The 2009 grassroots version of the “Chinese Guidelines for the Prevention and Treatment of Hypertension” (referred to as the grassroots guidelines) has been released. This is the first national-level hypertension prevention and treatment guide for urban communities and rural health services in China, as well as a unified teaching material for training primary care doctors. In order to match the new health care reform program, standardize and promote the prevention and treatment of hypertension at the grassroots level in China. The grassroots guidelines are concise and operational, and the main points are explained below. The guideline simplifies the risk stratification The biggest change in the primary guideline is that the risk stratification of the previous guideline has been simplified, and simplified into low risk, intermediate risk, and high risk, that is, the original high risk and very high risk are combined into high risk. Because the principles of treatment for high risk and very high risk are the same, both are given medication immediately. Low risk: hypertension grade 1 with no other risk factors; intermediate risk: hypertension grade 2, or hypertension grade 1 with 1~2 risk factors; high risk: hypertension grade 3, or hypertension grade 1~2 with ≥3 risk factors, or with any one of target organ damage, or with any one of clinical disorders. Laboratory tests in grades The inspection and assessment indicators for risk stratification are divided into two grades: basic requirements and routine requirements. It is recommended that each region try to complete them according to the actual situation and conditions in the region. Basic requirements are the minimum requirements, i.e., the examination and assessment indicators that can be completed by trained rural doctors. The basic requirements are applicable to some community health service stations and rural health stations with poor conditions, which should complete blood pressure measurement, height and weight, waist circumference measurement, ask about age, smoking status, blood lipid status, physical activity, family history of early onset, history of cardiovascular and cerebrovascular diseases, diabetes, etc. These are the indicators that can be collected by simple physical examination and raging questions. Routine requirements are the standard requirements, i.e. the relevant laboratory test indicators that should also be completed in conditional medical institutions, such as fasting blood glucose, blood lipids, creatinine, routine blood, routine urine. ECG, X-rays, ultrasound, and, if possible, urine microalbumin, fundus, and arterial stiffness (PWV) should be completed. It is important to emphasize that fewer items are evaluated by basic requirements, which may underestimate the risk of cardiovascular disease in patients; all laboratory tests should be completed as routinely required in areas with conditions. Emphasis on drug combination therapy In order to improve the blood pressure attainment rate, the guidelines emphasize the combination therapy. There are 200 million hypertensive patients in China, and 10 million new patients are added each year. For such a large hypertensive population, several more combination treatment options for primary care physicians to choose from will be beneficial to flash local control of hypertension. Primary guidelines recommend plant antihypertensive about the reference program of combined treatment. Drug treatment principles: 1, the initial small dose of single about or small dose of two drug combination therapy. If the blood pressure does not reach the standard after the first step of drug treatment, the original drug can be added to the dose or another antihypertensive drug. If the blood pressure reaches the standard, the medication is maintained; it is really recommended to use long-acting antihypertensive drugs to control blood pressure smoothly and effectively. For grade 2 and above hypertension a small dose of combination therapy is used at first. Implementation of individualized treatment. 2. Commonly used antihypertensive drugs: grass-roots guidelines recommend calcium antibodies, ACEI, ARB, diuretics, beta blockers as commonly used antihypertensive discretion. The above five types of antihypertensive fishing and low-dose fixed compound preparations can be used as the drug of choice for the initial or maintenance treatment of hypertension. Consider lowering the blood pressure level of hypertensive patients is more important than choosing the type of antihypertensive drugs. The choice of antihypertensive drugs: primary care physicians should first master the contraindications and indications for drug therapy, and choose the appropriate drug for the patient according to the condition and the patient’s willingness and affordability. 4. Combination therapy program: reasonable combination therapy program of antihypertensive drugs includes dihydropyridine calcium antagonist + ACEI/ARB, ACEI/ARB + small dose diuretic, calcium antagonist + small dose diuretic. Although there is some controversy about whether the composition of our traditional fixed compound is reasonable, it can still be used as an option for antihypertensive drugs in primary (especially in rural areas) because of its clear antihypertensive effect and low price. The contraindications and adverse reactions of the corresponding components should be noted in use. Timely detection of hypertensive patients The key to detecting blood pressure measurement in patients is a qualified blood pressure monitor, and the operation should be standardized. It is recommended that normal adults have their blood pressure measured at least once every 2 years and take advantage of various opportunities for screening; for people over 35 years of age, their blood pressure should be measured at the first visit; and for people susceptible to hypertension, it is recommended that their blood pressure be measured once every six months. Those who are found to have increased blood pressure for the first time should be followed up and evaluated, and blood pressure should be measured several times to clarify the diagnosis; if a hypertensive emergency is suspected, promptly refer to a higher level hospital. Diagnosis and evaluation Blood pressure ≥140 and/or ≥90 mmHg measured 3 times on non-same day is diagnosed as hypertension. Non-same-day 3 times, – general site means measurement at 2-week intervals, not non-same-day today, tomorrow, or the day after. Assessment of initial hypertension Patients with grade 3 hypertension or high risk of concomitant cardiovascular or cerebrovascular disease should begin drug therapy immediately; if hypertensive emergencies are suspected, refer to a higher level hospital immediately. patients with grade 1-2 hypertension with dizziness and other uncomfortable symptoms should consider low-dose drug therapy; if asymptomatic, carefully assess relevant risk factors, target organ damage and concomitant clinical disorders. The definition and grading of blood pressure in the primary guidelines are identical to the 2005 Chinese hypertension guidelines. Keeping the basic definition stable will facilitate the management of hypertension at the primary level. The goal of hypertension treatment is to achieve the blood pressure standard. The systolic blood pressure target for antihypertensive treatment of elderly hypertension is <150 mmFIg, and the blood pressure target for antihypertensive treatment of general hypertension is blood pressure <140 and/or <90 mmHg. Patients with diabetes mellitus, cerebrovascular disease, stable coronary artery disease, and chronic kidney disease (all at high risk) have their blood pressure reduced to less than 130/80 mnnHg. If tolerated, all of the above patients' blood pressure levels can be further reduced, and it is recommended that they be lowered to less than 20/80mmHg if possible. Regarding the time to achieve the blood pressure standard, the primary guideline recommends that: in general, grade 1-2 hypertension strive to achieve the blood pressure standard gradually in 4-12 weeks of medication, and adhere to the long-term standard; however, patients with poor tolerance or the elderly blood pressure standard time can be extended appropriately. The early achievement of blood pressure standard is conducive to reducing cardiovascular and cerebrovascular events. In addition, non-pharmacological therapy is an important part of hypertension treatment, and patients should be allowed to adhere to long-term changes in poor lifestyles.