy (as determined by electrocardiography, echocardiography, or chest x-ray)
. Proteinuria (>300 mg/day) and/or a slight increase in plasma creatinine concentration (1.2-2.0 mg/dL)
. Ultrasound or X-ray angiographic signs of atherosclerotic lesions of the carotid,
iliac and femoral arteries, aorta
. Generalized or focal narrowing of the retinal arteries
C. Associated clinical conditions
Vascular disease of the brain
. Ischemic stroke
. Hemorrhagic stroke
. Transient cerebrovascular accident
Heart disease
. Myocardial infarction
. Angina pectoris
. Coronary artery revascularization
. Congestive heart failure
Kidney disease
. Diabetic nephropathy
. Renal failure (plasma creatinine levels greater than 2.0 mg/dL)
Vascular disease
. Dissecting aneurysm
. Arterial damage with clinical manifestations
Severe hypertensive retinopathy
. Hemorrhages or exudates
. Papilledema

Note. Target organ damage corresponds to stage II of hypertension according to the 1996 WHO expert classification, and concomitant clinical conditions correspond to stage III of the disease.

Thus, in groups of patients with high and very high risk, drug therapy should be started immediately. In the group of patients with average risk ( ) treatment of arterial hypertension begins with lifestyle changes. If non-drug interventions within 3-6 months do not lead to a decrease in blood pressure below 140/90 mm Hg. Art., it is recommended to prescribe antihypertensive drugs.
In the group of low-risk patients, treatment also begins with non-drug methods, but The observation period increases to 6-12 months. If after 6-12 months the blood pressure remains at 150/95 mm Hg. Art. or higher, begin drug therapy (regimen).
The intensity of antihypertensive therapy also depends on which risk group the patient belongs to. The higher the overall risk of cardiovascular complications, the more important it is to reduce blood pressure to an appropriate level ("optimal", "normal" or "elevated normal") and to combat other risk factors. As calculations show, with the same degree of arterial hypertension, the effectiveness of antihypertensive therapy in patients with high and very high risk is much higher than in patients with low risk. Thus, antihypertensive therapy, which reduces blood pressure by an average of 10/5 mm Hg. Art., allows you to prevent less than 5 serious cardiovascular complications per 1000 patient-years of treatment in patients with low risk and more than 10 complications in patients with very high risk.

Lifestyle change

Lifestyle changes should be recommended to all patients with hypertension, although there is currently no direct evidence that non-pharmacological interventions, by lowering blood pressure, reduce the risk of cardiovascular complications. In addition to lowering blood pressure, non-pharmacological methods have been shown to reduce the need for antihypertensive drugs and increase their effectiveness, as well as help combat other risk factors.
Table 3. Risk level of cardiovascular complications in patients with arterial hypertension of varying degrees in order to determine the prognosis*

Risk factors (other than hypertension) and medical history	Risk level for arterial hypertension
Risk factors (other than hypertension) and medical history	Stage 1 (mild hypertension) AD 140-159/90- 99 mmHg Art.
No other factors risk	Short	Average	High
1-2 other factors risk	Average	Average	Very high
3 or more others risk factors, POM or sugar diabetes	High	High	Very high
Related disease**	Very High	Very high	Very high
Typical examples of the risk of developing a cerebral stroke or heart attack over 10 years: low risk - less than 15%; average risk - approximately 15-20%; high risk - approximately 20-30%; very high risk - 30% or higher. . POM - target organ damage ( 2).

Quitting smoking is especially important. Smoking cessation appears to be the most effective non-pharmacological way to reduce the risk of cardiovascular and non-cardiovascular diseases in patients with arterial hypertension.
Obese patients should be advised to reduce body weight by at least 5 kg. This change in body weight not only causes a decrease in blood pressure, but also has a beneficial effect on other risk factors such as insulin resistance, diabetes mellitus, hyperlipidemia and left ventricular hypertrophy. The antihypertensive effect of weight loss is enhanced by simultaneously increasing physical activity and limiting the consumption of table salt and alcoholic beverages.
There is evidence that regular drinking of alcohol in moderation ( up to 3 glasses a day) reduces the risk of developing coronary heart disease (CHD). At the same time, a linear dependence of blood pressure levels (or the prevalence of arterial hypertension) in populations on the amount of alcohol consumed was discovered. It has been established that alcohol weakens the effects of antihypertensive therapy, and its pressor effect persists for 1 - 2 weeks. For this reason, patients with arterial hypertension who drink alcohol should be advised to limit their alcohol consumption (no more than 20-30 ml per day for men and no more than 10-20 ml per day for women). Patients who abuse alcohol should be advised of the high risk of developing a cerebral stroke.
The results of randomized studies have shown that reducing dietary sodium intake from 180 to 80-100 mmol per day leads to a decrease in systolic blood pressure by an average of 4-6 mmHg. Art. Even a small restriction of sodium intake from food (by 40 mmol per day) significantly reduces the need for antihypertensive drugs. drugs. Patients with arterial hypertension should be advised to limit their dietary sodium intake to less than 100 mmol per day, which corresponds to less than 6 g of table salt per day.

Patients with arterial hypertension should reduce the consumption of meat and fatty foods and at the same time increase the consumption of fish, fruits and vegetables. Patients leading a sedentary lifestyle should be recommended regular physical exercise in the open air (30-45 minutes 3-4 times a week). Brisk walking and swimming are more effective than running and reduce systolic blood pressure by approximately 4-8 mmHg. Art. In contrast, isometric exercise (eg, weight lifting) may increase blood pressure.

Drug therapy

The main antihypertensive drugs are diuretics, b -adrenergic blockers, calcium antagonists, angiotensin converting enzyme (ACE) inhibitors, AT blockers 1 -angiotensin receptors and a 1 - adrenergic blockers. In some countries of the world, reserpine and methyldopa are often used in the treatment of arterial hypertension.
Different classes of antihypertensive drugs reduce blood pressure to approximately the same extent, but differ in the nature of side effects.
Table 4. Recommendations for the selection of antihypertensive drugs

Group of drugs	Indications		Contraindications
Group of drugs	Mandatory	Possible	mandatory	possible
Diuretics	Heart failure Accuracy + Elderly age + Systolic hypertension	Diabetes	Gout	Dyslipidemia Sexually active men
b -Blockers	Angina + After myocardial infarction + tachyarrhythmias	Heart failure accuracy + Pregnant- ness + Sugar di- abeth	Bronchial asthma and chronic ob- structural disease Pulmonary obstruction + Heart block*	Dyslipidemia + Athletes and physical chesically active patients + lesion peripheral arterial therium
ACE inhibitors	Heart failure accuracy + Dysfunction- tion of the left ventricle ka + After a heart attack myocardium + Diabetic nephropathy		Pregnancy + Hyperkalemia	Double-sided glass renal arterial disease riy
Calcium antagonists tion	Angina + Life- age + Systo- personal hypertension(****)	Peripheral damage rical arteries	Heart block**	Congestive heart failure***
a1-blockers	Hypertrophy pre- static gland	Violation of tolerance affinity for glucose + Dyslipidemia		Orthostatic hy- potonia
AT blockers 1 - Angiotensin receptors	Cough, called ACE inhibitors	Heart failure- Accuracy	Pregnancy + Double-sided glass renal arterial disease rium + Hyperkalemia
* Atrioventricular block II - III degree. Atrioventricular block II - III degree during treatment with verapamil or diltiazem. * For verapamil or diltiazem. ****In fact, in patients with isolated systolic hypertension, only dihydropyridine calcium antagonists and, in particular, nitrendipine have been found to have a beneficial effect. As for verapamil and diltiazem, their effectiveness and safety in isolated systolic hypertension, to our knowledge, have not been studied in controlled studies. (Note from the authors).

Several dozen randomized controlled studies have proven the ability of long-term therapy with diuretics and beta-blockers to prevent cardiovascular complications in patients with arterial hypertension. There is much less evidence of a beneficial effect of calcium antagonists and ACE inhibitors on long-term prognosis. There is not yet sufficiently convincing evidence that a 1 - adrenergic blockers and AT blockers 1 -angiotensin receptors may improve long-term prognosis in patients with arterial hypertension. However, it is assumed that in patients with arterial hypertension, the beneficial effect of antihypertensive therapy on prognosis depends mainly on the degree of blood pressure reduction achieved, and not on the class of drug.
Each of the main classes of antihypertensive drugs has certain advantages and disadvantages that must be taken into account when choosing a drug for initial therapy ().
For initial treatment, low doses of antihypertensive drugs are recommended to minimize side effects. In cases where a low dose of the first drug produces a good antihypertensive effect, it is advisable to increase the dose of this drug to reduce blood pressure to the desired level. If the first antihypertensive drug is ineffective or poorly tolerated, its dose should not be increased, but another drug with a different mechanism of action should be added. You can also replace one drug with another.

Abbreviations: SBP - systological blood pressure; DBP - diastolic blood pressure;
AH - arterial hypertension;
POM - target organ damage; SCS - associated clinical conditions

In the HOT (Hypertension Optimal Treatment) study, a stepwise regimen for prescribing antihypertensive drugs worked well. For initial therapy, a prolonged form of the calcium antagonist felodipine was used at a dose of 5 mg/day. At the second step, an ACE inhibitor or b was added to felodipine retard - adrenergic blocker. At the third stage, the daily dose of felodipine retard was increased to 10 mg. At the fourth stage, the dose of the ACE inhibitor was doubled or b-adrenergic blocker, and on the fifth, a diuretic was added if necessary.
It is best to use long-acting antihypertensive drugs that provide 24-hour blood pressure control when taken once a day. Examples of long-acting antihypertensive drugs include: b -adrenergic blockers such as betaxolol and metoprolol retard, ACE inhibitors such as perindopril, trandolapril and fosinopril, calcium antagonists such as amlodipine, verapamil and felodipine retard, AT blockers 1-angiotensin receptors, like valsartan and irbesartan. Monitors blood pressure a 1 for 24 hours - long-acting adrenergic blocker doxazosin.
The advantages of long-acting drugs are that they improve the adherence of patients with arterial hypertension to treatment and reduce fluctuations in blood pressure during the day. It is believed that antihypertensive therapy,which provides a more uniform reduction in blood pressure throughout the day, more effectively prevents the development of cardiovascular complications and target organ damage in patients with arterial hypertension.
Diuretics . Diuretics remain one of the most valuable classes of antihypertensive drugs. They are significantly cheaper than other classes of antihypertensive drugs. Diuretics are highly effective and generally well tolerated when administered in low doses (not more than 25 mg of hydrochlorothiazide or equivalent doses of other drugs). Controlled studies have demonstrated the ability of diuretics to prevent serious cardiovascular complications such as cerebral stroke and coronary artery disease. In the 5-year randomized SHEP trial (S y stolic Hypertension in the Elderly Program), in which chlorthalidone was used for initial therapy, the incidence of cerebral stroke and coronary complications in the study group was 36 and 27% lower, respectively, than in the control group. That's why It is believed that diuretics are particularly indicated for the treatment of elderly patients with isolated systolic hypertension.
b -Adrenergic blockers . b -Adrenergic blockers are inexpensive, effective and safe antihypertensive drugs. They can be used both for monotherapy of arterial hypertension and in combination with diuretics, dihydropyridine calcium antagonists and a-blockers. Although heart failure is certainly a contraindication to the use of beta-blockers at usual doses, there is evidence to support the beneficial effects of some beta-blockers (particularly bisoprolol, carvedilol and metoprolol) in some patients with heart failure when used at very low levels at the start of therapy. doses Should not be prescribed b - adrenergic blockers for patients with chronic obstructive pulmonary diseases and damage to peripheral arteries.
ACE inhibitors. ACE inhibitors are effective and safe antihypertensive drugs, the cost of which has decreased significantly in recent years. The effectiveness and safety of ACE inhibitors such as captopril, lisinopril, enalapril, ramipril, fosinopril have been best studied in randomized studies. It has been established that ACE inhibitors are especially effective in reducing mortality in patients with heart failure and preventing the progression of nephropathy in patients with insulin-dependent diabetes mellitus (type I). The most common side effect of ACE inhibitors is a dry cough, the most dangerous is angioedema, which, however, is extremely rare.
Calcium antagonists. All calcium antagonists have high antihypertensive efficacy and good tolerability. The ability of calcium antagonists (in particular, nitrendipine) to prevent the development of cerebral stroke in elderly patients with isolated systolic hypertension has been proven. Long-acting calcium antagonists (eg amlodipine, verapamil and felodipine retard) should be used preferentially and short-acting drugs should be avoided if possible.
AT blockers 1 -angiotensin receptors. AT blockers 1 -angiotensin receptors have many properties that make them similar to ACE inhibitors. In particular, they, like ACE inhibitors, are especially useful in patients with heart failure. The advantage of AT blockers 1 -angiotensin receptors (for example, such as valsartan, irbesartan, losartan, etc.) before ACE inhibitors is a low incidence of side effects. For example, they do not cause coughing. There is not yet sufficient evidence of the ability of AT blockers 1 -angiotensin receptors reduce the increased risk of cardiovascular complications in patients with arterial hypertension.
a 1 -Adrenergic blockers. a 1 -Adrenergic blockers are effective and safe antihypertensive drugs, but so far there has been no sufficient evidence of their ability to prevent the development of cardiovascular complications in patients with arterial hypertension. Main side effect a 1 -adrenergic blockers - orthostatic hypotension, which is especially pronounced in elderly patients. Therefore, at the beginning of treatment a 1-adrenergic blockers, it is important to measure blood pressure in the patient’s position, not only sitting, but also standing. a 1 -Adrenergic blockers may be useful in the treatment of hypertension in patients with dyslipidemia or impaired glucose tolerance. When treating a 1 -Adrenergic blockers should be given preference to doxazosin, the antihypertensive effect of which lasts up to 24 hours after oral administration, over short-acting prazosin.

Antiplatelet and hypocholesterolemic therapy

Considering that in patients with arterial hypertension, the high overall risk of cardiovascular complications is associated not only with elevated blood pressure, but also with other factors, it is not enough to use only antihypertensive drugs to reduce the risk.
The randomized HOT trial showed that in patients with hypertension receiving effective antihypertensive therapy, the addition of low doses aspirin(75 mg/day) can significantly reduce the risk of serious cardiovascular complications (by 15%), including myocardial infarction (by 36%).
A number of randomized studies have established the high effectiveness of cholesterol-lowering drugs from the group of statins in the primary and secondary prevention of coronary artery disease in people with different levels of cholesterol in the blood. The effectiveness and safety of long-term administration of statins such as lovastatin, pravastatin and simvastatin have been most well studied. The use of atorvastatin and cerivastatin, which are superior to other statins in terms of the severity of their hypocholesterolemic effect, seems promising.
The data obtained in these studies allow us to recommend the use of aspirin and statins (in combination with antihypertensive drugs) in the treatment of patients with arterial hypertension and a high risk of developing coronary artery disease. Thus, the new WHO-IOG recommendations for the treatment of arterial hypertension propose slightly different approaches to the assessment and management of patients with high blood pressure than in the recommendations of 1993. WHO-IOG experts draw attention to the importance of assessing the overall cardiovascular risk in patients with arterial hypertension. -vascular complications, and not just the condition of target organs. In this regard, treatment should be aimed at both reducing high blood pressure and other modifiable risk factors. The goal of antihypertensive therapy has been determined, which is to maintain blood pressure below 130/85 mm Hg. Art. in young and middle-aged patients and those suffering from diabetes mellitus and at levels below 140/90 mmHg. Art. in elderly patients. Blockers
AT 1 -angiotensin receptors are included in the number of first-line drugs for the treatment of arterial hypertension.

The word “hypertension” means that the human body had to increase blood pressure for some purpose. Depending on the conditions that can cause this condition, there are types of hypertension, and each of them is treated in its own way.

Classification of arterial hypertension, taking into account only the cause of the disease:

Its cause cannot be identified by examining those organs whose disease requires the body to increase blood pressure. It is because of an unclear reason that it is called essential or idiopathic(both terms translate as "unclear cause"). Domestic medicine calls this type of chronic increase in blood pressure hypertension. Due to the fact that this disease will have to be reckoned with all your life (even after the pressure returns to normal, you will need to follow certain rules so that it does not increase again), in popular circles it is called chronic hypertension, and it is this that is divided into the degrees, stages and risks discussed below.
- one for which the cause can be identified. It has its own classification - according to the factor that “triggered” the mechanism of increasing blood pressure. We'll talk about this below.

Both primary and secondary hypertension are divided according to the type of increase in blood pressure. So, hypertension can be:

There is also a classification based on the nature of the disease. It divides both primary and secondary hypertension into:

According to another definition, malignant hypertension is an increase in blood pressure to 220/130 mmHg. Art. and more, when the ophthalmologist detects grade 3-4 retinopathy in the fundus (hemorrhages, retinal edema or optic nerve edema and vasoconstriction, and a kidney biopsy diagnoses “fibrinoid arteriolonecrosis.”

Symptoms of malignant hypertension are headaches, spots before the eyes, pain in the heart, and dizziness.

Before this we wrote “upper”, “lower”, “systolic”, “diastolic” pressure, what does this mean?

Systolic (or “upper”) pressure is the force with which blood presses on the walls of large arterial vessels (that’s where it is thrown out) during compression of the heart (systole). Essentially, these arteries, with a diameter of 10-20 mm and a length of 300 mm or more, must “squeeze” the blood that is thrown into them.

Only systolic pressure increases in two cases:

when the heart pumps out a large amount of blood, which is typical for hyperthyroidism, a condition in which the thyroid gland produces an increased amount of hormones that cause the heart to contract strongly and frequently;
when the elasticity of the aorta is reduced, which is observed in older people.

Diastolic (“lower”) is the pressure of fluid on the walls of large arterial vessels that occurs during relaxation of the heart - diastole. In this phase of the cardiac cycle, the following occurs: large arteries must transfer the blood entering them during systole to arteries and arterioles of smaller diameter. After this, the aorta and large arteries need to prevent overload of the heart: while the heart relaxes, accepting blood from the veins, the large vessels must have time to relax in anticipation of its contraction.

The level of arterial diastolic pressure depends on:

The tone of such arterial vessels (according to Tkachenko B.I. “ Normal human physiology." - M, 2005), which are called vessels of resistance:
- mainly those that have a diameter of less than 100 micrometers, arterioles are the last vessels before the capillaries (these are the smallest vessels from where substances penetrate directly into the tissues). They have a muscular layer of circular muscles, which are located between various capillaries and are a kind of “faucets”. Switching these “faucets” determines which part of the organ will now receive more blood (that is, nutrition), and which will receive less;
- to a small extent, the tone of the medium and small arteries (“distribution vessels”), which carry blood to the organs and are located inside the tissues, plays a role;
Heart contraction rates: if the heart contracts too often, the vessels do not yet have time to deliver one portion of blood before the next one arrives;
The amount of blood that is included in the blood circulation;
Blood viscosity.

Isolated diastolic hypertension is very rare, mainly in diseases of the resistance vessels.

Most often, both systolic and diastolic pressure increase. This happens as follows:

When the heart begins to work against increased pressure, pushing blood into vessels with a thickened muscle wall, its muscle layer also increases (this is a common property for all muscles). This is called hypertrophy, and affects mainly the left ventricle of the heart, because it communicates with the aorta. There is no concept of “left ventricular hypertension” in medicine.

Primary arterial hypertension

The official widespread version says that the causes of primary hypertension cannot be found out. But physicist V.A. Fedorov and a group of doctors explained the increase in pressure by the following factors:

Carefully studying the mechanisms of the body, V.A. Fedorov with the doctors we saw that the vessels cannot nourish every cell of the body - after all, not all cells are close to the capillaries. They realized that cell nutrition is possible thanks to microvibration - a wave-like contraction of muscle cells, which make up more than 60% of body weight. These, described by academician Arinchin N.I., ensure the movement of substances and the cells themselves in the aqueous environment of the intercellular fluid, making it possible to provide nutrition, remove waste substances during the life process, and carry out immune reactions. When microvibration in one or several areas becomes insufficient, a disease occurs.

In their work, muscle cells that create microvibration use electrolytes present in the body (substances that can conduct electrical impulses: sodium, calcium, potassium, some proteins and organic substances). The balance of these electrolytes is maintained by the kidneys, and when the kidneys become diseased or the volume of working tissue in them decreases with age, microvibration begins to be lacking. The body tries as best it can to eliminate this problem by increasing blood pressure so that more blood flows to the kidneys, but because of this the whole body suffers.

Microvibration deficiency can lead to the accumulation of damaged cells and decay products in the kidneys. If they are not removed from there for a long time, they are transferred to the connective tissue, that is, the number of working cells decreases. Accordingly, the performance of the kidneys decreases, although their structure does not suffer.

The kidneys themselves do not have their own muscle fibers and receive microvibration from neighboring working muscles of the back and abdomen. Therefore, physical activity is necessary primarily to maintain the tone of the muscles of the back and abdomen, which is why correct posture is necessary even in a sitting position. According to V.A. Fedorov, “constant tension of the back muscles with correct posture significantly increases the saturation of internal organs with microvibration: kidneys, liver, spleen, improving their functioning and increasing the body’s resources. This is a very important circumstance that increases the importance of posture.” (" - Vasiliev A.E., Kovelenov A.Yu., Kovlen D.V., Ryabchuk F.N., Fedorov V.A., 2004)

A way out of the situation may be to provide additional microvibration (optimally in combination with thermal effects) to the kidneys: their nutrition is normalized, and they return the electrolyte balance of the blood to the “original settings.” Hypertension is thus resolved. At its initial stage, such treatment is enough to naturally lower blood pressure, without taking additional medications. If a person’s disease has “progressed far” (for example, it is grade 2-3 and the risk is 3-4), then the person may not be able to cope without taking medications prescribed by a doctor. At the same time, the message of additional microvibration will help reduce the doses of medications taken, and therefore reduce their side effects.

in 1998 - at the Military Medical Academy named after. S.M.Kirova, St. Petersburg (“ . »)
in 1999 - on the basis of the Vladimir Regional Clinical Hospital (“ " And " »);
in 2003 - at the Military Medical Academy named after. CM. Kirov, St. Petersburg (“ . »);
in 2003 - on the basis of the State Medical Academy named after. I.I. Mechnikova, St. Petersburg (“ . »)
in 2009 - in the boarding house for labor veterans No. 29 of the Department of Social Protection of the Population of Moscow, Moscow Clinical Hospital No. 83, clinic of the Federal State Medical Center named after. Burnazyan FMBA of Russia (“” Dissertation of candidate of medical sciences Svizhenko A. A., Moscow, 2009).

Types of secondary arterial hypertension

Secondary arterial hypertension occurs:

(arising from a disease of the nervous system). It is divided into:
- centrogenic – it occurs due to disturbances in the functioning or structure of the brain;
- reflexogenic (reflex): in a certain situation or with constant irritation of the organs of the peripheral nervous system.
(endocrine).
– occurring when organs such as the spinal cord or brain suffer from a lack of oxygen.
, it also has its division into:
- renovascular, when the arteries that bring blood to the kidneys narrow;
- renoparenchymatous, associated with damage to kidney tissue, which is why the body needs to increase blood pressure.
(caused by blood diseases).
(due to a change in the “route” of blood movement).
(when it was caused by several reasons).

Let's tell you a little more.

The main command to large vessels, causing them to contract, increasing blood pressure, or relax, decreasing it, comes from the vasomotor center, which is located in the brain. If its work is disrupted, centrogenic hypertension develops. This can happen due to:

Neuroses, that is, diseases when the structure of the brain does not suffer, but under the influence of stress a focus of excitation is formed in the brain. It involves the main structures that “include” an increase in pressure;
Brain damage: injuries (concussions, bruises), brain tumors, stroke, inflammation of the brain (encephalitis). To increase blood pressure you must:

or structures that directly affect blood pressure are damaged (the vasomotor center in the medulla oblongata or the associated hypothalamic nuclei or reticular formation);
or extensive brain damage may occur with increased intracranial pressure, when in order to ensure blood supply to this vital organ the body will need to increase blood pressure.

Reflex hypertension is also classified as neurogenic. They can be:

conditioned reflex, when at first there is a combination of some event with taking a medicine or drink that increases blood pressure (for example, if a person drinks strong coffee before an important meeting). After many repetitions, the pressure begins to rise only at the very thought of a meeting, without drinking coffee;
unconditioned reflex, when the pressure increases after the cessation of long-term constant impulses from inflamed or pinched nerves to the brain (for example, if a tumor that was pressing on the sciatic or any other nerve was removed).

Endocrine (hormonal) hypertension

These are secondary hypertension, the causes of which are diseases of the endocrine system. They are divided into several types.

Adrenal hypertension

These glands, located above the kidneys, produce a large number of hormones that can affect vascular tone and the strength or frequency of heart contractions. Increased blood pressure can be caused by:

Excessive production of adrenaline and norepinephrine, which is typical for a tumor such as pheochromocytoma. Both of these hormones simultaneously increase the strength and frequency of heart contractions and increase vascular tone;
A large amount of the hormone aldosterone, which does not release sodium from the body. This element, appearing in the blood in large quantities, “attracts” water from the tissues. Accordingly, the amount of blood increases. This happens with a tumor that produces it - malignant or benign, with non-tumor growth of the tissue that produces aldosterone, as well as with stimulation of the adrenal glands in severe diseases of the heart, kidneys, and liver.
Increased production of glucocorticoids (cortisone, cortisol, corticosterone), which increase the number of receptors (that is, special molecules on the cell that act as a “lock” that can be opened with a “key”) for adrenaline and norepinephrine (they will be the necessary “key” for “ castle") in the heart and blood vessels. They also stimulate the liver to produce the hormone angiotensinogen, which plays a key role in the development of hypertension. An increase in the amount of glucocorticoids is called Cushing's syndrome and disease (a disease when the pituitary gland commands the adrenal glands to produce a large amount of hormones, a syndrome when the adrenal glands are affected).

Hyperthyroid hypertension

It is associated with excessive production of the thyroid hormones – thyroxine and triiodothyronine. This leads to an increase in heart rate and the amount of blood ejected by the heart per beat.

The production of thyroid hormones can increase with autoimmune diseases such as Graves' disease and Hashimoto's thyroiditis, with inflammation of the gland (subacute thyroiditis), and some of its tumors.

Excessive release of antidiuretic hormone by the hypothalamus

This hormone is produced in the hypothalamus. Its second name is vasopressin (translated from Latin as “squeezing blood vessels”), and it acts in this way: by binding to receptors on the vessels inside the kidney, it causes them to narrow, resulting in less urine being produced. Accordingly, the volume of liquid in the vessels increases. More blood flows to the heart - it stretches more. This leads to increased blood pressure.

Hypertension can also be caused by an increase in the body's production of active substances that increase vascular tone (these are angiotensins, serotonin, endothelin, cyclic adenosine monophosphate) or a decrease in the amount of active substances that should dilate blood vessels (adenosine, gamma-aminobutyric acid, nitric oxide, some prostaglandins).

The decline of the function of the gonads is often accompanied by a constant increase in blood pressure. The age at which each woman enters menopause is different (it depends on genetic characteristics, living conditions and the state of the body), but German doctors have proven that the age over 38 years is dangerous for the development of arterial hypertension. It is after 38 years that the number of follicles (from which eggs are formed) begins to decrease not by 1-2 every month, but by dozens. A decrease in the number of follicles leads to a decrease in the production of hormones by the ovaries, as a result of which vegetative (sweating, paroxysmal feeling of heat in the upper body) and vascular (redness of the upper half of the body during a hot attack, increased blood pressure) disorders develop.

Hypoxic hypertension

They develop when blood supply to the medulla oblongata, where the vasomotor center is located, is disrupted. This is possible with atherosclerosis or thrombosis of the vessels carrying blood to it, as well as with compression of the vessels due to edema and hernias.

Renal hypertension

As already mentioned, there are 2 types of them:

Vasorenal (or renovascular) hypertension

It is caused by deterioration of the blood supply to the kidneys due to narrowing of the arteries supplying the kidneys. They suffer from the formation of atherosclerotic plaques in them, an increase in the muscle layer in them due to a hereditary disease - fibromuscular dysplasia, aneurysm or thrombosis of these arteries, aneurysm of the renal veins.

The disease is based on activation of the hormonal system, which causes blood vessels to spasm (contract), sodium retention occurs, and fluid in the blood increases, and the sympathetic nervous system is stimulated. The sympathetic nervous system, through its special cells located on the vessels, activates their even greater compression, which leads to an increase in blood pressure.

Renoparenchymal hypertension

It accounts for only 2-5% of hypertension cases. It occurs due to diseases such as:

With any of these diseases, the number of nephrons (the main working units of the kidneys through which blood is filtered) decreases. The body tries to correct the situation by increasing the pressure in the arteries that carry blood to the kidneys (the kidneys are an organ for which blood pressure is very important; if the pressure is low, they stop working).

Drug-induced hypertension

The following drugs can cause increased blood pressure:

vasoconstrictor drops used for a runny nose;
tablet contraceptives;
antidepressants;
painkillers;
drugs based on glucocorticoid hormones.

Hemic hypertension

Due to an increase in blood viscosity (for example, in Vaquez disease, when the number of all its cells in the blood increases) or an increase in blood volume, blood pressure may increase.

Hemodynamic hypertension

This is the name for hypertension, which is based on changes in hemodynamics - that is, the movement of blood through the vessels, usually as a result of diseases of large vessels.

The main disease causing hemodynamic hypertension is coarctation of the aorta. This is a congenital narrowing of the aorta in its thoracic (located in the chest cavity) section. As a result, in order to ensure normal blood supply to the vital organs of the thoracic cavity and cranial cavity, blood must reach them through rather narrow vessels that are not designed for such a load. If the blood flow is large and the diameter of the vessels is small, the pressure in them will increase, which is what happens with coarctation of the aorta in the upper half of the body.

The body needs the lower extremities less than the organs of the indicated cavities, so the blood reaches them “not under pressure.” Therefore, such a person’s legs are pale, cold, thin (the muscles are poorly developed due to insufficient nutrition), and the upper half of the body has an “athletic” appearance.

Alcoholic hypertension

How ethyl alcohol-based drinks cause increased blood pressure is still unclear to scientists, but 5-25% of people who regularly drink alcohol have increased blood pressure. There are theories suggesting that ethanol may affect:

through increased activity of the sympathetic nervous system, which is responsible for vasoconstriction and increased heart rate;
by increasing the production of glucocorticoid hormones;
due to the fact that muscle cells more actively absorb calcium from the blood, and are therefore in a state of constant tension.

Mixed hypertension

When any provoking factors are combined (for example, kidney disease and taking painkillers), they add up (summation).

Certain types of hypertension that are not included in the classification

There is no official concept of “juvenile hypertension”. Increased blood pressure in children and adolescents is mainly of a secondary nature. The most common causes of this condition are:

Congenital malformations of the kidneys.
Congenital narrowing of the diameter of the renal arteries.
Pyelonephritis.
Glomerulonephritis.
Cyst or polycystic kidney disease.
Kidney tuberculosis.
Kidney injury.
Coarctation of the aorta.
Essential hypertension.
Wilms tumor (nephroblastoma) is an extremely malignant tumor that develops from kidney tissue.
Lesions of either the pituitary gland or the adrenal glands, resulting in a lot of glucocorticoid hormones in the body (Itsenko-Cushing syndrome and disease).
Thrombosis of arteries or veins of the kidneys
Narrowing of the diameter (stenosis) of the renal arteries due to a congenital increase in the thickness of the muscular layer of the vessels.
Congenital disorder of the adrenal cortex, the hypertensive form of this disease.
Bronchopulmonary dysplasia is damage to the bronchi and lungs by air blown into the ventilator, which was connected to resuscitate the newborn.
Pheochromocytoma.
Takayasu's disease is a lesion of the aorta and large branches extending from it due to an attack on the walls of these vessels by one's own immunity.
Periarteritis nodosa is an inflammation of the walls of small and medium-sized arteries, resulting in the formation of saccular protrusions - aneurysms.

Pulmonary hypertension is not a type of arterial hypertension. This is a life-threatening condition in which the pressure in the pulmonary artery increases. This is the name of the 2 vessels into which the pulmonary trunk (the vessel emanating from the right ventricle of the heart) is divided. The right pulmonary artery carries oxygen-poor blood to the right lung, the left - to the left.

Pulmonary hypertension develops most often in women 30-40 years old and, gradually progressing, is a life-threatening condition, leading to disruption of the right ventricle and premature death. It occurs due to hereditary causes, connective tissue diseases, and heart defects. In some cases, its cause cannot be determined. Manifested by shortness of breath, fainting, fatigue, dry cough. In severe stages, the heart rhythm is disturbed and hemoptysis appears.

Stages, degrees and risk factors

In order to select treatment for people suffering from hypertension, doctors came up with a classification of hypertension according to stages and degrees. We will present it in the form of tables.

Stages of hypertension

The stages of hypertension indicate how much the internal organs have suffered from constantly increased pressure:

	Damage to target organs, which include the heart, blood vessels, kidneys, brain, retina
	The heart, blood vessels, kidneys, eyes, brain are not yet affected
	According to ultrasound of the heart, either the relaxation of the heart is impaired, or the left atrium is enlarged, or the left ventricle is narrower; The kidneys work worse, which is noticeable so far only in urine and blood creatinine tests (the test for kidney waste is called “Blood Creatinine”); vision has not yet become worse, but when examining the fundus of the eye, the ophthalmologist already sees a narrowing of the arterial vessels and an expansion of the venous vessels.
	One of the complications of hypertension has developed: heart failure, manifested either by shortness of breath, or swelling (in the legs or throughout the body), or both of these symptoms; coronary heart disease: either angina pectoris or myocardial infarction; severe damage to the vessels of the retina, due to which vision suffers.

Damage to target organs, which include the heart, blood vessels, kidneys, brain, retina

The heart, blood vessels, kidneys, eyes, brain are not yet affected

According to ultrasound of the heart, either the relaxation of the heart is impaired, or the left atrium is enlarged, or the left ventricle is narrower;
The kidneys work worse, which is noticeable so far only in urine and blood creatinine tests (the test for kidney waste is called “Blood Creatinine”);
vision has not yet become worse, but when examining the fundus of the eye, the ophthalmologist already sees a narrowing of the arterial vessels and an expansion of the venous vessels.

One of the complications of hypertension has developed:

heart failure, manifested either by shortness of breath, or swelling (in the legs or throughout the body), or both of these symptoms;
coronary heart disease: either angina pectoris or myocardial infarction;
severe damage to the vessels of the retina, due to which vision suffers.

Blood pressure figures at any stage are above 140/90 mmHg. Art.

Treatment of the initial stage of hypertension is mainly aimed at changing lifestyle: including mandatory in the daily routine. Whereas stage 2 and 3 hypertension should already be treated using. Their dose and, accordingly, side effects can be reduced if you help the body restore blood pressure naturally, for example, by giving it additional help.

Degrees of hypertension

The degrees of development of hypertension indicate how high the blood pressure is:

The degree is established without taking blood pressure-lowering drugs. To do this, a person who is forced to take medications that lower blood pressure needs to reduce their dose or completely stop it.

The degree of hypertension is judged by the number of the pressure (“upper” or “lower”), which is greater.

Sometimes grade 4 hypertension is classified. It is treated as isolated systolic hypertension. In any case, we mean a condition when only the upper pressure is increased (above 140 mm Hg), while the lower pressure is within normal limits - up to 90 mm Hg. This condition is most often recorded in older people (associated with decreased elasticity of the aorta). Occurring in young people, isolated systolic hypertension indicates that the thyroid gland needs to be examined: this is how hyperthyroidism “behaves” (an increase in the amount of thyroid hormones produced).

Definition of risk

There is also a classification according to risk groups. The higher the number indicated after the word “risk,” the higher the likelihood that a dangerous disease will develop in the coming years.

There are 4 risk levels:

At risk 1 (low), the probability of developing a stroke or heart attack in the next 10 years is less than 15%;
With risk 2 (average), this probability in the next 10 years is 15-20%;
At risk 3 (high) – 20-30%;
At risk 4 (very high) – more than 30%.

Risk factor	Criterion
Arterial hypertension	Systolic pressure >140 mm Hg. and/or diastolic pressure > 90 mm Hg. Art.
	More than 1 cigarette per week
Impaired fat metabolism (according to Lipidogram analysis)	total cholesterol ≥ 5.2 mmol/L or 200 mg/dL; low-density lipoprotein cholesterol (LDL-C) ≥ 3.36 mmol/l or 130 mg/dl; high-density lipoprotein cholesterol (HDL-C) less than 1.03 mmol/l or 40 mg/dl; triglycerides (TG) > 1.7 mmol/l or 150 mg/dl
Increased fasting glucose (based on blood sugar test)	Fasting plasma glucose 5.6-6.9 mmol/l or 100-125 mg/dl Glucose 2 hours after taking 75 grams of glucose – less than 7.8 mmol/L or less than 140 mg/dL
Low glucose tolerance (digestibility)	Fasting plasma glucose less than 7 mmol/L or 126 mg/dL 2 hours after taking 75 grams, glucose is more than 7.8 but less than 11.1 mmol/l (≥140 and<200 мг/дл)
Cardiovascular diseases in close relatives	They are taken into account in men under 55 years of age and women under 65 years of age
Obesity (it is assessed by the Quetelet index, I I=body weight/height in meters* height in meters. Norm I = 18.5-24.99; Pre-obesity I = 25-30)	Obesity of the first degree, where the Quetelet index is 30-35; II degree 35-40; III degree 40 or more.

To assess the risk, target organ damage is also assessed, which is either present or absent. Target organ damage is assessed by:

hypertrophy (enlargement) of the left ventricle. It is assessed by electrocardiogram (ECG) and cardiac ultrasound;
kidney damage: for this, the presence of protein is assessed in a general urine test (normally it should not be present), as well as blood creatinine (normally it should be less than 110 µmol/l).

The third criterion that is assessed to determine the risk factor is concomitant diseases:

Diabetes mellitus: it is diagnosed if fasting plasma glucose is more than 7 mmol/l (126 mg/dl), and 2 hours after taking 75 g of glucose - more than 11.1 mmol/l (200 mg/dl);
Metabolic syndrome. This diagnosis is established if there are at least 3 criteria from the following, and body weight is necessarily considered one of them:

HDL cholesterol less than 1.03 mmol/l (or less than 40 mg/dl);
systolic blood pressure more than 130 mm Hg. Art. and/or diastolic pressure greater than or equal to 85 mm Hg. Art.;
glucose more than 5.6 mmol/l (100 mg/dl);
waist circumference in men is more than or equal to 94 cm, in women – more than or equal to 80 cm.

Setting the risk level:

Risk level	Diagnosis criteria
	These are men and women under 55 years of age who, apart from high blood pressure, have no other risk factors, no target organ damage, or concomitant diseases
	Men over 55 years old, women over 65 years old. There are 1-2 risk factors (including arterial hypertension). No target organ damage
	3 or more risk factors, target organ damage (left ventricular hypertrophy, kidney or retinal damage), or diabetes mellitus, or ultrasound detected atherosclerotic plaques in any arteries
	Have diabetes, angina or metabolic syndrome. It was one of the following: angina pectoris; suffered a myocardial infarction; suffered a stroke or micro-stroke (when a blood clot temporarily blocked an artery in the brain and then dissolved or was eliminated by the body); heart failure; chronic renal failure; peripheral vascular disease; the retina is damaged; an operation was performed to restore blood circulation to the heart

There is no direct connection between the degree of pressure increase and the risk group, but at a high stage the risk will be high. For example, there may be hypertension Stage 1, degree 2, risk 3(that is, there is no damage to target organs, pressure is 160-179/100-109 mm Hg, but the probability of heart attack/stroke is 20-30%), and this risk can be either 1 or 2. But if stage 2 or 3, then the risk cannot be lower than 2.

Examples and interpretation of diagnoses - what do they mean?

What it is - hypertension stage 2, degree 2, risk 3?:

blood pressure 160-179/100-109 mmHg. Art.
there are heart problems, determined by ultrasound of the heart, or there is a disorder of the kidneys (according to tests), or there is a disorder in the fundus, but there is no visual impairment;
there may be either diabetes mellitus, or atherosclerotic plaques are found in some vessel;
in 20-30% of cases, either a stroke or a heart attack will develop in the next 10 years.

Stage 3, degree 2, risk 3? Here, in addition to the parameters indicated above, there are also complications of hypertension: angina pectoris, myocardial infarction, chronic heart or renal failure, damage to retinal vessels.

Hypertonic disease 3 degrees 3 stages risk 3- everything is the same as for the previous case, only the blood pressure numbers are more than 180/110 mm Hg. Art.

What is hypertension Stage 2, degree 2, risk 4? Blood pressure 160-179/100-109 mmHg. Art., target organs are affected, there is diabetes mellitus or metabolic syndrome.

It even happens when 1st degree hypertension, when the pressure is 140-159/85-99 mm Hg. Art., already available Stage 3, that is, life-threatening complications developed (angina pectoris, myocardial infarction, heart or kidney failure), which, together with diabetes mellitus or metabolic syndrome, caused risk 4.

This does not depend on how much the blood pressure increases (the degree of hypertension), but on what complications the persistently high blood pressure caused:

Stage 1 hypertension

In this case, there is no damage to target organs, so disability is not given. But the cardiologist gives recommendations to the person, which he must take to the workplace, where it is written that he has certain restrictions:

Heavy physical and emotional stress is contraindicated;
You cannot work the night shift;
work in conditions of intense noise and vibration is prohibited;
You cannot work at height, especially when a person is servicing electrical networks or electrical units;
You cannot perform those types of work in which a sudden loss of consciousness can create an emergency situation (for example, public transport drivers, crane operators);
those types of work in which there is a change in temperature conditions are prohibited (bathhouse attendants, physiotherapists).

Stage 2 hypertension

In this case, target organ damage is implied, which worsens the quality of life. Therefore, at the VTEK (MSEC) - medical labor or health expert commission - he is given disability group III. At the same time, the restrictions that are indicated for stage 1 of hypertension remain the same. A working day for such a person can be no more than 7 hours.

To obtain disability you need:

submit an application addressed to the chief physician of the medical institution where MSEC is carried out;
receive a referral to a commission at the clinic at your place of residence;
confirm the group annually.

Stage 3 hypertension

Diagnosis of hypertension 3 stages, no matter how high the pressure is - 2 degrees or more, implies damage to the brain, heart, eyes, kidneys (especially if there is a combination with diabetes mellitus or metabolic syndrome, which gives it risk 4), which significantly limits the ability to work. Because of this, a person can receive II or even I group disability.

Let's consider the “relationship” between hypertension and the army, regulated by Decree of the Government of the Russian Federation of July 4, 2013 N 565 “On approval of the Regulations on military medical examination”, Article 43:

Are they recruited into the army with hypertension if the increase in blood pressure is associated with disorders of the autonomic (which controls the internal organs) nervous system: sweating of the hands, variability of pulse and pressure when changing body position)? In this case, a medical examination is carried out under Article 47, on the basis of which either category “B” or “B” is assigned (“B” - fit with minor restrictions).

If, in addition to hypertension, the conscript has other diseases, they will be examined separately.

Is it possible to completely cure hypertension? This is possible if you eliminate those described in detail above. To do this, you need to be thoroughly examined, if one doctor does not help you find the cause, consult with him about which specialist you should go to. Indeed, in some cases, it is possible to remove a tumor or expand the diameter of blood vessels with a stent - and get rid of painful attacks forever and reduce the risk of life-threatening diseases (heart attack, stroke).

Don't forget: a number of causes of hypertension can be eliminated by giving the body additional information. This is called, and helps speed up the removal of damaged and spent cells. In addition, it renews immune reactions and helps to carry out reactions at the tissue level (it will act like a massage at the cellular level, improving the connection of necessary substances with each other). As a result, the body will not need to increase blood pressure.

The phonation procedure can be performed while sitting comfortably on the bed. The devices do not take up much space, are easy to use, and their cost is quite affordable for the general population. Its use is more cost-effective: this way you make a one-time purchase, instead of constantly purchasing medications, and, in addition, the device can treat not only hypertension, but also other diseases, and can be used by all family members). It is also useful to use phonation after eliminating hypertension: the procedure will increase the tone and resources of the body. With help you can achieve general health improvement.

The effectiveness of the devices is confirmed.

For the treatment of stage 1 hypertension, such an effect may be quite sufficient, but when a complication has already developed, or hypertension is accompanied by diabetes mellitus or metabolic syndrome, therapy should be agreed upon with a cardiologist.

Bibliography

Guide to Cardiology: Textbook in 3 volumes / Ed. G.I. Storozhakova, A.A. Gorbachenkova. – 2008 - T. 1. - 672 p.
Internal diseases in 2 volumes: textbook / Ed. ON THE. Mukhina, V.S. Moiseeva, A.I. Martynov - 2010 - 1264 p.
Aleksandrov A.A., Kislyak O.A., Leontyeva I.V. and others. Diagnosis, treatment and prevention of arterial hypertension in children and adolescents. – K., 2008 – 37 p.
Tkachenko B.I. Normal human physiology. – M, 2005
. Military Medical Academy named after. CM. Kirov, St. Petersburg. 1998
P. A. Novoselsky, V. V. Chepenko (Vladimir Regional Hospital).
P. A. Novoselsky (Vladimir Regional Hospital).
. Military Medical Academy named after. CM. Kirova, St. Petersburg, 2003
. State Medical Academy named after. I.I. Mechnikov, St. Petersburg. 2003
Dissertation of candidate of medical sciences Svizhenko A.A., Moscow, 2009.
Order of the Ministry of Labor and Social Protection of the Russian Federation dated December 17, 2015 No. 1024n.
Decree of the Government of the Russian Federation dated July 4, 2013 No. 565 “On approval of the Regulations on military medical examination.”
Wikipedia.

You can ask questions (below) on the topic of the article and we will try to answer them competently!

What is the classification? Why is it extremely important to understand the danger of this pathology for modern man? Some people believe that constantly elevated blood pressure numbers are not dangerous to health, and that it is necessary to go to the hospital only when they are “off scale.” This is a fundamentally erroneous opinion, so knowing what classification exists today according to world organizations, what stages of the disease are distinguished and how it is treated will be of great help in the prevention of hypertension.

What is the essence of the problem

Hypertension is one of the most common cardiovascular diseases. New degrees and stages of hypertension are increasingly being classified.

Statistics say that in different countries, hypertension affects from 10 to 20% of the active population. These numbers are a worldwide trend. Half of all patients with this diagnosis are not treated. The danger of this pathology is that it leads to a stroke or heart attack. The likelihood of developing the disease increases significantly with age. The disease leads to disability at a young age.

The latest data from the World Health Organization indicate that even teenagers are starting to suffer from arterial hypertension. The most susceptible to pathology are people who are subject to frequent stress and negative emotions. According to the modern classification, there are different degrees of hypertension, forms, stages of the pathological process, and its further complications.

According to the recommendations of health care institutions, hypertension should be understood as an increase in blood pressure relative to normal, regardless of the cause. Primary or essential hypertension is an independent pathology. Today, the reasons for its appearance have not yet been fully elucidated. Different stages of secondary hypertension develop against the background of existing diseases of the heart, kidneys, and endocrine glands.

The disease is chronic. It is characterized by a steady increase in pressure. This means that there are always increased degrees of risk for the heart and blood vessels, because they work under increased load all the time.

Development of views on the classification of hypertension

The disease has been studied by doctors for centuries. During all this time, the classification of arterial hypertension by stages and types has undergone changes. Experts looked differently at the reasons for its appearance, clinical symptoms, blood pressure levels and characteristics of its stability, and more. Some of them have long been irrelevant.

The most modern is the WHO classification based on blood pressure indicators. The following blood pressure indicators are considered to be normal and abnormal:

120/80 mm. rt. Art. - the best indicator;
from 120/80 to 129/84 - normal indicators;
borderline indicators - 130/85 - 139/89 mm. rt. st;
from 140/90 to 159/99 mm. rt. Art. - evidence that the patient is developing grade 1 hypertension;
with arterial hypertension of the 2nd degree, the tonometer reading varies from 160/100 to 179/109 mm. rt. Art.;
if a person’s blood pressure is recorded above 180/110 mm. rt. Art., he is diagnosed with hypertension degree 3.

Back in the 20s of the last century, doctors divided pathology into “pale” and “red”. Its shape was determined depending on the patient’s complexion. If he had cold limbs and a pale face, then he was diagnosed with the so-called pale type. On the contrary, when the blood vessels dilated, the patient’s face turned red, which means that he developed the “red” type of the disease. This classification did not take into account the stage and degree of the disease, and treatment was prescribed incorrectly.

Since the 30s. differentiated between benign and malignant forms. Benign was understood as a variant of the course of the disease when it progressed slowly. And if the disease developed quickly or began at a young age, then a malignant form was diagnosed.

Subsequently, the classification of hypertension was revised several times. Today, stages are distinguished depending on the magnitude of the change in blood pressure and its stability. The WHO classification of arterial hypertension is as follows:

borderline hypertension - its first degree (the tonometer reading does not exceed 159/99 mm);
moderate (2nd degree) - increased pressure to 179/109 mm;
severe (3rd degree) - blood pressure rises above 180/110 mm.

In some classifiers, the table is supplemented with a fourth stage. With it, blood pressure is higher than 210/110 mm. rt. Art. This stage is considered very difficult.

Stages, forms of hypertension

Such a disease has not only degrees. Doctors distinguish the stages of the disease process depending on the damage to the body organs:

If a patient has stage 1 hypertension, he experiences a slight and short-lived increase in blood pressure. No complaints. The functioning of the heart and blood vessels is not impaired.
At the 2nd stage of arterial hypertension, there is a persistent increase in blood pressure. The left ventricle is increasingly enlarged. A local narrowing of the vessels supplying the retina is diagnosed. No other pathological changes are recorded.
Arterial 3 is characterized by severe damage to all organs:

heart failure, angina pectoris, heart attack;
chronic kidney disorders;
acute cerebrovascular accidents - stroke, hypertensive encephalopathy, other circulatory disorders;
hemorrhages in the fundus of the eye, swelling of the nerve of the eye;
damage to peripheral blood vessels;
aortic aneurysm.

There is another classification of arterial hypertension that takes into account options for increasing blood pressure. In this regard, the following forms of pathology are distinguished:

systolic (in this case, only the “upper” pressure increases, and diastolic pressure may be normal);
diastolic (diastolic pressure increases, while the “upper” pressure remains less than 140 mm Hg);
systole-diastolic (in such a patient, regardless of the degree of hypertension, both types of pressure are equally elevated);
labile form (the patient’s blood pressure rises only for a short time and goes away quickly).

The above modern classification takes into account almost all aspects associated with increasing tonometer readings. Depending on what stage a particular patient has, appropriate treatment is prescribed. It does not take into account other nuances of the manifestation of hypertension.

Some manifestations of arterial hypertension

The WHO classification of arterial hypertension does not take into account other manifestations and forms of the disease. This means that they are “apart” from the above stages and forms of pathology. The table of manifestations of hypertension will be slightly supplemented.

The most severe consequence of arterial hypertension is hypertensive crisis. The pressure inside the arteries rises to critical levels. Most often it occurs if the patient is diagnosed with 3. Due to persistently high blood pressure, he develops the following complications:

blood circulation in the brain is impaired;
intracranial pressure rises sharply;
oxygen starvation of the brain increases;
dizziness and severe headache appear.

All this is accompanied by nausea and vomiting. With the hyperkinetic type of the disease, a person's diastolic pressure increases significantly. The hypokinetic form, on the contrary, is characterized by an increase in “lower” pressure. If the patient develops the eukinetic form of the disease, both numbers on the tonometer simultaneously increase.

Some degrees of arterial hypertension may be complicated by so-called refractory hypertension. In this case, the disease cannot be treated with medication. Sometimes the patient's condition does not improve, even if he has taken more than 3 medications.

This form of the disease can be confused and due to an inaccurate diagnosis, drug therapy will be ineffective. Refractory hypertension stage 2 or 3 can also be observed if the patient does not comply with all doctor’s prescriptions.

Finally, white coat hypertension is distinguished. In this case, a person experiences high blood pressure when he is in the hospital during medical procedures. In this case, it is customary to argue about an iatrogenic increase in pressure. It may seem harmless, but this is where its insidiousness lies. Such a patient needs to pay attention to his lifestyle and undergo a medical examination.

Risk factors for arterial hypertension

Any stage of hypertension has certain risk factors. Their exposure significantly increases the likelihood of a person developing dangerous complications. What are the main factors contributing to the development of arterial hypertension? This information should be taken into account by anyone who has had several episodes of high blood pressure, regardless of the reasons:

Age (men over 55 years old and women over 65 years old). In case of unfavorable heredity, special attention should be paid to men under 55 years of age.
Smoking. All cigarette consumers need to remember that their bad habit is the main factor in the development of the disease.
Increased cholesterol levels. For all patients, a total cholesterol level of more than 6.5 mmol/l is critical. The same indicators apply to HDL-C over 4 mmol/, and HDL-C over 1 mmol for male patients and 1.2 for female patients.
Poor family history of cardiovascular pathologies (especially for men under 55 years of age and women under 65 years of age).
Abdominal obesity (if men's waist circumference is over 102 cm or women's - 88 cm).
Presence of C-reactive protein greater than 1 mg/dl.
Impaired sugar tolerance.
Physical inactivity.
Increased fibrinogen content in the blood.

Such risk factors are especially relevant if the patient is diagnosed with stage 1 hypertension. If the disease has a second degree, then special attention should be paid to the following indicators:

left ventricular hypertrophy;
Ultrasound signs of the size of the artery wall or the presence of atherosclerotic growths;
increase in serum creatinine level - over 115 µmol/l in males and over 107 µmol/l in females;
the presence of microalbuminuria from 30 to 300 mg per day.

Other risk factors for stage 3 hypertension are:

age over 65 years for women and 55 years for men;
dyslipidemia;
unfavorable family history;
cerebrovascular pathologies - ischemic or hemorrhagic stroke, transient cerebral circulatory dysfunction;
myocardial infarction;
kidney disease caused by diabetes;
severe proteinuria;
severe degree of renal failure;
peripheral artery damage;
swelling of the optic nerve.

Features of malignant hypertension

Hypertension of grade 3-A or 3-B may have a malignant course. This is due to the patient’s lifestyle, psychological stress, and unfavorable environmental situation. Malignant hypertension is a very dangerous disease; if left untreated, the complications it causes can be fatal.

The main characteristics of malignant hypertension are as follows:

Sharply increased blood pressure. Diastolic readings can reach 220 and even exceed it.
Changes in the fundus. This significantly worsens vision. In severe cases, complete blindness occurs.
Kidney failure.
Migraines develop.
Patients feel weak and very tired.
Sometimes there is a drop in weight and appetite.
Fainting often occurs.
The functioning of the digestive system is disrupted - patients suffer from nausea and vomiting.
A sharp jump in blood pressure is recorded at night.

Malignant hypertension is caused by the following diseases:

Pheochromocytoma. This is a pathological process in the adrenal cortex. As a result of inflammation, substances are formed in the body that provoke a sudden increase in blood pressure.
Parenchymal diseases.
Violation of the condition of blood vessels in the kidneys. Because of this, blood flow to this organ significantly deteriorates, which is why the patient develops so-called renovascular hypertension.

The risk factors for this hypertension are as follows:

long-term smoking (patients who smoke more than a pack of cigarettes per day are at risk);
alcohol abuse;
endocrine disorders;
pregnancy (pregnancy with a malignant course may develop against its background);
overwork and prolonged physical activity;
stress, emotional breakdowns.

Treatment of all these conditions should only be carried out under the supervision of a physician.

Renal hypertension

If a patient is diagnosed with hypertension, classifying all its types can be very difficult. This happens when high blood pressure is caused by problems with the kidneys. Certain categories of patients may experience elevated systolic and diastolic pressure levels for a long time. Qualified care means that the patient undergoes comprehensive kidney treatment to stabilize all indicators.

This pathology develops with changes in the normal functioning of the excretory system. Those most susceptible to this type of hypertension are those with a tendency to edema. Then decay products, salts and other substances are not removed from the blood.

Due to complex processes triggered in the body due to chronic fluid retention, the lumen of the arteries that supply the kidneys narrows in the patient. At the same time, the synthesis of prostaglandins decreases, the main function of which is to maintain normal arterial tone. Therefore, in such patients, blood pressure is consistently elevated.

Normal function of the adrenal cortex is extremely important in the regulation of blood pressure. If it functions intermittently, the hormonal balance in the body is disrupted. And this leads to constantly elevated blood pressure.

Distinctive symptoms of such hypertension:

young age;
the patient’s blood pressure increases suddenly, without depending on previous emotional or physical stress;
asymmetrical pressure increase;
swelling of the legs;
hyperemia of the blood vessels of the eyes (possible hemorrhage in the retina of the eye);
severe damage to the optic nerve.

Therapy for such a disease is associated with the treatment of the underlying disease. Medicines are prescribed to slow down the production of renin.

Hypertension has a rather complex classification. This is due to the fact that the factors for the development of such pathology are extremely diverse. The clinical manifestations and forms of manifestation of the disease depend on them and on the pathogenesis. Regardless of the degree and stage of hypertension, before starting treatment for the disease, a comprehensive diagnosis of the patient is prescribed, and only after that can specially selected drugs be prescribed. For each patient, the complex use of medications will be individual; everyone has their own arterial hypertension.