Classification of arterial hypertension

Modern classifications of arterial hypertension are based on two main principles: the level of arterial 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 blood pressure, mmHg	Diastolic blood pressure, mmHg
Optimal blood pressure	< 20	<80
Normal blood pressure	<130	<85
Increased normal blood pressure	130-139	85-89

Arterial hypertension

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

Malignant course of arterial hypertension is characterized by high SBP (more than 220 mm Hg) and DBP (>130 mm Hg), development of complications with damage to the heart, central nervous system, kidneys. Signs of neuroretinopathy, progressive renal failure, hypertensive encephalopathy, acute left ventricular failure are characteristic.

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

Stages	Signs
1	Increased blood pressure without objective signs of target organ damage
II	Increased blood pressure with objective signs of damage to target organs (hypertrophy of the left ventricle of the heart, narrowing of the retinal vessels, microalbuminemia or a slight increase in creatinine levels to 1.2-2.0 mg/dl, atherosclerotic plaques in the carotid, iliac, and 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 optic disc edema, renal failure, dissecting aortic aneurysm)

Classification of arterial hypertension in children

In children and adolescents over 12 years of age, two degrees of arterial 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

Degree	Criteria
1	The mean systolic BP and/or diastolic BP values from three measurements are equal to or greater than the 95th percentile values but less than the 99th percentile values + 5 mmHg.
II (heavy)	The average of the three systolic and/or diastolic BP readings is equal to or greater than the 99th percentile by more than 5 mmHg.

For adolescents aged 16 years and older, the risk group is determined according to the criteria published in the 2001 Recommendations of experts of the All-Russian Scientific Society of Cardiologists for the diagnosis, treatment and prevention of arterial hypertension. The criteria for determining the risk group for stage I arterial hypertension are listed below.

• Low risk - no risk factors and no target organ damage.
• Average risk - 1-2 risk factors without target organ damage.
• High risk - 3 or more risk factors and/or target organ damage.

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

Given the characteristics of arterial hypertension in children and adolescents (association with autonomic dysfunction syndrome, often labile nature of arterial hypertension), the diagnosis of hypertension should be established only in adolescents aged 16 years and older in cases where primary arterial hypertension persists for 1 year or longer, or at an earlier age - in the presence of damage to target organs.

In stage I hypertension, there are no changes in target organs. In stage II hypertension, one or more target organs are affected.

Criteria for risk stratification of arterial hypertension

Risk factors	Target organ damage (hypertension stage II)	Associated (concomitant) clinical conditions (hypertension stage III)
Main risk factors: Age for men 55 years, for women 65 years; Smoking; Cholesterol level above 6.5 mmol/l; Family history of early cardiovascular disease (in women < 65 years, in men < 55 years); Diabetes mellitus Additional risk factors that negatively affect the prognosis of a patient with hypertension: Decreased high-density lipoprotein cholesterol; increased low-density lipoprotein cholesterol; microalbuminuria in diabetes; impaired glucose tolerance; obesity; Sedentary lifestyle; increased fibrinogen; socioeconomic risk group	Left ventricular hypertrophy (according to ECG, echocardiography or radiography); proteinuria and/or creatinemia 1.2-2.0 mg/dL; Ultrasound or radiographic evidence of atherosclerotic plaque; generalized or focal narrowing of retinal arteries	Cerebrovascular disease; ischemic stroke; hemorrhagic stroke; transient ischemic attack Heart diseases: 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 peripheral arterial disease Hypertensive retinopathy: hemorrhages or exudates; papilledema

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