The present analysis indicates the potential impacts of 2017 ACC/AHA guideline definition of hypertension, recommendation for anti-hypertensive medication in addition to nonpharmacological interventions and blood pressure goals with anti-hypertensive drug treatment for Chinese adults (Figure).. The present analysis revealed that 2017 ACC/AHA hypertension guideline will result in a substantial increase in the percentage and number of Chinese adults defined as having hypertension. However, the percentage of adults who are recommended anti-hypertensive medications will only be a small increase (2.7%) according to the 2017 ACC/AHA guideline compared to the 2010 Chinese guideline. In addition, 35.5% of Chinese adults taking anti-hypertensive medication had a blood pressure above the goal defined by the 2017 ACC/AHA guideline whereas they would have met the BP goal according to the 2010 Chinese guideline. More intensive management and anti-hypertensive medications are suggested to improve the control rate of hypertension among Chinese adults.
There is no doubt that the percentage and number of hypertension will have a substantial increase accompanying with the change in definition of hypertension according to the 2017 ACC/AHA guideline1. The prevalence of hypertension among US adults will have a relative 40% increase (from 31.9% to 45.6%)3. However, the present analysis indicates that the prevalence of hypertension among Chinese adults will increase from 25.6% to 55.6% according to the 2017 ACC/AHA guideline and the number of having hypertension will also increased steeply from 260 million to 630 million. So many new prevalent cases will be diagnosed because of 2017 ACC/AHA guideline. How to face the challenge? In fact, the percentage of adults with SBP/DBP of 130–139/80–89 mmHg contributes to the deviation according to the 2017 ACC/AHA guideline. Although several observational studies have demonstrated an association between the blood pressure of 130–139/80–89 mmHg and the risk of incident CVD 11–15, the 2017 ACC/AHA writing committee still emphasized there is insufficient evidence to support a recommendation for anti-hypertensive drug treatment for these individuals can obtain more benefits 3. However, it can provide an opportunity to discuss the value of nonpharmacological therapy in lowering blood pressure, to implement recommended lifestyle changes and to emphasize that blood pressure is a risk factor that can be controlled. Therefore, the aim of the definition is to raise these individuals awareness that implement recommended lifestyle changes and the definition of hypertension is mostly acceptable in China.
In addition, according to the 2017 ACC/AHA guideline, the recommended anti-hypertensive medication among US adults increased by 1.9% 3, while in the present study, the recommended anti-hypertensive medication will increase from 28.8% to 31.5% according to the 2017 ACC/AHA guideline and the 2010 Chinese guideline. The corresponding number of having anti-hypertensive medication will increase 28.4 million. However, we have to demonstrate that we didn’t consider the adults with CVD risk>10% because of the shortage of data in this study. So, the percentage and number of recommended anti-hypertensive medication will continue to increase if take the CVD risk into account. The 2017 ACC/AHA guideline using a combination of CVD risk and blood pressure levels to consider anti-hypertensive medications primarily based on the results of a diverse set of data from post-hoc randomized clinical trials, observational studies and computer simulation analyses 16, 17. Large-scale RCTs focus on the issue regarding combination the CVD risk and blood pressure levels to consider anti-hypertensive medications should be further encouraged. In addition, using the pooling CVD risk equation is not fully popularized in clinical practice and is not feasible to evaluate in primary health care services in China. We also have to consider the overuse of anti-hypertensive drugs with the 2017 ACC/AHA guideline concerning recommended anti-hypertensive medication. Finally, we should consider the recommendation carefully and do some researches in diverse population to focus on the necessity of taking anti-hypertensive medications in China.
The control rate of hypertension is relatively low compared to the western countries though it is increasing in recent years4, 5. According to the 2017 ACC/AHA hypertension guideline, the percentage of blood pressure above the goal increased from 39.0% to 53.4% in US and increase from 53.3% to 88.8% in China among adults taking anti-hypertensive medications. In fact, we temporarily suspend the definition of this target and whether it is suitable to Chinese adults, the benefits of anti-hypertensive medications reduce the CVD events are a common viewpoint. Therefore, whether refer to the 2017 ACC/AHA hypertension guideline or the 2010 Chinese hypertension guideline, it is urgent and necessary to further improve the control rate of hypertension and give more positive treatment and management for hypertension prevalent cases. The further management strategies of controlling of hypertension and reducing the burden of CVD events are essential to promote the Goal of Healthy China 2030.
The present study has strength that the study population is nationally and has certain representative. Meanwhile, some limitations should also be considered in light of these results. First, the blood pressure was measured only once which may induce the misclassification of blood pressure. Second, we did not have sufficient information on laboratory measurements such as cholesterol, serum glucose, and family history of CVD, etc to calculate the CVD risk which may help us to evaluate the exact impact of recommended anti-hypertensive medication to Chinese population.
In conclusion, the current analysis demonstrates 2017 ACC/AHA hypertension guideline has a potential impact on the prevalence of hypertension, recommended anti-hypertensive medications and control rate of Chinese hypertension population. The prevalence of hypertension will have a double substantial increase and the percentage of recommended anti-hypertensive medications has a small increase (2.7%). In addition, the control rate of hypertension will decrease sharply from 46.7% to 11.2% among adults taking anti-hypertensive medications. How to face the 2017 ACC/AHA hypertension guideline? Everything has two swords and we should pay more attention to the positive impact from 2017 ACC/AHA guideline and do some cost-effectiveness analysis regarding the guideline. Anyway, we should positively consider the control and management of hypertension, based on the real policies of China, further reduce the burden of CVD in China.