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Highlights of the 2018 Chinese hypertension guidelines

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Background: Blood pressure (BP) are uncontrolled in over 80% hypertensive population in China, indicating a compelling need for a pragmatic hypertension management strategy. The 2018 Chinese hypertension guidelines issued in 2019, after 3 years revision. During the periods, the latest United States (US) and European guidelines successively published, bringing new thoughts, wisdoms and schemes on hypertension management. This review aims to summarize the highlights of the new Chinese guidelines. Main text: Despite the fact that the 2017 US hypertension guidelines changed hypertension definition from ≥140/90 mmHg to 130/80 mmHg, the Chinese hypertension guidelines did not follow suit, and maintained 140/ 90 mmHg as the cut-point of for diagnosis of hypertension. A combined, cardiovascular risks and BP levels-based antihypertensive treatment algorithm was introduced. Five classes of antihypertensive drugs, including β-blockers were recommended as initiation and maintenance of BP-lowering therapy. Initiating combination therapy, including single pill combination (SPC) was indicated in high-risk patients or those with grade 2 or 3 hypertension. For those with grade 1 hypertension (BP ≥ 140/90 mmHg), an initial low-dose antihypertensive drugs combination treatment could be considered. Conclusions: China has never stopped exploring the best strategy for improving hypertension control. Based on clinical evidence and expertise, the newest Chinese guidelines and expert consensus will be of help in guiding physicians and practitioners to provide better management of hypertension in China.

Abstract

Background: Blood pressure (BP) are uncontrolled in over 80% hypertensive population in China, indicating a compelling need for a pragmatic hypertension management strategy. The 2018 Chinese hypertension guidelines issued in 2019, after 3 years revision. During the periods, the latest United States (US) and European guidelines successively published, bringing new thoughts, wisdoms and schemes on hypertension management. This review aims to summarize the highlights of the new Chinese guidelines. Main text: Despite the fact that the 2017 US hypertension guidelines changed hypertension definition from ≥140/90 mmHg to 130/80 mmHg, the Chinese hypertension guidelines did not follow suit, and maintained 140/ 90 mmHg as the cut-point of for diagnosis of hypertension. A combined, cardiovascular risks and BP levels-based antihypertensive treatment algorithm was introduced. Five classes of antihypertensive drugs, including β-blockers were recommended as initiation and maintenance of BP-lowering therapy. Initiating combination therapy, including single pill combination (SPC) was indicated in high-risk patients or those with grade 2 or 3 hypertension. For those with grade 1 hypertension (BP ≥ 140/90 mmHg), an initial low-dose antihypertensive drugs combination treatment could be considered. Conclusions: China has never stopped exploring the best strategy for improving hypertension control. Based on clinical evidence and expertise, the newest Chinese guidelines and expert consensus will be of help in guiding physicians and practitioners to provide better management of hypertension in China.

참고문헌 (17)

  1. Joint Committee for guideline revision, "2018 Chinese guidelines for prevention and treatment of hypertension—a report of the revision committee of Chinese guidelines for prevention and treatment of hypertension", J Geriatr Cardiol, 16(3), pp.182~241 (2019)
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  8. Hae-Young Lee, "2018 Korean Society of Hypertension Guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension", Clinical Hypertension, 25(4), pp.51~74 (2019), 대한고혈압학회[DOI]
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  13. The SPRINT Research Group, "A randomized trial of intensive versus standard blood-pressure control", N Engl J Med, 373(22), pp.2103~2116 (2015)
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  15. Su M, "Availability, cost, and prescription patterns of antihypertensive medications in primary health care in China : a nationwide cross-sectional survey", Lancet, 390, pp.2559~2568 (2017)
  16. Qi Y, "Long-term cardiovascular risk associated with stage 1 hypertension defined by the 2017 ACC", AHA hypertension guideline, 2018, pp.72, 1201~1210
  17. Jing Liu, "Expert consensus on the management of hypertension in the young and middle‐aged Chinese population", International Journal of Clinical Practice, 73(12), pp.e13426~ (2019), Wiley[DOI]

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