"At present, the country has not adjusted the diagnostic standards for adult hypertension." On November 15, the National Health Commission (NHC) gave a definitive response to the question of whether or not the domestic diagnostic criteria for hypertension have been adjusted. The response made it clear that the diagnostic standard for adult hypertension is a non-same-day 3-time blood pressure over 140/90mmHg. It also emphasized that the guidelines, *** knowledge, etc. issued by professional institutions, trade associations, individuals, etc., are the research results of experts and are not used as the national diagnostic standard for the disease.On November 13, the National Center for Cardiovascular Diseases, the Chinese Physicians Association, and other*** developed the "China Hypertension On November 13th, the National Center for Cardiovascular Disease, the Chinese Physicians Association and other **** jointly developed the "China Hypertension Clinical Practice Guidelines" will be the domestic diagnostic standard of hypertension in adults down to 130/80mmHg. Once the implementation of the number of hypertensive patients in the country will be doubled to nearly 500 million people. The news quickly sparked heated debate and controversy.
Media interpretation of hypertension diagnostic standards downward behind the pushers is what is going on, follow me to see it.
Red Star depth｜130/80 or 140/90? 200 million people "being hypertensive" behind the "normal high value" of the dispute
According to the Oriental IC
This is the first time in the history of the world that we have been able to see a lot of people with high blood pressure, but we are not sure if it's a good idea. p> Red Star News reporter Hu Yiwen Wu Yang Beijing
Editor Qiu Tim
According to the Chinese Journal of Cardiovascular Disease WeChat public number, on November 13, "China's Hypertension Clinical Practice Guidelines" (hereinafter referred to as the "Guidelines") was released. The Guidelines recommend that the diagnostic threshold for hypertension in adults in China be lowered from ≥140/90 mm Hg to ≥130/80 mm Hg. The Guidelines were jointly developed by the National Center for Cardiovascular Diseases, the Chinese Medical Association, the Hypertension Specialty Committee of the Chinese Medical Association, the Chinese Medical Association's Branch of Cardiovascular Diseases, and the Hypertension Specialty Committee of the Cross-Strait Medical and Health Exchange Association. The news has been reported by the media and has attracted widespread attention.
On November 15, the National Health Commission issued a news release stating that the country has not adjusted the diagnostic criteria for adult hypertension. By professional organizations, industry associations, individuals and other self-released guidelines, **** knowledge, etc., for the expert's research results, not as a national disease diagnostic standards.
Red Star News reporter found that, at present, the Guide in the Chinese Journal of Cardiovascular Disease network pre-publication link has been disabled. The above WeChat public message pointed out that the Guidelines will be officially published in the Chinese Journal of Cardiovascular Disease 2022 11 on November 24th.
What is the impact of the change in standards? The Guidelines indicate that national survey data show that among adults aged 18 years and older in China, the proportion of people with SBP (systolic blood pressure) 130~139 mmHg and/or DBP (diastolic blood pressure) 80~89 mmHg is 23.2%, with an estimated total of nearly 243 million people, and that the population with this range of blood pressure is mainly young and middle-aged people aged 18~54 years. The Guidelines also indicate that, according to the latest international guidelines recommending the initiation of antihypertensive medication, 22.7% of adults aged 35 years and older with SBP130~139 mmHg and/or DBP80~89 mmHg need antihypertensive medication, with an estimated total of 39.9 million people in China.
Chen Hui, a professor and chief physician at the Fujian Institute of Cardiovascular Disease, has learned about the development of this Guide, and after it was released, she has also communicated with Cai Jun, the initiator and chief expert of the Guide and a professor at the National Center for Cardiovascular Diseases, Fuwai Hospital of the Chinese Academy of Medical Sciences. She told Red Star News reporter that the initial intention of the Guidelines is good, but the clinical Guidelines revision involves a wide range of aspects, the National Health Commission to respond is necessary. Some studies have shown that intensive blood pressure lowering is good for the human body, especially for the elderly, so I hope to focus on the group of normal high values.
However, Chen Hui believes that the revision of hypertension standards is slightly radical, may go out of shape in the implementation process, resulting in doubling the number of people taking medication, increasing the burden on individuals and the national health insurance. She believes that there should be a return to strengthening lifestyle interventions for people with normal high values.
Differences in diagnostic criteria
Internationally, there have long been different voices
The National Health Commission pointed out that, with regard to the diagnostic criteria for hypertension, the publicity and education points, prevention and treatment guidelines, and clinical pathways issued by the national health administrative departments in 2005, 2010, and 2017 have all made it clear that the diagnostic criterion for hypertension in adults is a non-same-day, 3-times blood pressure of more than 140 / 90mmHg.
According to the First Finance: at present, the China Hypertension Alliance, the Hypertension Branch of the China Association for the Promotion of International Exchanges in Healthcare, the Hypertension Branch of the Chinese Geriatrics Society, the Key Laboratory of Hypertension Diagnosis and Treatment and Research of the National Health Commission, and the Shanghai Institute of Hypertension, who did not take part in the formulation of the aforesaid Guidelines, have already jointly submitted a statement to the NHAC to expound their relevant stance and give related The newest addition to the list is the newest addition to the list.
Red Star News reporter noted that the prevention and treatment guidelines released in 2010 are the "Chinese hypertension prevention and treatment guidelines". The latest version of the guidelines was revised in 2018 by the Revision Committee of China's Hypertension Prevention and Control Guidelines, the Hypertension League (China), the Cardiovascular Disease Branch of the Chinese Medical Association, the Hypertension Specialized Committee of the Chinese Physicians' Association, the Hypertension Branch of the China Association for the Promotion of International Exchange in Health Care and the Hypertension Branch of the Chinese Society of Geriatrics. Both editions are led by Liu Lisheng, Director of Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing Hypertension League Institute, and former President of the World Hypertension League.
In terms of relevant guidelines at home and abroad, the World Health Organization proposed the standard of ≥160/95 mmHg in 1977, which was changed to ≥140/90 mmHg in 1997, and has been widely adopted by countries around the world and is used today.
In 2017, the American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines took the lead in lowering the diagnostic criteria for hypertension to ≥130/80 mmHg. However, there are very few organizations and academic societies that have followed up on this standard. The American Diabetes Association, for example, has maintained the diagnostic criteria of ≥140/90 mmHg. The 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) Guidelines for the Management of Hypertension, and the 2020 International Society of Hypertension (IISH) International Guidelines for Hypertension Practice maintain the diagnostic criteria of ≥140/90 mmHg.
In May 2022, the 2022 Taiwan Hypertension Guidelines, published jointly by the Taiwan Cardiology Society and the Taiwan Society of Hypertension, lowered the diagnostic criteria for hypertension to 130/80 mmHg. Professor Chen-En Chiang, a professor at the Veterans General Hospital in Taipei, China, has pointed out at a cross-strait symposium on this topic that, as relevant research continues to progress, international differences have arisen in the setting of high blood pressure. The different academic organizations have different goals for lowering blood pressure, which are broadly divided into three schools of thought: positive blood pressure, traditional blood pressure, and negative blood pressure.
Guo Yifang, an expert in the guideline development group and vice president of Hebei Provincial People's Hospital, said in a post on his personal WeChat that it is normal for different scholars and different academic organizations to have different academic views. This standard downward adjustment, positive or negative have reasons and basis, but its starting point and the fundamental motive is the same, is a better control of blood pressure, minimize high blood pressure on the life and health of our residents.
People whose blood pressure is 130-139/80-89 mmHg are a population of great concern. According to Guo Yifang, the controversy caused by the Guidelines is a good thing for the general public to pay attention to their blood pressure health and be concerned that they may be patients. "If this happens, more people will go to consciously take the initiative to eat less and move more to reduce weight, quit smoking and limit alcohol and eat less salt, live a regular life and stay up less late, and mentally relax and get enough sleep."
Definition of a high normal value
Blood pressure is not a single, unchanging value
However, it is not the case that being below the diagnostic threshold means that blood pressure is normal. Normal blood pressure is generally defined internationally
Internationally, initiating antihypertensive medication is generally recommended only for high-risk individuals with an SBP of 130 to 139 mmHg. Another major adjustment of the Guidelines is that it is recommended that antihypertensive drug therapy be initiated immediately for people with blood pressure in the range of 130-139mmHg/80-89mmHg combined with 0-2 cardiovascular risk factors whose blood pressure still does not reach the standard after 3-6 months of lifestyle intervention.
Chen Hui explained that human blood pressure itself is not a single, unchanging value. The 140/90mmHg currently used is also the result of a population survey. This value applies to most people, but for some individuals, reaching it may not be a true diagnosis of hypertension.
According to Chen Hui, doctors should first strengthen education for people with normal high values in the category between 130/80mmHg and 140/90mmHg, and see if they can be reversed through lifestyle interventions, which past guidelines have also emphasized.
"At any level of hypertension, the first step is non-pharmacologic treatment, and healthy lifestyles can't meet the standard before considering pharmacologic treatment, which is a principle of hypertension treatment. But if 130/80mmHg becomes the standard in this guideline, drug companies will use it to promote people above that standard to take medication. This will lead to a massive increase in the number of people taking medication, and both individuals and national health insurance are under pressure." Chen Hui said.
Controversy over the adjustment of standards
Considering not only clinical research, but also the national context
For the basis of the downward adjustment of the standards, the Guidelines recommended that the note cited a number of domestic and international studies, said that based on evidence from observational studies, the harm exists, and based on evidence from clinical trials, the intervention is effective.
Liu Lisheng, director of the Beijing Hypertension League Research Institute and former president of the World Hypertension League, recently said there is no high-quality evidence that medication in the 130-139 mmHg/80-89 mmHg range yields significant benefits.
Wang Jiguang, president of the Chinese Hypertension League and professor at Ruijin Hospital of Shanghai Jiaotong University School of Medicine, also pointed out in an interview with China Business News that, to date, there is no published randomized controlled clinical study at home or abroad that confirms the benefits of pharmacological antihypertensive treatment for non-high-risk patients with blood pressure of 130-139/80-89mmHg, or the safety of pharmacological treatment for this group of people. There are also no studies confirming the safety of medication for this population. Wang Jiguang said that the downward revision of hypertension diagnostic criteria is not only unsuitable for China's national conditions, but also may lead to serious health hazards for non-high-risk blood pressure patients.
The adjustment of the US ACC/AHA 2017 hypertension guidelines has also been controversial internationally. For example, a collaborative study between the National Center for Cardiovascular Disease and Yale University, published in the British Medical Journal (BMJ) in 2018, concluded that both Chinese and American health systems would be overwhelmed and unsustainable if the new definition of the US hypertension guidelines were used.
Chen Hui explained that the United States lowered the standard in the hypertension guidelines to 130/80 mmHg, mainly because the United States has a large number of obese people, and the risk factors affecting hypertension are already difficult to control. In order to better make the blood pressure standard, reduce heart, brain and kidney complications, the United States of America's high blood pressure standard is lower than other countries. This is also related to the relatively better medical resources in the United States. However, this standard is too aggressive for other countries, the vast majority of which use the 140/90 mmHg standard.
In terms of cost-effectiveness, the conference was introduced by Zhao Dong, a professor at Beijing Anzhen Hospital of Capital Medical University, who said that people with blood pressure levels of 130-139 mmHg and/or 80-89 mmHg are mostly young and middle-aged, and that the downward revision of the diagnostic criteria reflects the concept of moving the line of defense forward and strengthening initial prevention, or else we'd be missing out on the critical time to reduce the harm of cardiovascular disease and other illnesses caused by high blood pressure. Otherwise, we will miss the critical time to reduce the harm of cardiovascular and other diseases caused by hypertension. Lifestyle interventions for people with blood pressure of 130-139/80-89 mmHg and the initiation of antihypertensive medications when non-pharmacological treatments are ineffective are important windows for reducing the adverse consequences of hypertension. Although the lowering of the diagnostic criteria for hypertension may result in an increase in the upfront cost of treatment (which is entirely affordable based on current national health insurance and centralized drug purchasing policies), in the long term, the high cost of treating serious complications is expected to decrease significantly, which is generally cost-effective.
The reporter did not note for the moment the article on which the Guide gives evidence for the health economics assessment or the specific measurement process.
Chen Hui said, China and the United States situation is different, China's obese population is not as large as the United States, normal high-value people can use non-pharmacological treatment. At the same time, China's medical resources are relatively insufficient, health insurance affordability is limited. "The development of clinical Guidelines should not only consider clinical research, but also take into account the national situation, such as the affordability of national health care, the national health level."
Shares of drug companies once soared
Is there an interest behind the push?
The development of a medical guideline needs to invite experts from all aspects and disciplines. According to the full text of the Guide, the members of the working group on the development of the Guide, in addition to clinicians and experts in the field of cardiovascular, but also includes experts in the fields of nephrology, endocrinology, urology, vascular surgery, psychiatry and psychology, epidemiology, nursing, clinical pharmacy, health economics and other areas, as well as representatives of patients. Red Star News reporter noted that the external review group experts have four policy makers.
Cai Jun, the initiator of the Guidelines, said in a recent media interview that the downward revision of the diagnostic threshold for hypertension was unanimously voted on by 50 of the nation's top experts in the cardiovascular field. According to Economic Observer, a core member of the guideline development committee also said that "the vast majority of experts voted very supportive."
Red Star News reporter learned from relevant sources, this "guide" before and after the release of the cardiovascular field in the country held a relevant discussion and symposium.
The stock market opened on Monday, November 14, Huahai Pharmaceuticals, Renfu Pharmaceuticals, Rundu shares and other hypertension drug plate enterprise share prices rose sharply in response. In this regard, some netizens questioned the interests of drug companies to promote.
Red Star News reporter learned that the source of funds, the "Guide" said the development of the funds required from the National Health Commission Bureau of Disease Prevention and Control project (T2021-ZC02) and the Chinese Academy of Medical Sciences medical and health science and technology innovation project (2021-I2M-1-007). Funds were primarily used to cover labor, materials, travel, and conference expenses, and guideline recommendations were not affected by the grant.
Regarding conflict of interest, the Guide states that all authors declare no conflict of interest. The core members of the guideline development committee interviewed by the Economic Observer also said that the guideline uses all of its own program's research funds, "without taking a penny from the pharmaceutical companies".
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Who's pushing for a downward revision of hypertension diagnostic standards?
"At present, the country has not adjusted the diagnostic criteria for hypertension in adults." On November 15, the National Health Commission gave a definitive response to the question of whether the domestic diagnostic criteria for hypertension have been adjusted.
The response made it clear that the diagnostic standard for adult hypertension is a non-same-day 3-time blood pressure of more than 140/90mmHg. At the same time, it was emphasized that the guidelines, **** knowledge, etc. issued by professional organizations, industry associations, individuals, etc., are the results of experts' research, and do not serve as the national diagnostic standard for the disease.
November 13, by the National Center for Cardiovascular Diseases, the Chinese Physicians Association and other *** with the development of "China's hypertension clinical practice guidelines" (hereinafter referred to as the new "Guide") will be the domestic adult hypertension diagnostic standards down to 130/80mmHg. Once the implementation of the number of hypertensive patients in the country will be doubled to nearly 500 million people. The news quickly sparked heated debate and controversy.
The day after the news was released, the stock prices of many companies in the hypertension drug sector, such as Huahai Pharmaceuticals, Renfu Pharmaceuticals, and Rundu shares, rose sharply.
Before the release of the new Guidelines, domestic hypertension diagnostic standards were based on the 2018 version of the Chinese Guidelines for the Prevention and Control of Hypertension, which were developed by the China Hypertension League and others. Sun Ningling, former chief physician of the hypertension department at Peking University People's Hospital, told China News Weekly that the latest edition of the China Hypertension Prevention and Control Guidelines, developed by the China Hypertension Alliance in conjunction with a number of societies***, will be published in late December this year. This guideline is based on the 2018 edition, and will be adjusted accordingly, taking into account emerging research evidence, clinical needs and the economic situation at this stage in the country. "This guideline will continue to use 140/90mmHg as the diagnostic standard for hypertension." She said.
Downward revision of diagnostic criteria stirs controversy among many parties
Hypertension, a phenomenon in which the body's blood flows through blood vessels at a consistently higher-than-normal pressure value against the vessel walls, is known as the silent killer because it can be silent in its early onset. Chronic high blood pressure can have a serious impact on the body's vital organs such as the heart, brain and kidneys.
The new Guidelines, released on the 13th, took 2 years to complete, and give more detailed evidence-based recommendations on 44 clinical issues related to the diagnosis, evaluation, and treatment of hypertension, including a downward revision of the diagnostic criteria for hypertension in Chinese adults.
Prior to the release of the new Guidelines, the Chinese Guidelines for the Prevention and Treatment of Hypertension were used as the diagnostic criteria for hypertension in China. The China Hypertension League has been involved in developing and releasing the first guideline since 1999, with subsequent updates basically every 5 years or so, with the most recent update coming in 2018.The 2018 update categorizes hypertension into three classes: class 1, class 2, and class 3, with blood pressure at 80-89mmHg/130-139mmHg being not judged as hypertension, but as a normal high value. This is similar to the standard that has been used worldwide for more than 20 years.
Data from the China Cardiovascular Health and Disease Report 2021, released in June of this year, shows that the number of people suffering from cardiovascular disease in China is 330 million, with 245 million people suffering from high blood pressure. 245 million people are projected according to the current diagnostic standard of 140/90mmHg used in China. The new Guidelines reduce this standard to 130/80mmHg, meaning that the number of hypertensive patients in China has increased from 245 million to 490 million.
In an interview with Caixin, Cai Jun, the initiator and chief expert of the new Guidelines and a professor at the National Center for Cardiovascular Diseases/Fuwai Hospital of the Chinese Academy of Medical Sciences, pointed out that, "There is now a large amount of evidence-based medical evidence, such as cohort studies and follow-up observational studies, proving that elevated blood pressure is an important risk factor for cardiovascular death, and that controlling blood pressure a little lower can bring clear cardiovascular benefits."
Cai Jun introduced that after the diagnostic criteria and antihypertensive target goals are adjusted, people with blood pressure values above 140/90 mmHg continue to receive drug therapy, while cardiovascular risk stratification is recommended for patients with blood pressure values between 130 and 139 mmHg/80 and 89 mmHg, and intensive antihypertensive treatment is only given to the high-risk groups among them; some high-risk groups should receive antihypertensive drug Some high-risk individuals should receive antihypertensive medications, while others can be treated with non-pharmacologic lifestyle interventions.
In response to this change, many hypertension experts are opposed. "There is no high-quality evidence pointing to significant gains from drug treatment when blood pressure is in the 130-139 mmHg/80-89 mmHg range." A number of hypertension experts have told China Newsweek that they are in favor of maintaining the original standard, and that they are not advocating a lower range of hypertension at this time.
Once the new Guidelines were released, the China Hypertension League held a meeting to discuss the matter. "The 'new guidelines' were not communicated with the alliance in advance and were suddenly released all at once." Liu Lisheng, honorary chairman of the Chinese Hypertension League and a professor at Fu Wai Hospital of the Chinese Academy of Medical Sciences, told China News Weekly that the criteria for other diseases can be adjusted because that is an academic issue, but only hypertension can't. The Chinese Hypertension League is an allied national organization of the World Hypertension League (WHL). Liu Lixiang has more than 50 years of experience in hypertension prevention and treatment, and has previously participated in the development of every Chinese hypertension prevention and treatment guideline.
"There is a lack of high-quality evidence-based medicine evidence for the downward revision of the criteria." Liu Lisheng said, hypertension is currently the only cardiovascular chronic disease prevention and treatment program included in the national management, standard-setting is not only an academic dispute, but also closely related to the country's livelihood, easily adjusted will have a subversive impact. "Downward adjustment by this standard has too wide a reach. People who were originally engaged in high-risk occupations, such as pilots, are now suddenly judged to be hypertensive, can they continue to engage in their original jobs? Who will be responsible if something goes wrong?" She asked her question.
"It was a shock when I first saw this downward standardization." Hu Dayi, chief physician of cardiovascular medicine at Peking University People's Hospital, told China News Weekly that according to this standard, overnight the number of domestic hypertensive patients increased to 500 million, which includes many young and middle-aged people.
"Hypertension diagnostic criteria should not be easily changed." Hu Dayi told China News Weekly that lowering the diagnostic criteria did not reduce the absolute risk of controlling hypertension by much, while at the same time, it also involves many problems such as drug side effects, costing huge medical overhead and labor costs, this downward adjustment does not have much clinical significance.
"This time the new Guidelines did not reach an important standard of **** knowledge between the Chinese Hypertension League." Sun Ningling said that the development of the guidelines should take into account both the need to keep up with international standards and the reality of China's economic situation, the current prevalence of hypertension, and so on.
On May 12 of this year, a 14-year, randomized controlled clinical study enrolling 10,624 people, led by Liu Lixiang and Zhang Xinhua, president of the World Hypertension League, was released. The study showed that in China 45-79 years old blood pressure 130-139/85-89mmHg non-high-risk individuals, taking antihypertensive drugs does not reduce the risk of cardiovascular and cerebrovascular disease, and there is also a trend of possible harm. The study also suggests that individuals with blood pressure in the high normal range may be best served by controlling their blood pressure through a healthy lifestyle.
Hu Daiyi said it is not recommended that people with high pressures in the range of 130 to 140 mmHg all go to the hospital and get prescribed medication, and that it is more important to make lifestyle changes, such as eating a healthy diet, not staying up too late, and abstaining from alcohol.
The new "Guidelines" development group experts, Hebei Provincial People's Hospital Vice President Guo Yifang said in an interview, downward adjustment of hypertension diagnostic criteria, so that more people from an earlier stage of attention to blood pressure, blood pressure reduction, can significantly reduce the occurrence of cardiovascular and cerebrovascular complications. So that in 5 to 10 years, cardiovascular and cerebrovascular disease reduction can save a lot of medical costs, a small number of people taking medication will be far less than the economic cost of these medical costs.
Downward revision of diagnostic standards will squeeze existing medical resources
In 2017, the American Heart Association (AHA) and the American College of Cardiology (ACC) jointly released a new version of the hypertension prevention and control guidelines, which shifted the standard for high blood pressure downward from 140/90mmHg to 130/80mmHg.
However, developed countries did not in the following years successively
However, the developed countries did not follow suit in the following years, and the WHO, the International Society of Hypertension, the European Society of Cardiology and Hypertension, and the World Hypertension League did not change the 140/90mmHg standard.
In fact, there is no universal **** understanding of the diagnostic criteria for hypertension within the U.S. In December 2017, the American Academy of Family Physicians (AAFP) issued a statement that it did not endorse the downward revision of the diagnostic criteria, and that the definition of hypertension would remain the same as the traditional criteria.According to the AAFP, although systematic evaluations have shown that the new criteria reduce cardiovascular events, there is no definitive evidence of a reduction in cardiovascular events in the population as a whole.
The AAFP believes that although systematic evaluations have shown that the new standards can reduce cardiovascular events, there is no definitive evidence that they can reduce all-cause mortality, cardiovascular mortality, and myocardial infarction for the population as a whole, and there are conflicting results from some of the studies.
Sun Ningling told China News Weekly that the United States hypertension awareness rate has been very high, the treatment rate can reach 70%, disease control rate of 50% to 60%. Even if the diagnostic standard downward pressure, but also can basically cover the new patients. In comparison, according to the existing standard estimates, the domestic hypertension control rate is only 15.3%, less than 6% in rural areas, there are many hypertensive patients to be treated. After the downward adjustment, the domestic hypertension control rate fell to 3%, antihypertensive drug treatment will cause a squeeze on existing medical resources.
"The National Health Commission does not support the new Guidelines this time, should also be for these levels to consider." Sun Ningling talked about, "the United States hypertension treatment and control rate is much higher than the level of the world, blood pressure target lowering has affordability, but China's health care resources are limited, downward adjustment of diagnostic standards should also consider the pressure of the community to prevent and control chronic diseases, the ability to pay for health insurance and the total cost of health care expenditure can be afforded in the long term and other issues. "Many grassroots areas will assess the control rate of blood pressure reduction, and the downward adjustment of diagnostic criteria will significantly squeeze the existing medical resources." Hu Dayi said.
A reluctant to name a senior medical professionals to the "China News Weekly" as an example, Beijing a **** more than 300 community health service centers, an average of a health service center to cover about 100,000 people, an average of a dozen or so family doctor teams in each community health service center. Possible management in the case of 50,000 to 60,000 patients, of which about half of the hypertensive patients, and community chronic disease patients are mostly elderly people, suffering from a variety of diseases at the same time. "According to this status quo, even in accordance with the 2018 version of the guidelines, it is difficult to achieve effective management of the hypertensive population." He said.
Even the 2017 U.S. guidelines only recommend that non-high-risk people with 130 to 139/80 to 89 mmHg be treated with lifestyle interventions, and not all need to be treated with medication. In Hu Daiyi's opinion, the U.S. downward adjustment of diagnostic criteria is more of a recommendation for patients to start with more lifestyle changes. The daily treatment of hypertension should be different from person to person, not a single only look at millimeters of mercury.
Many cardiology and cardiac surgery diagnostic and treatment guidelines are launched by companies
"The voice of the National Health Commission is still very timely." If a downward revision of standards does materialize, the biggest winners will be the drug companies behind it and certain experts who collude with them, Hu said. Even if they say they have no interests at stake, it's hard to stand up to scrutiny. When making major decisions like the Guidelines, especially when it comes to revising important standards, there must be a third party involved in the evaluation, and this third party should neither be involved in the interests of the companies, nor should they have an interest in the doctors.
Hypertension, like diabetes, is now two of the more prevalent chronic diseases in the country, with a large population base. Once diagnosed in the country, they basically require year-round medication, most of which are irreversible.
The aforementioned senior medical professionals, who did not want to be named, told China News Weekly that the overall hypertension treatment guidelines in the country, basically launched by the industry. "Many cardiology and cardiac surgery guidelines are basically launched by companies. The tiered policy of healthcare reform has been implemented in recent years to cut off the profit pathway between companies and doctors and medical institutions. But it is still difficult to avoid the 'kickback' link."
Sullivan Research Institute data show that under the diagnostic criteria of 140/90mmHg, the market size of anti-hypertensive drugs has increased from 45.7 billion yuan in 2013 to 88.5 billion yuan in 2019, and the market size is still increasing.
China News Weekly noted that due to the stimulus of the diagnostic standards downward, a number of anti-hypertensive drug manufacturers and sphygmomanometer manufacturers stock prices soared. on November 14, its anti-hypertensive drugs Jingxin Pharmaceuticals, Huahai Pharmaceuticals, Xinlite's rise reached 8.26%, 6.09% and 5.57% respectively; sphygmomanometer concept, Yuyue Medical stops, Kofu Medical , Lexin Medical also jumped 14.00% and 8.48% respectively.
"The real active promotion of some standards is the drug companies." Hu Dayi said.
"I didn't realize that a standard change would bring a huge influx of capital and stock market volatility." On the 15th, Sun Ningling pointed out in a post on her personal social account that from a medical point of view, the idea of preventing disease is very right, and many of the ideas in the new Guidelines she has ****ing, but scholars can't just live in self-space.
The launch of the new "Guide" triggered a lot of discussion in the industry, in the view of a number of experts, the positive side is that it triggered the industry and the public attention to the "invisible killer" hypertension. However, the industry has not yet reached a unified *** knowledge of whether it is appropriate to adjust the standard value of hypertension downward.
"Agree with some of the points of view of the new Guidelines in terms of treatment, but in the diagnostic criteria step too big." Sun Ningling said, such a "one foot in the world" of the "Guide", will involve the country's medical, economic, financial, insurance, public **** health construction and other areas, to be considered in a holistic manner, in order to stand.
Reporter: Niu Huo