Why is there always controversy over the diagnostic criteria for hypertension? 2 aspects explained!

In 2022, the topic of whether blood pressure ≥130/80 mmHg (1 mmHg = 0.133 kPa) should be used as the diagnostic standard for hypertension in adults in my country, and whether patients with "hypertension" who reach or exceed this level should start drug antihypertensive treatment after months of ineffective lifestyle adjustments has aroused heated discussions in the academic community and aroused the attention of the whole society, becoming the focus of discussion on the entire network. Subsequently, the National Health Commission released a message through its official media platform, pointing out that the diagnostic standard for hypertension in adults in my country has not changed, and it is still 3 blood pressures ≥140/90 mmHg on different days. Although the country has not adjusted the diagnostic standard for hypertension in adults, there has always been controversy about the diagnostic standard for hypertension. It even causes misunderstandings in clinical diagnosis to some extent. So, what is the debate about the adjustment of the diagnostic standard for hypertension? Low blood pressure obviously "does more good than harm" to the prevention and treatment of diseases to some extent, so why not clearly lower it?

First of all, when answering the above two questions, we must understand that determining the diagnostic criteria for hypertension is not a purely academic issue!

In fact, the main point of contention about the diagnosis standard of blood pressure is still based on the diagnosis and treatment of the disease and the impact of the change of the standard on all sectors of society. That is, is the lowering of the blood pressure diagnosis standard "more merit than demerit" or "less merit than demerit". From the perspective of my country's current social development, it is obviously still restricted to some extent. Because the determination of the diagnostic standard of hypertension is not a simple academic issue, it involves a wide range of aspects. Although the results of various studies in recent years have shown that controlling the blood pressure standard below 130/80 mmHg is conducive to the prevention and control of organ diseases such as the heart, brain and kidney. However, if this standard is implemented, the number of hypertensive patients in my country will increase to nearly 500 million, which means that this number is twice the number when the standard was not lowered, and with the increase in the number of patients, the number of people receiving drug treatment will inevitably increase significantly. Then, based on this situation, its necessity and feasibility will obviously cause doubts in the academic community, so there is a debate about whether to adjust or not.

In addition, once the diagnostic criteria for hypertension are lowered, the workload of primary medical and health institutions and medical insurance expenditures will face tremendous pressure and impact. Obviously, this is a necessary consideration for the feasibility of lowering the diagnostic criteria for hypertension. At the same time, the impact on the occupations and lives of social groups must also be considered. At this point, the focus of the debate is obvious. So, based on this situation, does it mean that the lowering of the standards for hypertension is unattainable? Actually not!

The prerequisite for lowering hypertension is to understand the underlying logic behind adjusting the diagnostic criteria.

First of all, we need to understand that lowering high blood pressure is not just a reduction in a numerical value, and we should know the logic behind adjusting the diagnostic criteria.

The diagnostic cut-off point and intervention threshold for hypertension are not unchangeable, but the right time for adjustment is key. The factors that determine whether to adjust include at least: broad consensus in the industry, general recognition by the public, significant results in blood pressure management, and strong support from social security. The current consensus in the academic community is that when the awareness and control rates of hypertension in the general population reach a high level and the baseline blood pressure level is low, there is sufficient and strong research evidence on the benefits of antihypertensive treatment. At this time, lowering the diagnostic criteria for hypertension becomes an inevitable choice.

At present, except for the United States, which lowered the diagnostic standard for hypertension to 130/80 mmHg in 2017, and Taiwan, China, no other country or region has followed the US approach.

Because the United States and Taiwan lowered the diagnostic criteria for hypertension based on the management level and quality and efficiency of the hypertensive population. The adult hypertension control rate in the United States is close to 60%, and Taiwan is similar. One of the important means to further reduce the risk of cardiovascular disease mortality and blood pressure-related target organ diseases in these countries and regions is to include more people who do not fall into the traditional blood pressure management category but have a certain degree of cardiovascular disease risk into blood pressure management through screening and evaluation, that is, early detection and early intervention, and lowering the blood pressure of those with high-risk characteristics to a lower level. Therefore, lowering the "entry threshold" for hypertension and promoting the "enhanced blood pressure reduction" management model have become inevitable options.

The awareness rate of hypertension in my country is only 46.9%, the blood pressure control rate under the current standard is only 15.3%, and only 37.5% of the hypertensive patients receiving treatment have achieved the target blood pressure reduction. The blood pressure control rate is only 1/4 of that in the United States, and many adults have never measured their blood pressure once in their lives. To achieve the goal of improving the "three rates" of the hypertensive population in my country and improving cardiovascular health, at this stage, it is still necessary to start with basic work such as raising the awareness of blood pressure measurement among the entire population, early detection, treatment and standardized management of hypertensive patients diagnosed under the current standards, rather than achieving it by lowering the diagnostic standards for hypertension. Therefore, changes in diagnostic standards are different from intervention goals, and the two cannot be forced to be consistent.

summary

Therefore, whether the diagnostic criteria for hypertension need to be adjusted should be determined based on my country's national conditions. In the process of disease prevention and treatment, patients with high-risk factors should be given more control. The awareness of hypertension prevention should be raised throughout the nation to achieve early detection and early treatment. After that, we can consider whether to make adjustments at an appropriate time.

References:

Zhang Xinjun. Do the diagnostic criteria for hypertension in adults in my country need to be adjusted?[J]. Chinese Journal of Hypertension, 2022, 30(12):1103-1105.