Hypertension in China is defined as a systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg on 3 non-same day measurements without the use of antihypertensive medication. patients with a previous history of hypertension who are currently using antihypertensive medication should be diagnosed with hypertension even though their blood pressure is below 140/90 mmHg. How is hypertension graded? According to the level of elevated blood pressure, it is further divided into grade 1 hypertension: systolic blood pressure 140-159 mmHg and/or diastolic blood pressure 90-99 mmHg; grade 2 hypertension: systolic blood pressure 160-179 mmHg and/or diastolic blood pressure 100-109 mmHg and grade 3 hypertension systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure ≥ Patients with hypertension are then classified into 4 levels according to their level of cardiovascular risk: low risk, intermediate risk, high risk and very high risk. Thus hypertensive patients often see the diagnosis of X-grade hypertension X-risk too. Is grade 1 hypertension mostly for patients at low risk? Hypertension is graded according to how high the blood pressure is. The risk level of a patient with hypertension is based on the combination of cardiovascular risk factors, target organ damage and concomitant clinical disease. Therefore, there are four levels of grade 1 hypertension: low risk, intermediate risk, high risk and very high risk. Does grade 1 hypertension not require drug therapy? Our hypertension guidelines state that low-risk patients should be observed for a longer period of time, with repeated blood pressure measurements, 24h ambulatory blood pressure monitoring or home blood pressure monitoring when possible, to assess target organ damage and then decide if and when to start drug therapy. In intermediate-risk patients, blood pressure and other risk factors are observed for several weeks, with repeated blood pressure measurements and, if possible, 24-h ambulatory blood pressure monitoring or home blood pressure monitoring to assess target organ damage before deciding whether and when to initiate drug therapy. In high-risk and very high-risk patients, comprehensive treatment is started as soon as the diagnosis is confirmed. Knowing that there are also 4 strata of grade 1 hypertension: low risk, intermediate risk, high risk, and very high risk, we should also know that a proportion of grade 1 hypertension requires pharmacotherapy. How is grade 1 hypertension treated internationally? The recently published International Expert Consensus on Antihypertensive Drug Therapy for Patients with Grade 1 Hypertension and Low to Moderate Cardiovascular Risk states that only “isolated” Grade 1 hypertension should be considered for a period of pure lifestyle intervention. “Isolated” class 1 hypertension is defined as having no comorbidities, low cardiovascular risk (overall absolute risk), and no other major cardiovascular risk factors or risk modification. Patients with intermediate-risk grade 1 hypertension should be given immediate antihypertensive medication. This is more aggressive when compared to the Chinese hypertension guidelines. China’s guidelines for patients at low and intermediate risk all call for a certain period of lifestyle intervention before choosing a treatment option based on the situation. The evidence proves that there are essential differences between Asians and Westerners in terms of the characteristics of hypertension and its associated cardiovascular disease burden, all we still go our own way according to our national conditions, epidemiological features of cardiovascular disease and evidence-based evidence.