When describing hypertension or hypertension, it is very common to divide this disease into degrees, stages and degrees of cardiovascular risk. Sometimes doctors even get confused in these terms, not like people who have no medical education. Let’s try to clarify these definitions.
What is hypertension?
Arterial hypertension (AH) or hypertensive illness (GB) is a persistent increase in blood pressure (BP) levels above normal levels. This disease is called the “silent killer” because:
- Most of the time there are no obvious symptoms.
- If untreated with AH, the damage caused to the cardiovascular system by elevated blood pressure contributes to the development of myocardial infarction, stroke and other health threats.
Degree of arterial hypertension
The degree of hypertension directly depends on the level of blood pressure. No other criteria for determining the degree of hypertension exist.
The two most common classifications of arterial hypertension according to the level of blood pressure are the classification of the European Society of Cardiology and the classification of the Joint National Committee (POC) for the prevention, recognition, assessment and treatment of high blood pressure (USA).
Table 1. Classification of the European Society of Cardiology (2013)
The classification of hypertension by stages is not used in all countries. It is not included in the European and American recommendations. Determining the stage of GB is made on the basis of an assessment of the progression of the disease – that is, by lesions of other organs.
Table 4. Stages of hypertension
As can be seen from this classification, the expressed symptoms of arterial hypertension are observed only at stage III of the disease.
If you look closely at this gradation of hypertension, you can see that it is a simplified model for determining cardiovascular risk. But, in comparison with the SSR, the definition of the stage of AH only states the fact of the presence of lesions of other organs and does not give any prognostic information. That is, does not tell the doctor what the risk of developing complications in a particular patient.
Target values of blood pressure in the treatment of hypertension
Regardless of the degree of hypertension, it is necessary to strive to achieve the following target values of blood pressure:
- In patients 2. This can be achieved through healthy eating and physical activity. Even a slight weight loss in obese people can significantly reduce blood pressure levels.
As a rule, these measures are sufficient to reduce blood pressure in relatively healthy people with grade 1 hypertension.
Drug treatment may be needed for patients younger than 80 years old who have signs of heart or kidney damage, diabetes mellitus, moderately high, high or very high cardiovascular risk.
As a rule, in case of hypertension of 1 degree, patients younger than 55 years old first prescribe one drug from the following groups:
- Angiotensin-converting enzyme inhibitors (ACE inhibitors – ramipril, perindopril) or angiotensin receptor blockers (ARA – losartan, telmisartan).
- Beta blockers (may be prescribed to young people with intolerance to an ACE inhibitor or women who may become pregnant).
If a patient is older than 55 years old, he is most often prescribed calcium channel blockers (bisoprolol, carvedilol).
The prescription of these drugs is effective in 40-60% of cases of grade 1 hypertension. If after 6 weeks the level of blood pressure does not reach the target, you can:
- Increase the dose of the drug.
- Replace the medication with a representative of another group.
- Add another tool from another group.
Hypertension 2 degrees
Grade 2 hypertension is a steady increase in blood pressure in the range from 160/100 to 179/109 mm Hg. Art. This form of arterial hypertension has moderate severity, it is necessary to begin drug therapy with it to avoid its progression to grade 3 hypertension.
With grade 2 symptoms of hypertension are more common than with grade 1, they may be more pronounced. However, there is no directly proportional relationship between the intensity of the clinical picture and the level of blood pressure.
Patients with grade 2 hypertension are required to conduct a lifestyle modification and immediate start of antihypertensive therapy. Treatment regimens:
- ACE inhibitors (ramipril, perindopril) or ARB (losartan, telmisartan) in combination with calcium channel blockers (amlodipine, felodipine).
- In case of intolerance to calcium channel blockers or signs of heart failure, a combination of an ACE inhibitor or an ARB with thiazide diuretics (hydrochlorothiazide, indapamide) is used.
- If the patient is already taking beta blockers (bisoprolol, carvedilol), add a calcium channel blocker, and not thiazide diuretics (so as not to increase the risk of developing diabetes).
If a person has blood pressure effectively kept within the target values for at least 1 year, doctors may try to reduce the dose or number of drugs taken. This should be done gradually and slowly, constantly monitoring the level of blood pressure. Such effective control of arterial hypertension can be achieved only with the combination of drug therapy with lifestyle modification.
Hypertension 3 degrees
Grade 3 hypertension is a steady increase in blood pressure ≥180 / 110 mmHg. Art. This is a severe form of hypertension, requiring immediate medical treatment to avoid the development of any complications.
Even patients with grade 3 hypertension may not have any symptoms of the disease. However, most of them still experience non-specific symptoms, such as headaches, dizziness, nausea. Some patients with this level of AD develop acute damage to other organs, including heart failure, acute coronary syndrome, renal failure, aneurysm dissection, and hypertensive encephalopathy.
With grade 3 hypertension, drug therapy regimens include:
- The combination of an ACE inhibitor (ramipril, perindopril) or a BRA (losartan, telmisartan) with calcium channel blockers (amlodipine, felodipine) and thiazide diuretics (hydrochlorothiazide, indapamide).
- If high doses of diuretics are poorly tolerated, prescribe alpha or beta blocker instead.