After a lapse of five years, a new version of hypertension prevention and treatment guidelines will be released soon. On March 11th, at the 2022 China Annual Meeting on Hypertension and the 24th International Symposium on Hypertension and Related Diseases, experts and scholars who participated in the revision of the guidelines interpreted the key points of updating the Guidelines for Prevention and Treatment of Hypertension in China.
1. Northerners are more prone to hypertension than southerners. Professor Wang Zengwu from Fuwai Hospital of China Academy of Medical Sciences introduced the prevalence of hypertension in China. According to the latest survey data of hypertension in China, in 2018, the weighted prevalence rate of hypertension among adults over 18 years old in China was 27.5%, and the prevalence rate of hypertension in China showed an overall upward trend, especially among young and middle-aged people in recent years. From the south to the north, the prevalence of hypertension is increasing; The prevalence of hypertension in rural areas is increasing faster than that in cities. Among them, high sodium and low potassium diet, smoking, social and psychological factors, overweight and obesity, excessive drinking and old age are important risk factors for hypertension in China.
Second, the diagnostic threshold of hypertension is still 140/90mmHg. The diagnostic threshold of hypertension is the blood pressure in the clinic (measured three times on the same day) ≥140/90mmHg. Professor Wang Jiguang from Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine introduced the evaluation of various blood pressure measurement methods. Routine clinic blood pressure is a common method for diagnosing hypertension, grading blood pressure levels and observing the antihypertensive effect in China. The automatic blood pressure measurement system in clinic will contribute to the standardization of blood pressure measurement in clinic. Blood pressure measurement outside the clinic should be carried out as far as possible to diagnose hypertension, evaluate the antihypertensive effect, and identify white coat hypertension, concealed hypertension and refractory hypertension. Ambulatory blood pressure monitoring can also observe the circadian rhythm of blood pressure, blood pressure at night, blood pressure in the morning and so on. For the first time, the new guidelines suggest that hypertension can be diagnosed according to out-of-office blood pressure (ambulatory blood pressure monitoring and family blood pressure monitoring), and emphasize the determination of hypertension phenotype based on out-of-office blood pressure and out-of-office blood pressure, and carry out classified management.
Third, the blood pressure is high, starting with improving the lifestyle. Professor Zhang Yuqing from Fuwai Hospital of China Academy of Medical Sciences focused on the timing of starting antihypertensive drug therapy, which depends on the overall cardiovascular risk including blood pressure level. Patients with hypertension whose blood pressure level is ≥160/100 mmHg should start antihypertensive drug therapy immediately, patients with hypertension whose blood pressure level is 140~159/90~99 mmHg, and those with high or very high cardiovascular risk should start antihypertensive drug therapy immediately; Low-risk and middle-risk people can improve their lifestyle for 4 to 12 weeks. If their blood pressure is still not up to standard, they should start antihypertensive drug treatment as soon as possible. People with normal high blood pressure level of 130~139/85~89 mmHg, those with high cardiovascular risk and very high risk should start antihypertensive drug treatment immediately; At present, there is no evidence that low-risk and middle-risk people can benefit from drug antihypertensive treatment, so it is suggested to continue lifestyle intervention.
IV. Lifestyle intervention changed from seven to eight. Professor Sun Ningling from Peking University People’s Hospital summarized the main points of lifestyle intervention for hypertension. Lifestyle intervention changed from seven in 2018 to eight in 2023 (reducing sodium intake, increasing potassium intake, reasonable diet, controlling weight, not smoking, limiting alcohol consumption, increasing exercise, psychological balance and managing sleep), and added measures of "managing sleep".
1. Reduce sodium intake and increase potassium intake.
The salt reduction measures are more clear and accurate: the sodium limit is reduced from < 6g to < ＜5g；;
Using simple urine counting formula to evaluate salt intake;
Taking potassium supplements (including drugs) to lower blood pressure is not recommended;
Renal function should be evaluated before applying low sodium and rich potassium salt. Those with good renal function are recommended to choose low sodium and rich potassium instead of salt; People with renal insufficiency should consult a doctor before supplementing potassium.
2. The new guidelines for rational diet recommend patients to adopt DASH diet, CHH diet and spicy diet mode to lower blood pressure.
3. Restricting drinking any type of alcohol is not beneficial to human body, and it is suggested that hypertensive patients should not drink alcohol to minimize health loss;
If you drink alcohol, the daily alcohol intake of adults should not exceed 15g；;
Evaluate the alcohol use and make personalized intervention plan according to the results.
4. Control normal weight, high blood pressure and all patients with hypertension should actively control their weight;
All overweight and obese patients lose weight;
Taking weight loss of 5%-15% or more as the goal of weight management; Lose 5%-10% of the initial weight within one year;
Firstly, weight control through comprehensive lifestyle intervention, including self-monitoring weight, reasonable diet, increasing physical activity/exercise and behavioral intervention;
For those who are not satisfied with the effect of comprehensive lifestyle intervention on weight loss, drug therapy or surgical treatment is recommended;
For special groups, such as lactating women and the elderly, individualized weight loss measures should be adopted according to specific conditions;
We should stick to the weight loss plan for a long time, the speed varies from person to person, and we should not rush for success. 5. Exercise intervention patients can take aerobic exercise, resistance exercise, meditation and breathing training, flexibility training and stretching training and other exercise intervention measures. For hypertensive patients with good blood pressure control, it is recommended to take aerobic exercise as the main training (moderate intensity, 30 min per day, 5-7 days per week), supplemented by resistance exercise (2-3 times per week); It is also suggested to combine breathing training with flexibility and stretching training. For those whose blood pressure is not controlled (SBP >160mmHg), high-intensity exercise is not recommended until the blood pressure is controlled.
6. Non-smokers should strongly advise and urge hypertensive smokers to quit smoking;
When necessary, use smoking cessation drugs to fight withdrawal reaction;
Try to avoid using electronic cigarette replacement therapy;
When quitting smoking, supplemented by physical exercise;
Joint smoking cessation intervention;
Personalized smoking cessation intervention.
7. Maintain psychological balance
Self-adjustment to avoid psychological imbalance;
Establish defensive barriers and maintain psychological balance, such as physical defense, emotional defense and spiritual defense.
8. Managing sleep to increase effective sleep time and/or improve sleep quality can significantly improve the efficacy of antihypertensive drugs and reduce the incidence and mortality of hypertension. The main measures to manage sleep include sleep assessment, sleep cognitive behavioral therapy and medication when necessary.
5. Patients with hypertension should usually take antihypertensive drugs in the morning.
Professor Chen Luyuan from Guangdong Provincial People’s Hospital systematically combed the drug treatment of hypertension. Professor Chen Luyuan pointed out that compared with the 2018 guide, the new version of the guide increased the time for taking medicine. Ordinary hypertensive patients should usually take medicine in the morning. Unless there is a clear need to control the increase of blood pressure at night, it is not recommended to take antihypertensive drugs before going to bed. In addition, the basic principles of the application of antihypertensive drugs include risk reduction, long-term hypotension, combined therapy, initial dose, medication time and individualized treatment. It is suggested to choose antihypertensive drugs with evidence to reduce the risk of cardiovascular disease and death, so as to reduce the risk of patients.
Sixth, the standard of blood pressure reduction for the elderly after the age of 80 can be appropriately relaxed. Professor Zhang Xinjun of west china hospital explained the treatment of hypertension for special people, and added the clinical evaluation of hypertension in the elderly compared with the 2018 and 2023 editions of the guidelines.
Suggestion: the target of blood pressure reduction for the elderly aged 65 ~ 79 is < 140/90 mmhg, and it can be reduced to < ＜130/80 mmHg； if the patient can tolerate it; The target of blood pressure reduction for the elderly aged 80 and above is < ＜150/90 mmHg.
The goal of lowering blood pressure in patients with multiple comorbidity or senile syndrome needs to be individualized, and the goal of SBP in frail patients should be less than ＜150 mmHg and not less than ＜130 mmHg.
Seven, some foods and drugs can also cause hypertension.
Professor Li Nanfang from People’s Hospital of Xinjiang Uygur Autonomous Region mainly interprets secondary hypertension, and some foods and drugs can also cause hypertension.
Food-induced hypertension is related to diet. Among them, too much sodium intake and too much saturated fatty acid in diet are closely related to the changes of blood pressure. Reasonable diet is beneficial to prevent and treat hypertension and reduce the risk of cardiovascular disease.
Drug-induced hypertension Drug-induced hypertension refers to the increase of blood pressure caused by the interaction between the conventional dose of the drug itself or the drug and other drugs. When the blood pressure is greater than ＞140/90 mmHg, drug-induced hypertension is considered. Drugs that can cause hypertension mainly include non-steroidal drugs, antihistamines, thyroid hormones, antidepressants, oral contraceptives, anti-tumor drugs, catecholamine drugs and so on.
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