Classification of arterial hypertension

The basis for modern classifications of hypertension is based on two main principles: the level of blood pressure and signs of damage to target organs. In 1999

Classification of blood pressure levels proposed by the World Health Organization and the International Society of Hypertension, 1999

Category	Systolic BP, mmHg	Diastolic blood pressure, mmHg
Optimum blood pressure	<20	<80
Normal blood pressure	<130	<85
Increased normal blood pressure	130-139	85-89

Arterial hypertension

I degree (soft)	140-159	90-99
Borderline	140-149	90-94
II degree (moderate)	160-179	100-109
III degree (heavy)	> 180	> 110
Isolated systolic hypertension	> 140	<90

Malignant course of arterial hypertension is characterized by high SBP (more than 220 mmHg) and DBP (> 130 mmHg), development of complications with cardiac, central nervous system, kidney damage. Characteristic signs of neuroretinopathy, progressive renal failure, hypertensive encephalopathy, acute left ventricular failure.

Classification of arterial hypertension (recommendations of experts by the World Health Organization and the International Society for Hypertension, 1993 and 1996)

Stages of	Symptoms
1	Increased blood pressure without objective signs of target organ damage
II	Increased blood pressure with objective signs of target organ damage (hypertrophy of the left ventricle of the heart, narrowing of the retinal vessels, microalbuminemia or a slight increase in the level of creatinine to 1.2-2.0 mg / dL, atherosclerotic plaques in the carotid, iliac, femoral arteries)
III	Increased blood pressure with objective signs of target organ damage and clinical manifestations (angina pectoris, myocardial infarction, stroke, transient ischemic attacks, hypertensive encephalopathy, hemorrhages or exudates with edema of the optic nerve, renal failure, exfoliating aortic aneurysm)

Classification of arterial hypertension in children

In children and adolescents over 12 years old, two degrees of hypertension are distinguished. If the values of SBP or DBP fall into different categories, then a higher degree of arterial hypertension is established. The degree of arterial hypertension is determined in the case of newly diagnosed arterial hypertension and in patients not receiving antihypertensive therapy.

Degrees of arterial hypertension in children and adolescents

Power	Criteria
1	Mean values of systolic blood pressure and / or diastolic blood pressure from three measurements are equal to or exceed the values of the 95th percentile, but less than the values of the 99th percentile + 5 mm of mercury.
II (Heavy)	The mean values of systolic blood pressure and / or diastolic blood pressure from three measurements are equal to or exceed the values of the 99th percentile by more than 5 mm Hg.

For adolescents 16 years and older use the establishment of a risk group according to the criteria published in the Recommendations of the experts of the All-Russian Scientific Society of Cardiologists for the diagnosis, treatment and prevention of hypertension in 2001. The criteria for establishing a risk group for hypertension of the 1st degree are listed below.

• Low risk - there are no risk factors and there is no defeat of target organs.
• The average risk is 1-2 risk factors without defeat of target organs.
• High risk - 3 risk factors and more and / or lesions of target organs.

Patients with arterial hypertension grade II belong to the high-risk group.

Taking into account the peculiarities of arterial hypertension in children and adolescents (the connection with the syndrome of autonomic dysfunction, often the labile nature of hypertension), the diagnosis of hypertension should be established only in adolescents 16 years and older in the case when primary arterial hypertension persists for 1 year or longer, or at an earlier age - in the presence of lesions of target organs.

In hypertensive disease stage I, there are no changes in the target organs. In hypertensive disease of stage II, one or more target organs are affected.

Criteria for stratifying the risk of hypertension

Risk factors	The defeat of the target organs (stage II hypertension)	Associated (concomitant) clinical conditions (Stage III hypertension)
Main risk factors: Age for men 55 years, for women 65 years; Smoking; Cholesterol levels higher than 6.5 mmol / l; Family history of early cardiovascular diseases (in women <65 years, in men <55 years); Diabetes Additional risk factors that negatively affect the prognosis of a patient with hypertension: Reduction of high-density lipoprotein cholesterol; increase in low-density lipoprotein cholesterol; microalbuminuria in diabetes; violation of glucose tolerance; obesity; Sedentary lifestyle; increased fibrinogen; socioeconomic risk group	Hypertrophy of the left ventricle (according to ECG, echocardiography or radiography); proteinuria and / or creatinemia 1,2-2,0 mg / dl; Ultrasound or roentgenologic signs of an atherosclerotic plaque; generalized or focal narrowing of retinal arteries	Cerebrovascular diseases; ischemic stroke; hemorrhagic stroke; transient ischemic attack Heart Disease: myocardial infarction; angina pectoris; Coronary revascularization; congestive heart failure Kidney diseases: diabetic nephropathy; renal failure (creatinemia above 2.0 mg / dL) Vascular diseases: dissecting aortic aneurysm; symptomatic lesion of peripheral arteries Hypertensive retinopathy: hemorrhages or exudates; edema of the nipple of the optic nerve

[1], [2], [3], [4], [5], [6], [7], [8],