2018 Chinese Guidelines for the Prevention and Treatment of Hypertension (English Version)
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
Basic Information
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Publication: Published in Journal of Geriatric Cardiology, 2019, 16(3): 182–245 (English full text)
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Chinese Original: Released December 2018 (China Medical Science Press)
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Developed by: Joint Committee for Guideline Revision (Chinese Hypertension League, Chinese Society of Cardiology, etc.)
Core Recommendations (Key Highlights)
1. Definition & Diagnosis
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Hypertension: Office BP ≥ 140/90 mmHg (unchanged from prior editions)
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Classification:
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Normal: <120/80 mmHg
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Elevated: 120–139/80–89 mmHg
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Grade 1: 140–159/90–99 mmHg
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Grade 2: 160–179/100–109 mmHg
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Grade 3: ≥180/110 mmHg
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Isolated systolic hypertension (ISH): SBP ≥140, DBP <90 mmHg
2. Cardiovascular (CV) Risk Stratification
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Stratified into Low, Moderate, High, Very High risk based on:
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BP level
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CV risk factors (age, smoking, dyslipidemia, diabetes, obesity, family history)
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Target organ damage (TOD: left ventricular hypertrophy, renal impairment, etc.)
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Clinical complications (stroke, MI, CKD, etc.)
3. BP Targets
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General population:
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Initial target: <140/90 mmHg
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If tolerated: <130/80 mmHg (especially high-risk)
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Elderly (65–79 years):
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Target: <150 mmHg SBP; if tolerated, <140 mmHg SBP
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≥80 years:
4. Treatment Strategy
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Lifestyle modification: Foundation for all patients (salt restriction, weight control, exercise, smoking/alcohol cessation)
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Pharmacotherapy:
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First-line drugs (5 classes):
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ACE inhibitors (ACEI)
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Angiotensin II receptor blockers (ARB)
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Calcium channel blockers (CCB)
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Thiazide diuretics
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β-blockers
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Initiation:
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Low/moderate risk: lifestyle for 1–3 months; start meds if BP uncontrolled
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High/very high risk or Grade 2–3 hypertension: immediate drug therapy
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Combination therapy: Preferred for Grade 2+ or high-risk; single-pill combinations (SPC) recommended
5. Special Populations
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Diabetes: Target <130/80 mmHg; ACEI/ARB first-line
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Chronic kidney disease (CKD): Target <140/90 mmHg; ACEI/ARB for proteinuria
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Coronary artery disease (CAD): β-blockers + ACEI/ARB + CCB/diuretic
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Pregnancy: Methyldopa, labetalol, nifedipine; avoid ACEI/ARB