Expert: Move the threshold forward, early prevention and early treatment

Recently, the "Chinese Clinical Practice Guidelines for Hypertension" (hereinafter referred to as the "Guidelines") jointly formulated by the National Center for Cardiovascular Diseases, the Chinese Medical Doctor Association and other institutions was released, involving 44 key clinical issues related to the diagnosis and treatment of hypertension, and 102 recommendations were given
.
Among them, the change of hypertension diagnostic criteria has aroused strong concern in the society: the Guidelines have lowered the original clinical diagnostic criteria for hypertension from ≥140/90mmHg to ≥130/80mmHg
.
The lowered standard has made many people who were originally in the "critical line" wear the hat
of "high blood pressure".
In response, the National Health Commission responded, "Regarding the diagnostic criteria for hypertension, the publicity and education points, prevention and treatment guidelines, and clinical pathways issued by the national health administrative department in 2005, 2010 and 2017 are clear: the diagnostic criteria for adult hypertension are blood pressure exceeding 140/90mmHg
three times a day.
" At present, the country has not adjusted the diagnostic criteria for hypertension in adults"
.
So, what is the intention of the Guidelines to adjust the diagnostic criteria? What is the significance of the prevention and treatment of hypertension in the population?

The new diagnostic criteria are the same as those in the world, and the number of hypertensive patients in China will double in the short term

The National Health Commission issued an article through the "Healthy China" WeChat account: hypertension is a chronic disease
that seriously endangers the health of Chinese residents.
The state has continuously increased the prevention and treatment of hypertension, focusing on high-risk groups to promote health management, and promote the prevention and control threshold forward
.
After years of efforts, the awareness, treatment and control rates of hypertension have continued to improve, and great progress
has been made in prevention and treatment.
The state has standardized procedural requirements
for the formulation and issuance of diagnostic standards for hypertension and other diseases.
Guidelines, consensus, etc.
issued by professional institutions, industry associations, individuals, etc.
, are the research results of experts and are not used as national disease diagnostic standards
.

In fact, the threshold for diagnosing hypertension in China has been revised downward for
decades.
In 1977, the international diagnostic threshold for hypertension was changed to systolic blood pressure ≥ 160, or diastolic blood pressure ≥95
.
In 1997, the World Health Organization adjusted the diagnostic threshold for hypertension again to systolic blood pressure ≥ 140, or diastolic blood pressure ≥90
.
This standard was subsequently used in our country and is still used today
.

As the most common chronic disease, hypertension is also the most important risk factor for cardiovascular and cerebrovascular diseases, and is the main complication
of stroke, myocardial infarction, heart failure and chronic kidney disease.
Cardiovascular and cerebrovascular diseases not only have a high disability rate, but also have become one of the leading causes of
death among Chinese residents.

According to public information, in 2017, the United States revised the diagnostic criteria for hypertension to blood pressure ≥ 130/80mmHg, replacing the previous ≥ 140/90mmHg
.
In the latest European guidelines for the treatment of hypertension in children and adolescents released this year, hypertension is defined as more than 130/80mmHg
.
In other words, more and more countries are beginning to recognize 130/80mmHg, a new diagnostic criterion
for hypertension.

Hu Dayi, chief physician of the Department of Cardiology at Peking University People's Hospital, revealed that a few years ago, an international double-blind clinical trial led by foreign institutions had randomly divided hypertensive patients into two groups, one group controlled blood pressure below 140/90mmHg, and the other group reduced blood pressure below 130/80mmHg
.
The results found that the latter group of hypertensive patients had a relatively smaller risk of stroke, myocardial infarction and cardiovascular death, thus promoting the adjustment
of international hypertension diagnostic standards.

"According to the diagnostic criteria of the Guidelines, there will be a short-term surge
in the number of patients.
" Ying Xiaoying, deputy chief physician of the Department of Cardiology of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, said that according to the original 140/90mmHg cut-off value, there are about 250 million people with hypertension in China; after adjusting to 130/80mmHg, the data directly soared to 500-600 million people
.
"But we need to note that blood pressure data exists objectively regardless
of how the criteria change.
Hypertension is not only a chronic non-communicable disease with the largest number of people in China, but also the most important risk factor for cardiovascular disease death among urban and rural residents, and it is positively correlated with age, which requires vigilance
.
She believes that letting more people "wear hats" aims to move the prevention and control threshold forward, have a sense of prevention and control earlier, and take the initiative to seek medical intervention
.

In addition, the "Guidelines" changed the grading standards, originally according to the systolic blood pressure of 140, 160, 180 respectively defined as grade 1, 2, 3 hypertension, the "Guidelines" listed 130-139mmHg/80-89mmHg as grade 1 hypertension, greater than 140/90mmHg are classified as grade 2 hypertension
.

What is the significance of such a rating? Ying Xiaoying said that according to the results of big data surveys, most of the grade 1 hypertension are middle-aged and young people with hypertension aged 18-54 in China
.
In addition to genetic factors, most patients have other risk factors for cardiovascular disease, such as overweight, obesity, blood glucose dyslipidemia, poor lifestyle, etc.
, "through the new classification, such patients can be identified earlier, and the risk of cardiovascular disease will be reduced in the future"
.

"China's hypertensive population base is large, after this adjustment, it is not to let the public 'talk about disease discoloration', but to pay earlier and better attention to hypertension and disease risk
.
" Ying Xiaoying said
.

The Guidelines make it clear that there is still a lack of strong evidence-based medical evidence
before clinical questioning.
Huang Xinghe, a lecturer at Peking Union Medical College, believes that the main basis of the Guidelines is based on the results of European and American research
.
She introduced that some scholars in China are conducting a study focusing on antihypertensive target values and cardiovascular benefits, which may provide a better evidence-based medical evidence
for clinical practice.
"From the overall trend, the diagnostic criteria for hypertension have dropped to 130/80mmHg, or the general trend
.
" Huang Xinghe said
.

Medication accounts for only 5 points, and the daily diet should pay attention to "high potassium and low sodium"

Many people believe that after the surge in high blood pressure people, does it mean that the cost of medication becomes higher and the cost of medical insurance becomes larger? Ying Xiaoying said, "Although the number of patients has doubled, not all new grade 1 hypertension patients need drug treatment
.
The guidelines also point out that only 22% of patients meet the criteria for initiating drug therapy, and the rest of the patients can use non-drug treatment interventions such as diet control, aerobic exercise, smoking cessation and alcohol withdrawal, and then decide whether to use drugs
after follow-up.

"But at the same time, the guidelines also have new recommendations for the treatment of patients ≥ 140/90mmHg: in the past, many patients would undergo 3-6 months of observation and follow-up after the diagnosis was clear, and now they will immediately start drug treatment; In patients with grade 1 hypertension, drug therapy
should also be started immediately if there are other comorbidities (diabetes, heart disease, stroke, etc.
), more than 3 risk factors, or organ damage such as kidneys has occurred.
She believes that advancing the timing of treatment will better intervene and control the development of the disease, and will also be conducive to blood pressure control
.
For most patients, our post-treatment goal is to reduce to less than
130/80 mmHg.
”

For patients who have been diagnosed with hypertension before, Hu Dayi suggested that the latest diagnostic criteria for hypertension should be used as the goal of active treatment, and correspondingly drugs may be added to regulate through exercise, diet and other aspects
.
If there are no other disorders (eg, poor renal function) or malaise, older patients should also aim for 130/80 mmHg to regulate blood pressure, as lowering blood pressure does not lead to cerebral ischemia
.

Hu Dayi reminded that at present, there are many young patients with hypertension in China, and the unhealthy lifestyles associated with this include lack of exercise, heavy drinking, unhealthy diet, obesity and so on
.
Among them, obese people are prone to sleep apnea, a condition that is also associated
with high blood pressure.
Overweight or obese people, such as "managing the mouth, opening the legs, eating and moving the balance", using 3-6 months to lose 10% of their weight, blood pressure, blood sugar, triglycerides and fatty liver will improve
comprehensively.

Negative emotions and psychological diseases such as anxiety and depression can also lead to fluctuations in blood pressure, and the blood pressure in this case is not stable, which cannot be solved by taking antihypertensive drugs alone, and it is also necessary to "cure the root"
by regulating emotions.

Hu Dayi particularly emphasized that for young and middle-aged hypertensive patients with blood pressure values between 130/80mmHg and 140/90mmHg, it is recommended not to take medicine immediately, but to use five prescriptions that effectively control hypertension, namely drug prescription, exercise prescription, nutrition prescription, mental and psychological sleep prescription, smoking cessation and alcohol restriction prescription
.

"In the outpatient clinic, we often tell patients with high blood pressure that taking medicine only accounts for 5 points of treatment, and the remaining 5 points have to be relied on themselves
.
" Ying Xiaoying said that China is a high-sodium diet country, heavy oil and salt meals are delicious, but they are also the "culprits"
of high blood pressure.
"At present, the average daily intake of Chinese adults is 10 grams of salt, but the guidelines recommend that the daily intake should be less than 5 grams, which is a small spoon
on the surface of the matcha teaspoon.
"

What foods are high in sodium? "In addition to putting salt when cooking vegetables, soy sauce also contains salt; There is a lot of sodium salt
in snacks and takeaways.
Ying Xiaoying said that the guidelines mentioned that for hypertensive patients, it is recommended to replace sodium salt with potassium salt, "because low-sodium and high-potassium diet has a positive effect on hypertension control, but if the patient has renal insufficiency, hyperkalemia, etc.
, should follow the doctor's advice, we recommend potassium supplementation through natural foods, such as DASH (Dietary Approaches to Stop Hypertension) diet, daily intake of enough vegetables, fruits, low-fat (or skimmed) milk, Maintaining adequate intake of potassium, magnesium, calcium and other ions, and minimizing the amount of fat in the diet (especially animal fats rich in saturated fatty acids), can effectively lower blood pressure
.
”

With the development of economy and society, the improvement of residents' living standards, the incidence and prevalence of chronic diseases such as hypertension in China are on the rise, and the prevention and management of hypertension has a long
way to go.
"It is necessary to increase publicity and explain the whole process of blood pressure from normal to abnormal to abnormal to more clearly, so that the people can truly understand the harm of hypertension and increase the prevention and treatment of hypertension
.
" Wang Xiaoyue, director of the Institute of Endocrinology of Yueyang Central Hospital in Hunan Province, said
.
Zhang Guogang, president of the Third Xiangya Hospital of Central South University, also said, "The incidence
of hypertension can be reduced by exercising more, not smoking, and controlling weight.
" Hypertension is a preventable and controllable disease, as long as hypertension is controlled to the standard, its complication rate will be significantly reduced, and there will be little impact
on the life expectancy of residents.
”

(Han Songyan, comprehensive arrangement)

China Food News(Version 03, December 14, 2022)

(Responsible editor: Han Songyan).