The China Hypertension Annual Conference and International Symposium on Hypertension and Related Diseases have just announced the updated points of the "Chinese Guidelines for the Prevention and Treatment of Hypertension".
The guideline is the main basis for the clinical practice of hypertension in mainland China, and a new version of the hypertension prevention and treatment guideline will be released soon after revision in 2018. This session determined that the diagnostic cut-off value for hypertension remains at 140/90mmHg and presented updated points in the guidelines in terms of research evidence, blood pressure measurement, diagnostic process, timing of blood pressure reduction, lifestyle recommendations, drug and device therapy, and management of special populations. The summary is as follows:
Epidemiological characteristics and cardiovascular risk
Key groups to strengthen the prevention and control of hypertension: men, young and middle-aged people, rural and ethnic minority groups (based on prevalence comparison).
Important risk factors for hypertension in mainland populations: high sodium, low potassium diet, overweight and obesity, smoking, excessive alcohol consumption, psychosocial factors, advanced age, etc.
Blood pressure outside the clinic: 24-hour ambulatory blood pressure and nighttime blood pressure are even more strongly associated with cardiovascular risk, in addition to the usual office blood pressure. Family blood pressure, especially early morning blood pressure, is strongly associated with prognosis. Blood pressure variability that reflects how fluctuating blood pressure levels are also associated with cardiovascular risk.
Blood pressure measurement and assessment
Office blood pressure (3 measurements on the same day) ≥140/90mmHg is the cut-off value for the diagnosis of hypertension.
Hypertension diagnostic process
Blood pressure measurement outside the clinic is carried out as much as possible to confirm the diagnosis, evaluate the efficacy of blood pressure reduction, and identify white coat hypertension, occult hypertension, and refractory hypertension.
Wearable blood pressure measurement: Wearable wrist electronic blood pressure monitors using oscillometric technology have passed accuracy verification and need to be widely used.
Cardiovascular risk stratification: It is beneficial to more accurately determine the timing and goal of initiating antihypertensive therapy, optimize antihypertensive treatment regimens, and carry out comprehensive management.
The most important complication in people with hypertension in mainland China is stroke, and CVD risk assessment rather than ASCVD risk assessment should be used.
Blood pressure and cardiovascular risk
Buck strategies and goals
Patients with intermediate-risk hypertension and hypertensive patients with normal hypertension above high-risk are the main groups that benefit from antihypertensive therapy.
Antihypertensive therapy requires a trade-off between benefits and potential risks. Adverse effects of the patient's treatment regimen and patient tolerance should be considered.
Timing of initiation of antihypertensive therapy
Recommended antihypertensive goals for different populations (office blood pressure)
Lifestyle interventions
The "eight-step" of therapeutic lifestyle interventions was proposed: low-sodium and high-potassium diet (but potassium supplementation is not recommended), reasonable diet, weight control, non-smoking, limiting alcohol consumption, increasing exercise, psychological balance, and managing sleep.
All patients with hypertension should undergo therapeutic lifestyle interventions. Lifestyle intensive management should be the cornerstone of treatment for hypertensive patients and throughout treatment. People with normal blood pressure and high values should also improve their lifestyle to prevent the occurrence of hypertension.
Drug and instrumental therapy
Basic principles of antihypertensive drugs: risk reduction, long-acting antihypertensive, combination therapy, starting dose, duration of administration, individualized treatment.
The results of the TIME study showed that taking antihypertensive drugs in the evening did not confer more cardiovascular benefit than taking it in the morning. Unless there is a clear need to control nighttime blood pressure increases, antihypertensive drugs should not be routinely recommended at bedtime.
On the basis of the five major classes of antihypertensive drugs such as CCB, ACEI, ARB, thiazide diuretics and β receptor blockers, angiotensin receptor neprilyprilysin inhibitors are supplemented as a new class of commonly used antihypertensive drugs.
On the basis of differential diagnosis and treatment of secondary hypertension, transrenal artery desympathetic (RDN) therapy is considered. RDNs may be considered in high-risk cardiovascular patients who have difficulty controlling blood pressure with medications excluding secondary causes, and in hypertensive patients with poor medication adherence. Other device treatments for hypertension have limited research evidence and are not suitable for widespread clinical practice.
Blood pressure management in special populations
1) High blood pressure in old age:
65~79 years old blood pressure ≥140/90mmHg should be started with drug therapy, antihypertensive target < 140/90mmHg, if tolerated, can be reduced to <130/80mmHg.
≥ 80 years of age, SBP ≥150mmHg can be started with a blood pressure lowering target of 150/90mmHg <.
Patients with geriatric syndrome such as frailty can be appropriately relaxed.
2) High blood pressure during pregnancy:
≥ 140/90 mmHg Antihypertensive therapy should be initiated. It may be reasonable to set 110/70mmHg as the safe lower limit for antihypertensive therapy.
3) High blood pressure combined with cognitive dysfunction
Blood pressure can be reduced to less than 140/90mmHg or, if tolerated, to 130/80mmHg; In patients with severe cognitive decline or even dementia, <150/90 mmHg can be used as the initial goal of blood pressure control.
4) High blood pressure combined with coronary heart disease
A < 140/90mmHg is recommended as a buck target, and can be reduced to <130/80mmHg if tolerated.
5) High blood pressure combined with heart failure
For patients with hypertension and heart failure, the recommended goal of antihypertensive therapy is
6) High blood pressure combined with kidney disease
In patients without proteinuria, initiate pharmacotherapy at SBP ≥140 mmHg and/or DBP ≥90 mmHg, with a blood pressure lowering target of <140/90 mmHg, which can be reduced to 130/80 mmHg if tolerated.
For proteinuria, initiate pharmacotherapy at SBP ≥130 mmHg and/or DBP ≥80 mmHg, with a blood pressure control target of <130/80 mmHg.
7) High blood pressure combined with diabetes
The control target is <130/80mmHg. Older patients with diabetes or severe coronary heart disease can set relatively loose blood pressure control targets.
In patients with diabetes with blood pressure ≥ 140/90 mmHg, antihypertensive therapy may be considered. When blood pressure ≥ 160/100 mmHg or above the target value of 20/10 mmHg, antihypertensive therapy should be started immediately.
8) High blood pressure combined with peripheral vascular disease
Blood pressure in patients with lower extremity arteriopathy should be controlled at
Secondary hypertension
Secondary hypertension is hypertension with clear etiology, involving hundreds of diseases of multiple systems such as kidney and renal vascular, endocrine, sleep-breathing, autoimmune, neurological, psychiatric, psychological, and blood, as well as pathophysiological conditions such as drugs, mechanical blood flow disorders, and single gene mutations.
The new guidelines update their management recommendations for all currently known forms of secondary hypertension.
At the same time, the meeting also announced that after the release of the key points of the guidelines, the guidance committee will continue to collect opinions from people inside and outside the industry, improve the content of the guidelines, and publish the full text of the guidelines as soon as possible.
Source: China Hypertension Annual Conference and International Symposium on Hypertension and Related Diseases
Curated by: Yunye | Executive Producer: Gyouza
Source: Visual China