The 23rd Annual Meeting of the European Society of Hypertension (ESH) was held in Italy from June 15-17. The biggest highlight of the meeting was the release of the 2013 ESH/ESC Guidelines for the Management of Hypertension, which included three major highlights. Professor Wang Wen from Beijing Fu Wai Cardiovascular Hospital explained the highlights of the guidelines. 1. The European Guidelines for the Management of Hypertension highlight three major concepts First, the importance of out-of-office blood pressure is emphasized. For the diagnosis and treatment assessment of hypertension, in addition to in-office blood pressure, the important role of out-of-office blood pressure measurement (including home blood pressure measurement and 24h ambulatory blood pressure measurement) in the diagnosis and treatment assessment of hypertension is clearly pointed out, especially the important role of home blood pressure measurement should be emphasized. Compared with in-office blood pressure, out-of-office blood pressure has a stronger correlation with cardiovascular events, and out-of-office blood pressure provides blood pressure data outside the medical setting, which better reflects the true blood pressure level of patients. Second, the adjustment of BP target values. The new guideline has adjusted the target BP target value to <140 mmHg for both high-risk and low-risk hypertensive patients, and <90 mmHg for diastolic BP, except for diabetic patients whose diastolic BP target value has been adjusted to 85 mmHg. 90 mmHg is strongly associated with the risk of cardiovascular events, so adjusting the target BP value is more conducive to simplifying clinicians' management of hypertensive patients. Third, the issue of blood pressure management is raised for the first time. The new guidelines put forward "patient-centered" and clarify that the physician level, community level and other relevant parties should collaborate to effectively manage blood pressure in a comprehensive manner, so as to more effectively control blood pressure. The 2013 ESC/ESH Guidelines for the Management of Hypertension emphasize that in-office blood pressure measurement remains the "gold standard" for the screening, diagnosis and management of hypertension. The limitations of in-office blood pressure have led to the increasing use of out-of-office blood pressure measurement in the management of hypertension. Out-of-office blood pressure measurements include ambulatory blood pressure monitoring and home blood pressure measurement, each of which has its own shortcomings and complements, but does not replace, the other. Several studies have shown that ambulatory blood pressure parameters with clear clinical application include only daytime, nighttime, and all-day mean blood pressure values, while ambulatory blood pressure-derived indicators that have emerged in recent years, such as parameters of blood pressure variability, morning peak of blood pressure, and blood pressure load, are still in the clinical research stage. In addition, the 2013 ESC/ESH Guidelines for the Management of Hypertension also point out that in recent years, scholars in European countries and Japan have organized several studies on ambulatory blood pressure and home blood pressure measurement, and their results show that blood pressure levels are clearly correlated with prognosis, but due to the poor reproducibility of some derived indicators and the lack of large-scale clinical trials targeting out-of-office blood pressure interventions with prognostic indicators, in-office blood pressure However, because of the poor reproducibility of some derivatives and the lack of large-scale clinical trials on out-of-office BP interventions with prognostic targets, out-of-office BP has not yet replaced in-office BP in the management of hypertension. The Guidelines for Blood Pressure Measurement in China, published in 2011, clearly state that in-office blood pressure is currently the standard method for diagnosis, treatment, and evaluation of hypertension, with good accuracy and ease of use; it recommends that in-office blood pressure, ambulatory blood pressure, and home blood pressure are the three methods for blood pressure measurement, each with its own characteristics (Table 1), and states that ambulatory blood pressure can measure blood pressure throughout the day in daily life and obtain 24-h blood pressure information. Ambulatory blood pressure measurement can be used to help diagnose hypertension if available. Home blood pressure is easy to perform and therefore it is recommended for hypertensive patients to adhere to home blood pressure measurement to help improve treatment compliance and increase the rate of blood pressure control. This shows that the European and Chinese hypertension guidelines are consistent in their strategies for blood pressure measurement, and it is evident that the current blood pressure measurement strategies are synchronized with internal and external progress. Accurate blood pressure measurement: the first step in the prevention and treatment of hypertension The Chinese Guidelines for Blood Pressure Measurement recommend that: the patient rests quietly for at least 5 min; the environment is comfortable and quiet; the patient generally takes a sitting position; the upper arm is exposed and the cuff is tied to the upper arm; the brachial artery is palpated and the stethoscope is placed in the brachial position; the patient is inflated until the arterial pulsation disappears, then raised by 20-30 mmHg, and then slowly deflated; the first sound of the Koch sound is heard as the systolic pressure, and the disappearing sound is the diastolic pressure. The disappearance of the sound is the diastolic pressure. Rest for 1 min, repeat the measurement, and measure 2~3 times. Note that the cuff is in line with the level of the heart; record the blood pressure values truthfully, with the trailing numbers expressed as 0, 2, 4, 6, and 8 mmHg; be quiet and do not speak during the measurement. In general, residents who come to the office to measure blood pressure, if found to be mildly to moderately elevated, can make an appointment for the patient to be rechecked every 1~2 weeks; if the blood pressure is ≥140/90mmHg on three occasions, hypertension can be diagnosed. If the blood pressure is elevated in the office, with target organ damage and other high-risk conditions, then antihypertensive treatment will be started; if there is no target organ damage or multiple risk factors, home blood pressure measurement may be recommended, and treatment will be started for home blood pressure ≥ 135/85 mmHg, followed up for those < 125/70 mmHg, and 24h ambulatory blood pressure measurement will be performed for those 125~134/76~89 mmHg. Treatment was started for those who monitored ≥130/80 mm. In addition, differences in the cut-off values for diagnostic hypertension, white coat hypertension, and occult hypertension were noted (Table 2). Environmentally friendly electronic sphygmomanometers will gradually replace mercury sphygmomanometers The 2013 ESC/ESH Guidelines for the Management of Hypertension suggest that non-mercury sphygmomanometers, including electronic sphygmomanometers, will be used more often in hospitals as mercury-containing blood pressure measurement devices are gradually phased out; if possible, attempts can be made to set up automatic sphygmomanometers in consultation rooms, where patients can take their own blood pressure, which can reduce the white coat effect; blood pressure should be measured while Record heart rate. In January 2013, the United Nations issued the International Convention for the Prevention of Mercury Pollution, which calls for a ban on the production and import of mercury-containing products after 2020. The phasing out of mercury sphygmomanometers is the general trend, and certified automatic sphygmomanometers will certainly replace mercury sphygmomanometers. Management, enterprises, academic groups, and medical institutions should be prepared early. Recently, the China Hypertension Alliance, the National Cardiovascular Center, the Chinese Society of Cardiovascular Diseases, and the Chinese Physicians Association of Hypertension jointly organized the "National Green Health Action to Prevent Medical Mercury Pollution and Popularize Environmentally Qualified Blood Pressure Monitors", that is, the "Green Health Action 2020 ", more than 70 experts and representatives from multiple fields agreed that the Convention should be actively implemented, and issued an initiative.