The previous two articles on hypertension talked about whether there is no obvious discomfort with elevated blood pressure, as well as the common harm of hypertension, interested friends can take a look at the previous article, and today this article talks about how to distinguish the severity of hypertension.
At present, the diagnostic criteria for hypertension in China are: blood pressure measured on the same day without the use of antihypertensive drugs, systolic blood pressure of 140mmHg and/or diastolic blood pressure of 90mmHg; If you have high blood pressure in the past, and your blood pressure is in the normal range after using antihypertensive drugs, it also falls into the category of high blood pressure. Depending on the specific level of blood pressure and the presence or absence of associated complications, hypertension can be risk-stratified.
Normal blood pressure is systolic blood pressure 120 mmHg and diastolic blood pressure 80 mmHg;
high systolic blood pressure of 120-139 mmHg and/or diastolic blood pressure 80-89 mmHg for normal blood pressure; Grade 1 hypertension (mild) systolic blood pressure 140-159 mmHg and/or diastolic blood pressure 90-99 mmHg;
Hypertension grade 2 (moderate) systolic blood pressure 160-179 mmHg and/or diastolic blood pressure 100-109 mmHg;
Grade 3 (severe) hypertension systolic blood pressure 180 mmHg and/or diastolic blood pressure 110 mmHg;
isolated systolic hypertension with systolic blood pressure of 140mmHg and diastolic blood pressure of 90mmHg;
The above criteria are suitable for any adult over the age of 18, and the criteria for hypertension in children are not discussed here.
Studies have shown that blood pressure levels are positively correlated with the risk of cardiovascular and cerebrovascular morbidity and mortality in a continuous and independent manner, and the risk of cardiovascular and cerebrovascular complications doubles for every 20 10 mmHg increase in blood pressure above 115 75 mmHg. Therefore, even if the blood pressure is not high blood pressure at a normal high value, it will still increase the occurrence of related complications, and at this time, you can reduce blood pressure and reduce the occurrence of related complications by adjusting diet, life, exercise, etc.
Let's talk about the factors that affect the prognosis of patients with hypertension:
Risk factors for cardiovascular disease: elevated systolic and diastolic blood pressure, reaching the level of hypertension grade 1-3; Males are older than 55 years and females are older than 65 years; Smoking; Dyslipidemia: total cholesterol 57mmol L, or LDL cholesterol 36mmol L, or HDL cholesterol 10mmol/l；Parents, children, siblings with a history of cardiovascular disease before the age of 50; Abdominal obesity or obesity, abdominal obesity waist circumference 85 cm for males and 80 cm for females, with an obese body mass index of 28;lack of physical activity; High sensitivity C-reactive protein 3 mg L or C-reactive protein 10 mg L.
Target organ damage: ECG or cardiac ultrasonography or x-ray showing left ventricular hypertrophy; Arterial wall thickening: carotid intima-media thickness 0Ultrasound findings of 9 mm or atherosclerotic plaques; Mild increase in serum creatinine: 115-133 umol l in males and 107-124umol l in females. Microalbuminuria: 30 to 300 mg of albumin in 24 hours, albumin to creatinine ratio: 22 mg g (2.)5 mg mmol), 31 mg g (3.)5mg/mmol）。
Diabetes mellitus: fasting blood glucose 70mmol l, postprandial blood glucose 111mmol/l。
Coexisting clinical conditions: transient ischemic attack, cerebral hemorrhage, cerebral ischemic stroke and other cerebrovascular diseases; heart diseases such as angina, myocardial infarction, congestive heart failure, coronary revascularization, etc.; Kidney disease: diabetic nephropathy, impaired renal function (serum creatinine): 133umol l for males, 124umol l for females, 24-hour urine albumin 300 mg; peripheral vascular inflammation; Retinopathy: hemorrhage or exudation, papilledema.
Risk stratification of hypertension:
Hypertension grade 1 (systolic blood pressure 140-159 mmHg or diastolic blood pressure 90-99 mmHg): low-risk in the absence of the risk factors mentioned above; If there are 1-2 risk factors mentioned above, it is considered intermediate; If there are more than 3 risk factors mentioned above, it is considered high-risk; If there are any of the coexisting clinical conditions mentioned above, it is considered a high risk.
Grade 2 hypertension (systolic blood pressure 160-179 mmHg or diastolic blood pressure 100-109 mmHg): intermediate risk in the absence of the risk factors mentioned above; If there are 1-2 risk factors mentioned above, it is considered intermediate; If there are more than 3 risk factors mentioned above, it is considered high-risk; If there are any of the coexisting clinical conditions mentioned above, it is considered a high risk.
Hypertension grade 3 (systolic blood pressure 180 mmHg or diastolic blood pressure 110 mmHg): high risk in the absence of risk factors mentioned above; If there are 1-2 risk factors mentioned above, it is considered very high; If there are more than 3 risk factors mentioned above, it is considered very high; If there are any of the coexisting clinical conditions mentioned above, it is considered a high risk.
The more severe the risk stratification, the greater the likelihood of a cardiovascular event. The likelihood of a major cardiovascular event within 10 years of a clear diagnosis of hypertension is 15% in the low-risk group, 15-20% in the intermediate-risk group, 20-30% in the high-risk group, and 30% in the high-risk group. Therefore, if a patient with hypertension is clearly diagnosed, it is necessary to consult a doctor as soon as possible to evaluate whether antihypertensive drugs are needed and which antihypertensive drugs are needed.
This article mainly lists the classification and risk stratification of hypertension, and will talk about the common manifestations of hypertension, what tests need to be done for hypertension, the difference between primary hypertension and secondary hypertension, the medication principles of hypertension and the dialectical treatment of hypertension in traditional Chinese medicine.