Highlights of the 2018 Chinese hypertension guidelines

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.

Keywords: Chinese; Guidelines; Hypertension.

Fig. 1

Evaluation and monitoring procedures for newly diagnosed hypertension. Diagnostic criteria of hypertension for ABPM: daytime mean SBP ≥ 135 mmHg or DBP ≥ 85 mmHg, nighttime mean SBP ≥ 120 mmHg or DBP ≥ 70 mmHg, or 24-h mean SBP ≥ 130 mmHg or DBP ≥ 80 mmHg; Criteria for HBPM: mean SBP ≥ 135 mmHg or DBP ≥ 85 mmHg. High risk patients with BP 130–139/85–89 mmHg or above, or moderate risk patients with BP ≥ 160/100 mmHg should start drug therapy immediately. ABPM: ambulatory blood pressure monitoring; BP: blood pressure; CBPM: clinic blood pressure measurement; DBP: diastolic blood pressure; HBPM: home blood pressure monitoring; SBP: systolic blood pressure

Fig. 2

Flowchart for BP-lowering drugs therapy. A: ACEI or ARB; B: β-blockers; C:dihydropyridines CCB; D: thiazide-type diuretics; F: fixed-dose combination drugs.*For those with BP ≥ 140/90 mmHg and at high risk, initial low-dose combination therapy can also be recommended; **Including dosage titration and sequential addition of other agents to achieve BP target