Over the course of my medical career, I have seen the diagnosis of hypertension change over time and geographically. As a physician, I understand that hypertension is not just a numerical problem, it is a global health challenge that involves the quality of life and long-term health of countless individuals. However, what you may not know is that the diagnostic criteria for hypertension are not uniform in different countries. In China and the United States, for example, there are significant differences in the diagnostic criteria for hypertension: the standard in China is 140/90 mmHg, while in the United States it was adjusted to 130/80 mmHg in 2017.
The story behind these numbers is full of medical judgment and consideration of prevention strategies. For example, there was a patient, Mr. Lee, who had lived in the United States for many years, was diagnosed with hypertension by American standards and began treatment. A few years later, he returned to China and found that his blood pressure was actually within the normal range by Chinese standards. Mr. Li asked me in confusion, "Does this mean that I don't actually need those drugs?" This question triggered me to think deeply about the difference in the diagnostic criteria for hypertension between the two countries.
US diagnostic criteria for hypertension: 130/80 mmHg
Causes and motivations: The revision of this criterion is based on years of research and data showing that lower blood pressure thresholds help identify risk groups earlier, thereby preventing hypertension-related cardiovascular events. Studies have shown that people with blood pressure above 130/80 mmHg have a significantly increased risk of heart disease and stroke. Therefore, by lowering the diagnostic criteria, doctors can intervene earlier and use lifestyle modifications or medications to manage blood pressure, aiming to reduce long-term cardiovascular problems.
Reinforcement of prevention strategies: The introduction of new standards means that more U.S. adults (nearly half) are now classified as having hypertension. This not only raises awareness of the potential dangers of high blood pressure, but also reinforces the importance of preventive measures. Doctors are now more inclined to recommend non-pharmacological methods such as a healthy diet, regular exercise, and maintaining a healthy weight to control blood pressure.
Benefits of early intervention: By lowering blood pressure standards, hypertension can be diagnosed and treated early in the disease. This strategy helps to avoid or delay the development of serious health problems such as heart disease, stroke, kidney disease, etc. Early intervention can not only improve the quality of life of patients, but also reduce the burden on the healthcare system and reduce the high medical costs caused by complications of advanced hypertension.
Public health impacts: New blood pressure standards have driven changes in public health policy, prompting governments and health organizations to increase investment in hypertension prevention and treatment. This includes wider blood pressure monitoring programs, health education programs, and community health activities to raise awareness of the importance of healthy lifestyles.
By lowering the diagnostic criteria for hypertension, medical experts in the United States hope to be able to control hypertension more effectively, thereby reducing the morbidity and mortality of cardiovascular disease. Although this strategy includes many people in the category of hypertension, it is aimed at better protecting the health of the public and preventing the development of the disease.
Chinese diagnostic criteria for hypertension: 140/90mmHg
Scientific basis
The diagnostic criteria for hypertension in China are set taking into account the economic conditions, distribution of medical resources and demographic characteristics in most regions of China. Chinese guidelines for the prevention and treatment of hypertension emphasize that 140/90mmHg as a starting point for diagnosis can effectively identify high-risk groups that require clinical intervention. This standard is also close to that of the World Health Organization, as well as that of many other countries, ensuring consistency in global public health strategies.
Long-term effects on health
The use of 140/90 mmHg as the diagnostic criterion helps doctors to better balance the urgency of treatment with the side effects of drug treatment in actual clinical practice. Individuals below this threshold may still be able to control their blood pressure through lifestyle modifications and avoid premature or unnecessary medications.
Match the epidemic status of the disease in the country
The prevalence of hypertension in China is high, especially in middle-aged and older people. Current diagnostic criteria can help physicians more accurately identify and manage patients with hypertension, especially in rural and remote areas. In addition, this standard will also help governments and health authorities to allocate health resources and health education more effectively with limited resources.
The Chinese diagnostic standard of 140/90mmHg for hypertension is set based on the specific disease conditions and medical practice experience in China, with the aim of maximizing the prevention of hypertension-related cardiovascular diseases. This criterion takes into account China's special national conditions and population characteristics, and is a scientific and practical reflection of the country's health status.
The scientific basis and controversy of the standard differences
Scientific basis
In the United States, the diagnostic criteria for hypertension were lowered from 140/90 mmHg to 130/80 mmHg in 2017, largely based on extensive epidemiological studies and clinical trials. These studies have shown that blood pressure levels above 130/80 mmHg are associated with a significantly increased risk of heart disease, stroke, and other cardiovascular diseases. Therefore, the standard adjustment in the United States aims to reduce the incidence of long-term cardiovascular disease through earlier diagnosis and intervention.
In contrast, China maintains the standard of 140/90mmHg, reflecting consideration of population-specific epidemiological data and health risks in Chinese. Studies in China have shown that setting the diagnostic threshold at 140/90 mmHg can balance the need for early intervention with the rational allocation of medical resources, and avoid over-medical treatment and unnecessary treatment stress.
Points of Issue
The adjustment of the standard has caused widespread controversy. On the one hand, experts who support the new US standard believe that lowering the threshold can help identify risk groups in advance, implement lifestyle modifications and drug treatments, and thus reduce the occurrence of cardiovascular events. However, critics point out that this adjustment could lead to a large number of healthy people being overdiagnosed with hypertension, subjecting them to unnecessary medical intervention and psychological stress.
In China, the decision to maintain existing standards is seen as prudent, taking into account the constraints of treatment resources and the actual situation of the population's health status. However, there is also an argument that as the burden of cardiovascular disease increases, China may need to consider adjusting its diagnostic criteria for hypertension based on new epidemiological data to more effectively prevent and manage hypertension and its complications.
Ultimately, the diagnostic criteria for hypertension in each country should be based on local disease trends, the capacity of the healthcare system, and the health needs of the population. Although the standards of the United States and China are different, each has its own scientific basis and rationality. The key is to find the best balance between early diagnosis and effective management, taking into account socio-economic factors and the practical impact of public health policies.