Recently, we often encounter patients in hypertension clinics who are concerned about world events and ask if the standards for controlling hypertension have changed. I heard that Americans have defined over 130/80 mmHg as hypertension, should our treatment plan be adjusted as well? 1. How is hypertension defined? In the natural population, different people will have different blood pressure values. For example, most people’s systolic blood pressure will be concentrated between 90-140mmHg, and a small number of people’s blood pressure will be more than 140mmHg or less than 90mmHg. If the blood pressure values of all people are drawn as icons, it forms a normal distribution image with high in the middle and low on both sides. People have known about blood pressure and how to measure it for more than 100 years, but it is only in the last 30 or 40 years that they have known how much higher blood pressure is bad or harmful to the body. In the 1970s and 1980s, scientists studied coronary heart disease and stroke, common cardiovascular diseases, and found many risk factors, such as high blood pressure, smoking, lack of exercise, and so on. Among them, elevated blood pressure is a very important risk factor. One study found that when blood pressure rises from 115/75 mmHg to 185/115 mmHg, cardiovascular events double for every 20 mmHg increase in systolic blood pressure or 10 mmHg increase in diastolic blood pressure. Therefore, there is a continuous positive correlation between elevated blood pressure and cardiovascular disease. 2. Why did the Americans redefine the cut-off value for hypertension? Since the risk of cardiovascular disease increases continuously as blood pressure rises, what happens if blood pressure decreases from 140 mmHg to below 130 mmHg? The SPRINT study by American clinicians, which included elderly hypertensive patients over the age of 75, found that lowering blood pressure to below 130/80 mmHg resulted in a further significant reduction in complications such as myocardial infarction and stroke, and a good overall safety profile. There are also many other findings that support the safety and effectiveness of intensive antihypertensive measures (<130/80 mmHg). The results of the above studies were the theoretical basis for the change in the definition of hypertension in the United States. The overall control rate of hypertensive patients in the United States is now better (up to 50% or more) and has redefined hypertension. Although the number of people with hypertension has increased by about 31 million across the United States, the new increase is in the class I hypertensive range (130-139/80-89 mmHg) and most are able to improve their hypertensive status through lifestyle modifications, with a smaller proportion requiring antihypertensive medication. In this way, in fact, the increased burden in the prevention and control of hypertension, prevention and control of cardiovascular and cerebrovascular diseases will not be too heavy, and it is entirely possible to do a better job in the prevention and control of hypertension. 3. Will China's hypertension guidelines adjust the blood pressure reduction target? The threshold of normal blood pressure is artificially determined, mainly based on a cut-off point that cardiovascular disease increases significantly when blood pressure rises to a certain level. This normal value has also been revised as scientists continue to develop a better understanding of these diseases. For example, before the 1990s, we set the cut-off value for hypertension at 160/95 mmHg, but later found that cardiovascular disease increased significantly whenever blood pressure exceeded 140/90 mmHg. When sufficient research evidence became available, the World Health Organization revised the cut-off value for hypertension. As of today, the WHO definition of hypertension is three or more blood pressure measurements greater than or equal to 140/90 mm Hg on non-same day. once hypertension is detected, if one can manage to lower the blood pressure by 10/5 mm Hg, it can reduce coronary events by 22% and stroke events by 41%. In other words, good blood pressure control can greatly reduce the occurrence of cardiovascular disease. To date, the goal of antihypertensive treatment in our country is still less than 140/90mmHg. In elderly people, if the pulse pressure difference is particularly large and the diastolic blood pressure is particularly low, a systolic blood pressure <150mmHg is also possible, or if tolerated, it should be brought to less than 140/90mmHg. China's most recent guidelines for the prevention and treatment of hypertension were revised in 2010, and China's own guidelines for the prevention and treatment of hypertension should be issued in 2018 and are under discussion by relevant experts. The new guidelines may not follow the U.S. guidelines in revising the diagnostic criteria for hypertension, but at least some of the U.S. guidelines will be consulted, with higher requirements for antihypertensive treatment, and more emphasis on lifestyle modification for people in the pre-hypertension stage. This includes a low-salt diet, proper exercise, weight control, and so on. Therefore, referring to the latest U.S. guidelines for the prevention and treatment of hypertension, although we will not make adjustments to the blood pressure control criteria for the time being, in order to obtain better cardiovascular and cerebrovascular protection, we should pay more attention to blood pressure control and maintain a good daily lifestyle.