We are very interested in the 2020 International Society of Hypertension global hypertension practice guidelines (2020 ISH global hypertension practice guidelines) [1]. To fulfill the mission of improving the global burden of elevated blood pressure (BP), the ISH developed practice guidelines for global adult hypertension management. After reading and comparing with the Guidelines for the Prevention and Control of Hypertension in China (revised edition 2018) [2], we found that the 2020 ISH guidelines have a profound impact on the prevention and control of hypertension in China. Specific highlights were as follows:
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Scientific and precise diagnosis of hypertension and risk rating: The 2020 ISH global hypertension practice guidelines propose more scientific and precise hypertension diagnostic criteria, emphasizing that BP ≥ 140/90 mmHg can be confirmed as hypertension after repeated BP measurements, and the guidelines also emphasize that office BP measurements need to be obtained two or three times within 1-4 weeks. If BP is ≥180/110 mmHg and there is evidence of cardiovascular disease, the patient can be diagnosed at the first visit, which better excludes interference from other factors. The 2020 ISH global hypertension practice guidelines simplify the grading of hypertension and cardiovascular risk levels, in which third-grade hypertension over 180/110 mmHg was deleted, and only two grades are now included. Based on BP levels and other risk factors, hypertension patients are now divided into three grades, low, middle and high risk, and the extreme high-risk grade was canceled [1]. Because hypertension affects a large proportion of the population (245 million) in China, the number of hypertension doctors is relatively insufficient, and the experience of physicians varies greatly by region, which shows the characteristics of a low awareness rate, treatment rate and control rate in the prevention and treatment of hypertension [2]. This change is simpler, more operable and more easily accepted by Chinese medical workers without changing the risk assessment of patients. It is helpful to match the treatment method with BP level, and then to optimize the treatment strategy and improve the awareness rate of Chinese hypertension patients, then the treatment rate, and ultimately the control rate.
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Simple and feasible objectives and methods of hypertension treatment: As for the antihypertensive targets, the standard of treatment is relative lowering of the initial BP value (the BP needs to be lowered by 20/10 mmHg) and then gradually reaching the target value. The new guidelines innovatively set out two BP management standards: basic and optimal standards. The basic standard indicates that any antihypertensive drugs can be used for lowering BP, and the optimal standard explicitly provides four combined-drug protocols. Patients with 1st-grade hypertension with low risk, older age (≥80 years old) or weakness can be treated with a single drug. If the above conditions are not met, these patients can choose the following antihypertensive treatment protocols: ①combined treatment with two drugs at low dose (1/2 of the largest recommended dose), optimally choosing RAAS blockers+CCB; ② combined treatment with two drugs at full dose, optimally choosing RAAS blockers+CCB; ③ combined treatment with three drugs, optimally choosing RAAS blockers+CCB + diuretics; and ④ combined treatment with three drugs+spironolactone or other drugs [1]. The ideal standard of BP management is for high-income countries and regions, and the basic standard of BP management is for low- and middle-income countries and regions, which are still suitable for China, with a wide geographical distribution and different levels of economic and medical care. For areas with low economic and medical care levels, the basic standard reflects the idea that decompression is the absolute principle, and lowering BP levels can reduce the incidence of cardiovascular and cerebrovascular diseases. For higher-level economies, the optimal standard is adopted, in which BP-lowering treatment is conducted while minimizing the possible side effects of drugs to achieve the dual purpose of reducing BP and ensuring quality of life.
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Detailed and comprehensive influencing factors of hypertension: It is emphasized that there is no enough explicit content in the Guidelines for the Prevention and Control of Hypertension in China (revised edition 2018) on influencing factors of hypertension [2], including the choice of healthy drinks, differences in alcohol intake, weight loss indicators, or air pollution or low-temperature exposure. The 2020 ISH global hypertension practice guidelines describe many comprehensive influencing factors of hypertension. The 2020 ISH global hypertension practice guidelines are very detailed, personalized and similar in style to the recent Japanese hypertension guidelines [3]. The comprehensive and detailed elaboration on the influencing factors of hypertension within the 2020 ISH global hypertension practice guidelines will benefit Chinese hypertension patients more and will play a leading role in the formulation of the guidelines for the prevention and treatment of hypertension in China.
Scientific and precise diagnosis of hypertension and risk rating: The 2020 ISH global hypertension practice guidelines propose more scientific and precise hypertension diagnostic criteria, emphasizing that BP ≥ 140/90 mmHg can be confirmed as hypertension after repeated BP measurements, and the guidelines also emphasize that office BP measurements need to be obtained two or three times within 1-4 weeks. If BP is ≥180/110 mmHg and there is evidence of cardiovascular disease, the patient can be diagnosed at the first visit, which better excludes interference from other factors. The 2020 ISH global hypertension practice guidelines simplify the grading of hypertension and cardiovascular risk levels, in which third-grade hypertension over 180/110 mmHg was deleted, and only two grades are now included. Based on BP levels and other risk factors, hypertension patients are now divided into three grades, low, middle and high risk, and the extreme high-risk grade was canceled [1]. Because hypertension affects a large proportion of the population (245 million) in China, the number of hypertension doctors is relatively insufficient, and the experience of physicians varies greatly by region, which shows the characteristics of a low awareness rate, treatment rate and control rate in the prevention and treatment of hypertension [2]. This change is simpler, more operable and more easily accepted by Chinese medical workers without changing the risk assessment of patients. It is helpful to match the treatment method with BP level, and then to optimize the treatment strategy and improve the awareness rate of Chinese hypertension patients, then the treatment rate, and ultimately the control rate.
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