2018 Chinese Guidelines for the Prevention and Treatment of Hypertension (English Version)

Basic Information

• Official Full Title: 2018 Chinese Guidelines for Prevention and Treatment of Hypertension—A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension
• Issuing Body: Joint Committee for Guideline Revision (led by Hypertension Alliance (China), Chinese Society of Cardiology, etc.)
• Publication: Published in December 2018 (Chinese version); English full text officially published in Journal of Geriatric Cardiology, 2019, 16(3): 182–241
• DOI: 10.11909/j.issn.1671-5411.2019.03.014
• Core Position: Maintains the diagnostic threshold of office blood pressure (BP) ≥140/90 mmHg (not following the US 130/80 mmHg standard), and adopts a management strategy combining BP levels with cardiovascular risk assessment.

Core Content & Key Recommendations

1. Definition & Classification of Hypertension

• Diagnostic Criterion: Office BP ≥140/90 mmHg (systolic/diastolic).
• Grading:
  • Grade 1: 140–159 / 90–99 mmHg
  • Grade 2: 160–179 / 100–109 mmHg
  • Grade 3: ≥180 / ≥110 mmHg
  • Isolated systolic hypertension: SBP ≥140 mmHg & DBP <90 mmHg
   
• Measurement Methods: Standardized office BP, home BP monitoring (HBPM), ambulatory BP monitoring (ABPM) are all recommended; ABPM is used for white-coat hypertension, masked hypertension, and circadian rhythm assessment.

2. Cardiovascular Risk Stratification

• Stratification based on BP grade + risk factors + target organ damage (TOD) + clinical complications (qualitative stratification: low/moderate/high/very high risk).
• Key risk factors: age (male ≥55, female ≥65), smoking, dyslipidemia, diabetes, family history of premature CVD, obesity, etc.
• TOD: left ventricular hypertrophy, carotid atherosclerosis, renal dysfunction (eGFR decline, microalbuminuria), etc.

3. Non-pharmacological Prevention & Treatment (Lifestyle Interventions)

• Salt restriction: <5 g/day sodium intake (core intervention for Chinese population).
• Weight control: BMI 18.5–23.9 kg/m²; waist circumference <90 cm (men), <85 cm (women).
• Diet: high potassium, high fiber, low fat, low sugar; increase fruits, vegetables, whole grains.
• Exercise: ≥150 min/week moderate aerobic exercise (brisk walking, cycling, etc.).
• Others: quit smoking, limit alcohol, mental stress management, regular sleep.

4. Pharmacological Treatment Principles

• First-line Drugs: 5 classes recommended as initial/maintenance therapy:
  1. ACEIs (Angiotensin-Converting Enzyme Inhibitors)
  2. ARBs (Angiotensin Receptor Blockers)
  3. CCBs (Calcium Channel Blockers, dihydropyridine)
  4. Thiazide diuretics
  5. β-blockers
   
• Treatment Initiation:
  • BP ≥140/90 mmHg + high/very high risk: immediate drug therapy + lifestyle.
  • Moderate/low risk: 1–3 months lifestyle intervention; if BP remains ≥140/90 mmHg, start drugs.
   
• Combination Therapy:
  • Preferred for Grade 2–3 hypertension (≥160/100 mmHg), high/very high risk, or BP >20/10 mmHg above target.
  • Prioritize single-pill combinations (SPCs) for better adherence.
   
• Dosing & Duration:
  • Start with low dose; titrate gradually for elderly/frail patients.
  • Prefer long-acting agents (24-hour control, reduce morning BP surge).
  • Long-term maintenance; avoid abrupt discontinuation.
   

5. BP Targets by Population

6. Management of Special Populations & Comorbidities

• Hypertension + Diabetes: Target <130/80 mmHg; prioritize ACEI/ARB + CCB/diuretic; avoid β-blockers as monotherapy (metabolic effects).
• Hypertension + CKD: ACEI/ARB as first-line (reduce proteinuria); adjust diuretic dose with eGFR decline; avoid hyperkalemia.
• Isolated Systolic Hypertension (Elderly): Prioritize SBP control; use long-acting CCB, thiazide diuretic, ACEI/ARB.
• Resistant Hypertension: Confirm adherence, exclude secondary causes, optimize triple therapy (ACEI/ARB + CCB + diuretic); add mineralocorticoid receptor antagonist (e.g., spironolactone) if needed.
• Secondary Hypertension: Screen for renal parenchymal, renovascular, primary aldosteronism, OSA, drug-induced (NSAIDs, steroids, etc.) causes; treat the etiology first.

7. Prevention & Population Strategy

• Primary Prevention: Focus on population-wide salt reduction, healthy diet, physical activity, weight control, smoking/alcohol control.
• Integrated Management: Integrate hypertension into primary care; combine "general population" and "high-risk population" strategies; use digital health (Internet +) for follow-up and management.
• Goal: Raise awareness, treatment, and control rates; target ~50% control rate by 2025–2030 (consistent with Healthy China 2030).

Official English Full Text Access

1. Journal of Geriatric Cardiology Website:
   • URL: http://www.jgc301.com/article/doi/10.11909/j.issn.1671-5411.2019.03.014
   • Full text PDF available for open access/download.
    
2. PubMed/PMC:
   • PMID: 31955513 (summary/commentary); full text linked to the journal page.
    
3. DXY (Dingxiangyuan) Clinical Guidelines:
   • Platform entry: https://drugs.dxy.cn/pc/clinicalGuidelines/yW-b5jdB5l-8ZoDKpPZn1QQ (English version summary + full text access).
    

Citation Format

Notes

• This English version is the official translation of the 2018 Chinese Revised Guidelines, consistent with the Chinese original in core recommendations.
• For the latest updates, refer to the 2024 Chinese Guidelines for the Prevention and Treatment of Hypertension (revised edition) and international guidelines (ESC/ACC/AHA).