The need for treatment in patients with hypertension depends not only on blood pressure levels, but also on the presence of other risk factors. The risk factors used for risk stratification are.
(1) The level of systolic and diastolic blood pressure. grade 1: systolic blood pressure in the range of 140 to 159 mmHg and diastolic blood pressure in the range of 90 to 99 mmHg; grade 2: systolic blood pressure in the range of 160 to 179 mmHg and diastolic blood pressure in the range of 100 to 109 mmHg; grade 3: systolic blood pressure ≥ 180 mmHg and diastolic blood pressure ≥ 110 mmHg.
(2) Men aged 55 years or older, women aged 65 years or older.
(3) Smoking.
(4) Total cholesterol >5.72 mmol/L.
(5) Diabetes mellitus.
(6) Family history of early-onset cardiovascular disease (age of onset < 55 years for men or < 65 years for women).
The World Health Organization recently classified the absolute risk of cardiovascular disease into 4 groups based on information
(1) Low-risk group: This includes people with grade 1 hypertension who are less than 55 years old in men or less than 65 years old in women and have no other risk factors. Patients in this group have less than a 15% risk of major cardiovascular events over 10 years.
(2) Intermediate risk group: includes patients with different blood pressure levels and risk factors for cardiovascular disease. Some had lower blood pressure levels but other risk factors were present, or higher blood pressure levels but no or fewer risk factors. The physician’s judgment is critical as to whether this group needs medication or how long they need to be observed before starting medication. The risk of major cardiovascular events in this group of patients is 15% to 20% over 10 years.
(3) High-risk group: Includes those with 3 or more risk factors or grade 1 and 2 hypertension with diabetes or cardiovascular damage, or grade 3 hypertension without other risk factors. Patients in this group have a 20-30% risk of major cardiovascular events within 10 years.
(4) Very high risk group: This group includes patients with grade 3 hypertension with more than one risk factor or with complications caused by hypertension. Patients in this group have the highest risk of cardiovascular events, with a risk of major cardiovascular events exceeding 30% within 10 years. Therefore, aggressive treatment is required.
There are many factors that affect the prognosis of hypertensive patients. First, the risk factors for the development of cardiovascular disease, which have been described earlier, are among the factors that determine the prognosis of hypertensive patients. Persistently elevated blood pressure with dyslipidemia, obesity and hyperglycemia, older age, smoking and lack of exercise, and a family history of cardiovascular events are all factors that affect the prognosis of hypertensive patients, and the more these risk factors, the worse the prognosis.
Secondly, the complications of heart, brain, kidney and fundus due to hypertension also affect the prognosis of hypertensive patients. Electrocardiogram, echocardiogram or chest X-ray suggesting left ventricular hypertrophy, ultrasound or X-ray confirming atheromatous plaques in the carotid, iliac, femoral or aorta, protein in the urine or elevated creatinine concentration in the blood, and retinal artery stenosis on fundus examination all indicate that hypertensive patients have damage to the heart, brain, kidney, fundus and other organs to varying degrees, and once the complications appear, they will irreversibly aggravate the condition of hypertension Once complications occur, they will irreversibly aggravate hypertension and affect the prognosis.
Again, other concomitant diseases will also affect the prognosis of hypertensive patients. For example, stroke, coronary artery disease, myocardial infarction, diabetic nephropathy, coarctation aneurysm, and various arterial stenosis ischemic diseases can all affect the prognosis of hypertensive patients at the same time. Therefore, hypertensive patients should be evaluated and treated in a comprehensive manner.
Hypertension classification and cardiovascular risk stratification and cardiovascular risk factors: In fact, this is a complete diagnosis of primary hypertension. Clinically, patients with essential hypertension are generally graded and cardiovascular risk stratification to which they belong is indicated in order to facilitate individualized intervention and treatment.
1, hypertension grading
Grade 1 140~159 or 90~99
Grade 2 160~179 or 100~109
Grade 3 ≥180 or ≥110
2.Cardiovascular risk stratification criteria for hypertensive patients
Other risk factors and medical history
Blood pressure(mmHg)
Grade 1 Grade 2 Grade 3
No other risk factors Low-risk Medium-risk High-risk
1-2 risk factors Medium risk Medium risk Very high risk
3 or more risk factors or sugar High risk High risk Very high risk
Uropathy or target organ damage
Complications Very high risk Very high risk Very high risk Very high risk
3. Cardiovascular risk factors: men >55 years, women >65 years; smoking; blood cholesterol >5.72ummol/L; diabetes mellitus; family history of early-onset cardiovascular disease; target organ damage: left ventricular hypertrophy; proteinuria and/or mildly elevated blood creatinine; atheromatous plaque; retinopathy; complications: cardiac disease; cerebrovascular disease; renal disease; vascular disease; severe hypertensive retinopathy.
Definition of hypertension stratification
(1) Four bases for determining stratification: hypertensive patients were stratified according to their
① blood pressure classification.
(ii) combination of risk factors, the
(③ target organ damage, and
④Coexisting clinical conditions and other factors affecting prognosis to determine risk stratification.
(2) Risk is divided into four tiers: according to the combined effect of risk factors, target organ damage and coexisting clinical conditions, the risk is quantified into four tiers: low risk, medium risk, high risk and very high risk.
Low-risk tier: those with hypertension grade 1 and no other risk factors.
Intermediate risk tier: those with hypertension grade 2 or grade 1 to 2 with 1 to 2 risk factors.
High-risk tier: people with hypertension grade 1 to 2 with 3 or more risk factors, or with diabetes or target organ damage; or people with hypertension grade 3 without other risk factors.
Very high risk level: hypertension grade 3 with more than 1 risk factor or target organ damage, or hypertension grade 1 to 3 with clinically relevant diseases.