Heavy! 130／80 mmhg was diagnosed as hypertension! China hypertension clinical practice guidelines released.
On the morning of November 13th, the press conference of Clinical Practice Guide of Hypertension in China was held online.
Based on a large number of high-quality evidences in recent years, the new version of the guidelines has made important adjustments in view of the critical values of hypertension diagnosis and the antihypertensive targets of different populations.
1. The diagnostic threshold of hypertension is lowered.
The new guidelines recommend that the diagnostic threshold of adult hypertension in China be lowered from systolic blood pressure (SBP)≥140mmHg and/or diastolic blood pressure (DBP)≥90mmHg to systolic blood pressure ≥130mmHg and/or diastolic blood pressure ≥80mmHg.
National survey data show that:
Among adults aged 18 and above in China, the proportion of people with SBP130~139mmHg and/or DBP80~89mmHg is 23.2%, and the estimated total number is nearly 243 million.
2. Graded adjustment of blood pressure level
Grade 1: SBP130~139mmHg and/or DBP80~89mmHg.
Grade 2: SBP≥140mmHg and/or DBP≥90mmHg.
3, blood pressure measurement methods and monitoring frequency
1) Measurement method
Get at least two blood pressure readings every time, with an interval of 1~2min, and take the average of the two readings.
If the difference between the first and second blood pressure readings is greater than 10mmHg, it is recommended to measure it for the third time and take the average of the last two blood pressure readings.
2) Monitoring time and frequency
It is recommended to measure blood pressure once every morning and once every night.
It is recommended to measure blood pressure before taking medicine, before breakfast and after emptying bladder in the morning.
It is recommended to measure blood pressure before dinner at night, and within 1 hour before going to bed when conditions do not permit.
For patients who are newly diagnosed or have uncontrolled blood pressure, it is recommended to continue for at least 3 days every week. For patients with good blood pressure control, it is recommended to do it for 1~2 days a week.
4. Simplify cardiovascular risk stratification.
The cardiovascular risk of patients with hypertension is divided into high risk and non-high risk.
1) High-risk patients:
SBP≥140mmHg and/or DBP≥90mmHg;
SBP130~139mmHg and/or DBP80~89mmHg with clinical complications, target organ damage or ≥3 cardiovascular risk factors.
2) Non-high risk patients:
SBP130~139mmHg and/or DBP80~89mmHg and fail to meet the above high-risk standards.
Table 1: Important factors affecting cardiovascular risk stratification in patients with hypertension
5. Adjust the blood pressure control target.
It is suggested that the target value of blood pressure control should be < 130/80mmHg for patients with hypertension who have no clinical complications and are younger than 65 years old.
It is suggested that the target value of blood pressure control should be < 130/80mmHg for hypertensive patients aged 65~79.
For hypertensive patients over 80 years old, it is suggested that SBP should be reduced to < 140mmHg at first, and to < 130mmHg if they can tolerate it.
Table 2: Target value of blood pressure control in hypertensive patients with complications:
6. Non-drug intervention measures for patients with hypertension
It is recommended that patients with hypertension in China should use low sodium salt instead of common salt.
All patients with hypertension should have lifestyle intervention, and non-drug intervention measures are the cornerstone of their treatment.
Table 3: Non-drug intervention measures for patients with hypertension
7, start the timing of antihypertensive drug treatment
1) Patients with high cardiovascular risk stratification: Start antihypertensive drug therapy immediately, including the following three situations:
SBP≥140mmHg and/or DBP≥90mmHg, it is recommended to start antihypertensive drug treatment immediately;
SBP130~139mmHg and/or DBP80~89mmHg with clinical complications, it is recommended to start antihypertensive drug therapy;
SBP130~139mmHg and/or DBP80~89mmHg with target organ damage or ≥3 cardiovascular risk factors can start antihypertensive drug therapy.
2) cardiovascular risk is classified as non-high-risk:
Patients with SBP130~139mmHg and/or DBP80~89mmHg, accompanied by 0~2 cardiovascular risk factors, can undergo lifestyle intervention for 3~6 months. If SBP is still ≥130mmHg and/or DBP≥80mmHg, antihypertensive drug therapy can be considered.
Special reminder
SBP≥140mmHg and/or DBP≥90mmHg, it is recommended to start antihypertensive drug treatment immediately.
It is suggested that patients with hypertension who have no clinical complications and are younger than 65 years old should reach the blood pressure standard within 4 weeks.
8, the choice of antihypertensive drugs
Tips:
ACEI and/or diuretics are recommended as the first choice for hypertensive patients with a history of stroke or transient ischemic attack (TIA). If the above drugs are not applicable or the effect is not good, CCB or ARB； can be selected; Beta blockers are not recommended as first-line antihypertensive drugs.
Table 4: Recommended antihypertensive drugs
9. The principle of lowering blood pressure in acute phase of hypertension emergency.
The decrease of SBP within the first hour of treatment did not exceed 25% of the pre-treatment level;
If the condition is stable, the blood pressure will be reduced to about 160/100mmHg within the following 2 ~ 6 hours;
After that, the blood pressure was gradually reduced to the target level within 24 ~ 48 hours.
For hypertensive emergency patients with severe complications (such as severe preeclampsia or eclampsia, pheochromocytoma crisis, etc.), it is suggested that SBP should be reduced to below 140mmHg within the first hour of treatment.
For hypertensive emergency patients with aortic dissection, it is suggested that SBP should be reduced to 110~120mmHg within 1 hour, and the heart rate should be controlled at < 60 beats /min.
Source: chinese journal of cardiovascular medicine.