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6 main points, please collect
Hypertension is not only the chronic non-communicable disease with the largest number of patients in China, but also the most important risk factor for the death of cardiovascular disease among urban and rural residents.
In November 2022, the National Center for Cardiovascular Diseases, the Chinese Medical Association, the Chinese Medical Association Hypertension Professional Committee, the Chinese Medical Association Cardiovascular Branch, and the Cross-Strait Medical and Health Exchange Association Hypertension Professional Committee jointly formulated the "China Hypertension Clinical Practice Guidelines 2022", and gave a detailed evidence-based recommendation for common problems in the diagnosis and treatment of hypertension, in order to comprehensively improve the diagnosis and treatment level of hypertension in my country. We will interpret this from the following aspects.
01 New definition and new stratification of hypertension
1) Definition of hypertension: The diagnostic boundary of adult hypertension in my country is down-regulated from SBP (systolic blood pressure) ≥140mmHg and/or DBP (diastolic blood pressure) ≥90mmHg to SBP ≥130mmHg and/or DBP ≥80mmHg;
2) Hypertension classification: It is recommended that adult hypertension in my country be divided into grade 1 (SBP 130~139mmHg and/or DBP 80~89mmHg) and grade 2 (SBP ≥1 40mmHg and/or DBP ≥90mmHg);
3) Cardiovascular risk stratification of hypertension: a) High-risk patients: SBP ≥140mmHg and/or DBP ≥90mmHg, or SBP 130~139mmHg and/or DBP 80~89mmHg with clinical comorbidities, target organ damage or ≥3 cardiovascular risk factors; b) Non-high-risk patients: SBP 130~139mmHg and/or DBP 80~89mmHg and do not meet the above high-risk standards.
02 The target value of blood pressure control in patients with hypertension
1) It is recommended that the target value of blood pressure control in patients with hypertension without clinical comorbidities and age <65>
2) For patients with hypertension and atrial fibrillation, the target value of blood pressure control is <130/80mmhg;>
3) For patients with hypertension and coronary heart disease, the target value of blood pressure control is <130/80mmhg;>
4) For patients with hypertension and coronary heart disease, the target value of blood pressure control is <130/80mmhg;>
4) For patients with hypertension and coronary heart disease, the target value of blood pressure control is <130/80mmhg;>
4) For patients with hypertension and ejection fraction decreased (HFrEF ) and heart failure patients with ejaculation fraction retention (HFpEF), it is recommended that the blood pressure control target value is <130/80mmhg;>
5) For patients with hypertension and diabetes, it is recommended that the blood pressure control target value is <130/80mmhg;>
6) For elderly patients with hypertension, a) aged 65 to 79, the blood pressure control target value is <130/80mmhg;>
7) For patients with hypertension and acute hemorrhagic stroke, it is recommended that the target value of blood pressure control in the acute phase is <130/80mmhg;>
8) For patients with hypertension and acute ischemic stroke: a) No intravenous thrombolysis and intravascular treatment are recommended to initiate antihypertensive treatment with SBP ≥220mmHg and/or DBP ≥120mmHg; b) Intravenous thrombolysis and intravascular treatment are recommended, and blood pressure control is ≤185/110mmHg before treatment;
9) For patients with stable hypertension and condition with stable hypertension and condition For stroke patients, it is recommended that the blood pressure control target value is <130/80mmhg>
10) For patients with non-dialysis of hypertension and chronic renal disease, a) urine protein <300mg/d,>
03 Hypertensive Lifestyle Intervention
All hypertensive patients are recommended to undergo lifestyle intervention, including dietary intervention, exercise intervention, stress reduction intervention, weight loss intervention, smoking cessation, alcohol restriction and comprehensive lifestyle intervention (Figure 1).
Figure 1 Lifestyle intervention for patients with hypertension
04 Hypertensive drug treatment
1) The timing of the initiation of antihypertensive drugs: a) High-risk patients immediately initiate antihypertensive drug treatment; b) Non-high-risk patients undergo 3-6 months of life intervention. If SBP ≥130mmHg or DBP ≥80mmHg, antihypertensive drug treatment can be considered;
2) Patients with hypertension without clinical comorbidities, angiotensin converting enzyme inhibitor (ACEI), angiotensin II receptor blocker (ARB), calcium channel antagonist (CCB) and diuretics are used as one Linear antihypertensive drugs;
3) Patients with hypertension and coronary heart disease: a) symptoms of angina pectoris, the first choice of beta blockers and CCB of drugs are recommended; b) history of myocardial infarction, the first choice of beta blockers and ACEI/ARB of antihypertensive drugs are recommended;
4) Patients with hypertension and heart failure: a) HFrEF, the recommended angiotensin receptor-enerphalin inhibitor (ARNI) is recommended to replace ACEI/ARB as the preferred drug; b) HFpEF, ARNI/ARB/ACEI All can be used as the first choice drug;
5) Patients with hypertension combined with stroke or transient ischemia attack (TIA), ACEI, diuretics or ACEI+ diuretics are recommended for antihypertensive treatment. If the above drugs are not applicable or have poor results, CCB or ARB can be used as first-line antihypertensive drugs;
6) Patients with hypertension combined with type 2 diabetes, ACEI/ARB is recommended for blood pressure control;
7) Patients with hypertension combined with chronic kidney disease, Regardless of whether there is or not, ACEI/ARB can be preferred as the preferred antihypertensive drug;
8) combined treatment: a) for patients with hypertensive blood pressure ≥140/90mmHg, initial combined antihypertensive drugs are recommended; b) for patients with hypertensive blood pressure that require combined antihypertensive drugs to treat, single-piece compound preparation (SPC) is recommended; c) for SPC selection, and renin-angiotensin system inhibitor (RASI) + CCB or RASI + diuretic combination is recommended.
05 Hypertension interventional treatment
For patients with hypertension who are refractory hypertension, unable to tolerate antihypertensive drugs, and whose clinical characteristics are consistent with hypersympathetic function, renal artery desympathetic surgery can be used as a strategy to lower blood pressure.
06 Hypertension follow-up
1) For hypertensive patients without clinical comorbidities and age <65,>
2) It is recommended that patients with hypertensive treatment with antihypertensive drugs follow up 2 to 4 weeks after starting to take the medication or adjust the medication (based on the condition) until their blood pressure meets the criteria;
3) Patients with blood pressure compliance after treatment with antihypertensive drugs can consider follow-up once every 3 months.
07
Summary
The formulation of this "China Hypertension Clinical Practice Guidelines" is guided by clinical needs and problems, and only forms recommendations for the most important, important impact on clinical decision-making and the most controversial issues. It is different from previous traditional guidelines in terms of format and content.
In addition, the new guide has redefined the diagnostic standards, grading, stratification and the timing of starting antihypertensive treatment for hypertension, which is a major update from previous guidelines recommendations. It will inevitably bring certain challenges to the current clinical diagnosis and treatment inertia and routine. Clinicians should be familiar with and mastered the new guideline as soon as possible and put it into practice.
References:
[1]
National Center for Cardiovascular Disease, Chinese Medical Association, Chinese Medical Association Hypertension Professional Committee, etc. Chinese Hypertension Clinical Practice Guide. Chinese Journal of Cardiovascular Disease, 2022, 50(00):1050-1095.DOI:10.3760/cma.j.cn112148-20220809-00613
This article was first published: Medical World Cardiovascular Channel
This article is compiled: Renjianshi
Editor: Peng Jianping
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