Interviewed experts: Hebei Provincial People's Hospital Deputy Director and Chief Physician of Cardiology Guo Yifang
Global Times Health Client Reporter Shan Qiwen
November 11th, the "China Hypertension Clinical Practice Guidelines" jointly formulated by National Cardiovascular Disease Center , Chinese Medical Association , Chinese Medical Association Cardiovascular Branch and other academic institutions were officially promulgated. Compared with the current domestic and foreign hypertension -related guidelines, the biggest focus of the new guidelines is to lower the diagnostic criteria for hypertension to 130/80 mmHg . This is the third guideline document to downgrade the diagnostic criteria for hypertension after the 2017 US Hypertension Guidelines and the 2022 Taiwan Hypertension Guidelines. " Global Times Health Client Reporter" interviewed Guo Yifang, one of the makers of the guide, deputy director of Hebei Provincial People's Hospital and chief physician of the Department of Cardiology. He said that the "Guidelines for Clinical Practice of Hypertension in China" has ten key points.
1. Down-regulate the diagnostic criteria for hypertension: use systolic blood pressure or more than 130 mmHg or/and diastolic blood pressure or more than 80 mmHg as the diagnostic limit for hypertension.
2. Simplify the classification of hypertension into a dichotomy: systolic blood pressure of 130~139 mmHg or/and diastolic blood pressure of 80~89 mmHg is grade 1 hypertension; systolic blood pressure of 140 mmHg or/and diastolic blood pressure of 90 mmHg is grade 2 hypertension.
3. It is recommended that adults use standardized verified electronic blood pressure meter to measure blood pressure , and standardized blood pressure measurement methods are the same as before.
4. Clinic blood pressure, dynamic blood pressure , and home self-test blood pressure can all be used as the basis for diagnosis and evaluation of hypertension. dynamic blood pressure monitoring is preferred for diagnosis of hypertension; home self-test blood pressure is preferred for efficacy evaluation and follow-up.
5. It is clearly recommended that patients with hypertension use potassium-rich and low-sodium salt instead of ordinary table salt, and the daily salt intake is controlled below 5 grams.
6. Start drug treatment earlier: If the blood pressure is greater than or equal to 140/90 mmHg, drug treatment should be initiated immediately; if the blood pressure is greater than or equal to 130/80 mmHg and is accompanied by clinical comorbidities or target organ damage, or three risk factors should also be initiated.
7. Downregulate blood pressure control target: Those who are less than 65 years old should control their blood pressure to be less than 30/80 mmHg; those who are 65 to 79 years old should control their blood pressure to be less than 130/80 mmHg; those who are more than or equal to 80 years old should first reduce the systolic blood pressure to be less than 140 mmHg, if tolerated, it can be reduced to less than 130 mmHg.
8. First-line antihypertensive drugs for removing beta blockers from hypertensive patients without comorbidity: First-line antihypertensive drugs for hypertensive patients without clinical comorbidity are ACEI (angiotensin converting enzyme inhibitor), ARB (angiotensin receptor blocker), CCB (calcium channel blocker) and diuretics. Spinalactone can be used as the fourth drug for patients with refractory hypertension without comorbidity.
9. Initiate combination treatment of antihypertensive drugs earlier: for those with blood pressure greater than or equal to 140/90 mmHg, it is recommended to use the combination of the initial treatment, and single-piece compound preparations (ACEI/ARB+CCB or ACEI/ARB+diuretics) are preferred.
10. Regarding the application of aspirin: Patients with hypertensive combined with ASCVD (atherosclerotic cardiovascular disease) are recommended to take 75-100 mg/day for secondary prevention ; patients with high cardiovascular risk and hypertensive age 40-65 years old can consider small doses of aspirin for primary prevention .
In the past, the internationally common diagnosis of hypertension was defined as the clinic systolic blood pressure (i.e., high pressure) greater than or equal to 140 mm Hg and (or) diastolic blood pressure (i.e., low pressure) greater than or equal to 90 mm Hg (the same below). The pre-hypertension period was high pressure of 120~139 and (or) low pressure reached 80~89. Previously, the American Heart Association announced a new version of the American Hypertension Guidelines at the 2017 academic annual meeting, which clearly stated that high pressure reaches 130 and low pressure reaches 80. If one of them meets the two, it can be diagnosed as hypertension, that is, the diagnostic standards for high pressure and low pressure are both reduced by 10 mmHg.
"We downgraded the diagnostic standard value of hypertension, which is a decision based on the current situation of hypertension prevention and control in my country. The purpose is to move the front line of prevention and control of hypertension forward." Guo Yifang said that the harm of hypertension to the human body is continuous, which can gradually increase the risk of heart, brain and kidney damage. "In recent years, with the emergence of new research evidence, it also reminds us that we should moderately lower the diagnostic standards, so that ordinary people can pay attention to blood pressure earlier and conduct reasonable intervention earlier, which will help minimize the health harm of hypertension."
"Healthy China Action (2019-2030)" shows that there are 270 million hypertensive patients in my country, and the prevalence of hypertension among residents aged 18 and above is 25.2%, showing an upward trend. Now that the diagnostic criteria for hypertension have been lowered, isn’t it because many people “have hypertension overnight”? Will they have many worries and panic? Guo Yifang explained: "The systolic blood pressure is between 130 and 139 mmHg and the diastolic blood pressure is between 80 and 89 mmHg, which was originally a normal high value. Now, according to the definition of the new guideline, this numerical range belongs to first-level hypertension and is considered to be a patient with hypertension. However, most people in this group do not need to take medicine to treat it, and only need lifestyle intervention, such as improving dietary structure, controlling total calorie intake, increasing exercise, controlling weight, living routine, ensuring sleep, quitting smoking and limiting alcohol, eating less salt, etc. Through a series of combined measures, it can effectively intervene in blood pressure and achieve the standard of blood pressure." Guo Yifang emphasized that this measure not only lowers blood pressure, but also is very effective in controlling blood sugar blood lipids . "However, if the systolic blood pressure is between 130 and 139 mmHg and the diastolic blood pressure is between 80 and 89 mmHg, and coronary heart disease , heart failure , cerebral infarction , and diabetes , these people should actively intervene and take medication to treat it." ▲
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-