1.High blood pressure with diabetes
Nearly 70% of doctors surveyed believe that blood pressure in diabetic patients should be lowered to below 130/80 mmHg
Since 2013, the relevant guidelines in Europe and the United States have been revised to varying degrees, relaxing the blood pressure target for diabetic patients from <130/80 mmHg to 140/80-90 mmHg. This revision has also attracted a lot of attention in China, and has had an impact on the blood pressure management philosophy of Chinese scholars. The 2013 Chinese guidelines for the prevention and treatment of type 2 diabetes recommend that blood pressure in diabetic patients be controlled at 140/80 mmHg or less.
The epidemiological characteristics and genetic background of the disease vary greatly from country to country and region to region, so the development of guideline documents must also take into account the characteristics of the country and should not simply copy the guidelines of any other country. For example, the ratio of myocardial infarction to stroke caused by hypertension is about 1:1 among the residents of Europe and the United States, but in China it is 1:5. Therefore, reducing the risk of stroke is the main task of hypertension prevention and treatment in China, and the focus of hypertension prevention and treatment in China should be different from that in Europe and the United States.
In recent years, updated hypertension guidelines in Japan and Taiwan continue to recommend controlling blood pressure to <130/80 mmHg in diabetic patients, taking into account the higher risk of stroke in the corresponding region or population and the moderately strict blood pressure control strategy to help minimize the risk of stroke. China's current hypertension guidelines, issued in 2010, set <130/80 mmHg as the target value for lowering blood pressure in patients with diabetes.
Currently, the revision of China’s hypertension guidelines has been officially launched, and the target value of blood pressure lowering for diabetic patients is one of the key discussions. According to the majority of cardiovascular and endocrinologists in China, the new version of the Chinese guidelines for the prevention and treatment of hypertension may continue to include <130/80 mmHg as the blood pressure control target for diabetic patients. This study showed that more than two-thirds of the respondents supported <130/80 mmHg, which suggests that clinicians in China are becoming more mature in their academic concepts and are able to correctly treat the views of foreign guidelines and the specific situation in China, and no longer blindly follow the academic ideas of European and American countries.
2. Hypertension with coronary artery disease
The target value of blood pressure reduction for patients with hypertension with coronary heart disease is more controversial among the doctors interviewed
There is not enough evidence from relevant studies, and the target value of blood pressure reduction for hypertensive patients with coronary artery disease is also controversial. The current guidelines for the prevention and treatment of hypertension in China recommend controlling blood pressure to <130/80 mmHg in patients with coronary artery disease, but some guidelines in Europe and the United States relax this goal to <140/90 mmHg. In fact, the blood pressure control goal for such patients should not be generalized, but should be individualized according to the patient's specific situation.
If the patient tolerates the lowering of blood pressure well, it is recommended to lower the blood pressure to less than 130/80 mmHg, and if not, to <140/90 mmHg. The same problem is illustrated by the fact that more than 40% of respondents in this study chose 140/90 mmHg and 130/80 mmHg each.
3. Hypertension with heart failure
Most physicians surveyed have a low awareness of antihypertensive therapy in heart failure patients
In the past two years, the US guidelines have relaxed the blood pressure control targets for patients with chronic heart failure, which has had an impact on some physicians in China. The current guidelines for the prevention and treatment of hypertension in China require that blood pressure in patients with chronic heart failure be controlled to <130/80 mm Hg. The data from this survey showed that 39% of the respondents chose 140/90 mm Hg, reflecting the lack of awareness of the importance of antihypertensive therapy in patients with chronic heart failure. In the absence of contraindications, all patients with chronic heart failure should be treated with β-blockers and ACEIs, and the target doses of both drugs should be used as tolerated by the patient. If the target doses of these drugs are used according to the guidelines, most patients will be able to reduce their blood pressure to <130/80 mmHg or less.
4. Hypertension with atrial fibrillation
Less than 40% of the physicians surveyed had a correct understanding of the BP target for patients with atrial fibrillation
If patients can tolerate it, efforts should be made to control their blood pressure to <130/80 mmHg, because aggressive control of blood pressure helps reverse cardiac remodeling, reduces the risk of atrial fibrillation recurrence, and improves the patient's diastolic function. Nearly half of the respondents in this study chose a BP lowering target of 140/90 mmHg, reflecting clinicians' lack of awareness of the importance of BP lowering therapy in patients with AF.
5. Hypertension with chronic kidney disease
51% of surveyed physicians believe that the BP target for people with chronic kidney disease is 130/80 mmHg
The current guidelines for the prevention and treatment of hypertension in China recommend that the target value for hypertension with chronic kidney disease is <130/80 mmHg. The survey results show that 51% of the doctors interviewed chose 130/80 mmHg, which is in line with the recommended standard of the guidelines, but nearly half of the population chose other antihypertensive targets.
6. Hypertension with stroke
Most physicians interviewed were able to grasp the antihypertensive targets for stroke patients
For the treatment of patients with hypertension combined with stroke, 70% of the physicians interviewed believed that lowering blood pressure to 140/90 mmHg was sufficient. This is consistent with our guideline requirements.
7. Hypertension in the elderly
Nearly 60% of the physicians surveyed believe that blood pressure in elderly hypertensive patients needs to be lowered to below 140/90 mmHg.
Our guidelines recommend <150/90 mmHg as the goal of blood pressure reduction for elderly patients with hypertension. If the patient is in good general health, has no serious comorbidities and tolerates antihypertensive treatment well, lowering blood pressure to below 140/90 mmHg can also be considered.