2010 Chinese guidelines for the management of hypertension

The 2010 Chinese guidelines for the management of hypertension is an update of the previous versions in 2005 and 1999. A guideline committee of nearly 100 members appointed by the Chinese Hypertension League (CHL) and the National Centre for Cardiovascular Disease (NCCD), in collaboration with the Chinese societies of cardiology, nephrology, neurology, gynecology and endocrinology, convened on several occasions and discussed the guidelines, drafted by a core writing group. The prevalence of hypertension has been increasing in China for decades, and reached 18.8% in the year 2002. Although substantial improvements have been made since 1991, the rates of awareness, treatment and control for hypertension remain low compared to high income countries In some communities, the control rate of hypertension has increased up to 60%. The mortality rate of stroke, which is the major complication of hypertension in the Chinese population, gradually decreased during the period, more so in urban areas than in rural areas for the middle-aged and elderly populations. In the younger age groups, however, it increased. As hypertension is a “cardiovascular syndrome”, the management strategy should be based on the overall risk of cardiovascular disease estimated with all related risk factors, target organ damage and comorbidity of patients. The target blood pressure is set at SBP/DBP <140/90 mm Hg (1 mm Hg=0.133 kPa) in uncomplicated hypertension; <150/90 mm Hg for the elderly (≥65 years) or, if tolerable, <140/90 mm Hg; and <130/80 mm Hg for those with diabetes, coronary heart disease or renal disease. For these high risk patients, the management should be individualized. In general, lifestyle modification, such as sodium restriction, smoking cessation, moderation of body weight and alcohol consumption, and increasing dietary potassium intake and physical activity, should be implemented for prevention and control of hypertension. Five classes of antihypertensive drugs, including calcium channel blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, diuretics and β receptor blockers, as well as single pill combinations of these agents, can be used for initial and maintenance of antihypertensive treatment. Several populations require special attention in the prevention and control of hypertension, such as children and adolescents, the elderly, pregnant women, and patients with various cardiovascular complications. Since health care policies and resources vary substantially from one place to another, two levels of recommendations of management are proposed: a sophisticated level and a basic level, allowing doctors-in-charge to manage their patients in a more feasible way.