2018 Chinese Guidelines for Prevention and Treatment of Hypertension——A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension

Table of Contents Preamble 1 Prevalence of hypertension in Chinese population 1.1 Prevalence,incidence and epidemic trend of hypertension in Chinese population 1.2 Awareness,treatment and control of Hypertension in China 1.3 Important risk factors for hypertension in Chinese population 2 Hypertension and cardiovascular risk 2.1 Relationship between blood pressure and cardiovascular risk 2.2 Cardiovascular risk characteristics of hypertension population in China 3 Diagnostic evaluation 3.1 Medical history 3.2 Physical examination 3.3 Laboratory examinations 3.4 Genetic analysis 3.5 BP measurement 3.6 Evaluation of target organ damage.

Exploring the prevention and treatment of perimenopausal hypertension based on the theory of"Preventive Treatment of Disease"

"Preventive Treatment of Diseases"is an important theory of Traditional Chinese medicine(TCM)to prevent and treat diseases.This review explored the prevention and treatment of perimenopausal hypertension with the idea of"Preventive Treatment of Disease".Strengthening the health care awareness of perimenopausal women,carring community education activities,health education publicity,health screening,early screening and identification of high-risk groups play the important role in prevention of perimenopausal hypertension.TCM treatment has unique advantages in improving patients'anxiety,and other bad emotions,regulating patients'constitution,promoting the early arrival of the disease recovery period,and preventing recurrence after the disease;Western medicine can control blood pressure quickly and effectively in the stage of disease progression,and both TCM and Western medicine have their own advantages.Rational and effective application of combined TCM and Western medicine in clinical practice can significantly improve patients'symptoms,improve treatment effect,and prevent disease progression or recurrence.

Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-Child Transmission of Hepatitis B Virus(Version 2024)

The Chinese Clinical Practice Guidelines for the prevention and treatment ofmother-to-child transmission of hepatitis B virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China.As new evidence emerges,it is crucial that timely and regular updates are made to the clinical practice guidelines so as to optimize guidance for clinical practice and research.To this end,the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practice,in order to provide guidance and reference for clinicians andmaternal and child healthcare workers.

Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus(Version 2024)

The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus,developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019,serves as a valuable reference for standardizing the prevention of mother-to-child transmission in China.As new evidence continues to emerge,it is essential to update these guidelines regularly to optimize clinical practice and research.To this end,the Infectious Disease Physician Branch of the Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of the Chinese Medical Association,in collaboration with multidisciplinary experts,have updated the guidelines based on the latest domestic and international research advancements and clinical practices,providing upto-date guidance for clinicians and maternal and child healthcare workers.

Alcohol-induced hypertension: Mechanism and prevention

Epidemiological, preclinical and clinical studies es-tablished the association between high alcohol con-sumption and hypertension. However the mechanism through which alcohol raises blood pressure remains elusive. Several possible mechanisms have been pro-posed such as an imbalance of the central nervous system, impairment of the baroreceptors, enhanced sympathetic activity, stimulation of the renin-angio-tensin-aldosterone system, increased cortisol levels, increased vascular reactivity due to increase in intracel-lular calcium levels, stimulation of the endothelium to release vasoconstrictors and loss of relaxation due to inflammation and oxidative injury of the endothelium leading to inhibition of endothelium-dependent nitric oxide production. Loss of relaxation due to inflamma-tion and oxidative injury of the endothelium by angio-tensin II leading to inhibition of endothelium-dependent nitric oxide production is the major contributors of the alcohol-induced hypertension. For the prevention of alcohol-induced hypertension is to reduce the amount of alcohol intake. Physical conditioning/exercise trainingis one of the most important strategies to prevent/treat chronic alcohol-induced hypertension on physiological basis. The efficacious pharmacologic treatment includes the angiotensin-converting enzyme(ACE) inhibitors or angiotensin Ⅱ type 1 receptor blockers(ARBs) which have antioxidant activity and calcium channel blockers. The most effective prevention and treatment of alcohol-induced hypertension is physical exercise and the use of ACE inhibitors or ARBs in the

Prevalence and treatment of hypertension in China： impacts of 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline

The definition, recommended treatment thresholds and targets of hypertension have been updated in the recent 2017 American College of Cardiology/American Heart Association(ACC/AHA) Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. However,the impacts of this guideline on Chinese population are currently unknown. In this study, we aim to provide updated data in China using criteria from the updated guideline. A multistage, stratified sampling method was used to obtain a representative sample of 50,171 adults aged 18 years and above.Hypertension was defined as an average systolic blood pressure !130 mm Hg, or an average diastolic blood pressure !80 mm Hg, or self-reported use of antihypertensive medications in past 2 weeks. The weighted prevalence of hypertension was 60.1%(95% confidence interval [CI] 59.3%–61.0%). The treatment rate and recommended treatment rate were 16.8%(95% CI 16.1%–17.6%) and 53.7%(95% CI52.6%–54.9%), respectively; the gap was more prominent among men and participants from rural areas.Hence, the adoption of the 2017 ACC/AHA guideline will lead to a substantial increase in both prevalence and number of patients needing treatment in China. The applicability of this guideline should be carefully evaluated based on evidence from Chinese population.

Effects of USPSTF guidelines on patterns of screening and treatment outcomes for prostate cancer

The updated United States Preventive Services Task Force(USPSTF) for prostate cancer in 2012 recommends against prostate-specific antigen(PSA) based screening for men of all ages. Prostate cancer is the second most common and second most deadly cancer in American men. PSA screening for prostate cancer has been present since 1994 leading to an over diagnosis and over treatment of low volume disease. There is an overall agreement of men towards the guidelines but even with the understanding of the USPSTF, these men tend to follow more personal beliefs that have been influenced by their knowledge of the disease process and physician influence. Physicians also followed the directions of the patients and opted not to change their current practice of PSA screening despite the new guidelines. Time, legal, and ethical issues were some of the barriers that physicians faced in tailoring their practice towards screening. The importance of informed consent is highlighted by both the patients and the physicians and clearly more effective when the patient was pre-informed of the disease processand prompted the physicians to initiate conversation of informed screening. Younger patients were inclined towards aggressive treatment and older patients opted towards watchful waiting both with emphasis on the importance of evidence-based information provided by the physician. Decision aids were useful in making informed decisions and could be used to educate patients on screening purposes and treatment options. However, even with well-created decision aids and physician influence, patients' own belief system played a major part in healthcare decision making in either screening or treatment for prostate cancer.

Non-pharmacological therapy of TCM for the treatment of essential hypertension

Non-pharmacotogicat treatment is an important means to control hypertension, with many advantages such as tow cost, tess medication, stable btood pressure, tess compHcations, and improved prognosis. This article reviews the research progress of non-drug treatment of hypertension in Chinese medicine in the past five years, and evaluates traditional Chinese medicine such as TCM Qigong, Wuhuo opera, Ba Duanjin and Taijiquan, and Chinese medicine acupuncture, moxibustion, massage, apptication, acupoint embedding and other traditional Chinese medicine. The effect of external treatment in hypertension control provides guidance for non-drug therapy to control hypertension.

Chinese national clinical practice guidelines on prevention,diagnosis and treatment of early colorectal cancer

Background:The incidence and mortality of colorectal cancer(CRC)in China are increasing in recent years.The clarified pathogenesis and detectable precancerous lesions of CRC make it possible to prevent,screen,and diagnose CRC at an early stage.With the development of endoscopic and surgical techniques,the choice of treatment for early CRC is also worth further discussion,and accordingly,a standard follow-up program after treatment needs to be established.Methods:This clinical practice guideline(CPG)was developed following the recommended process of the World Health Organization,adopting Grading of Recommendations Assessment,Development and Evaluation(GRADE)in assessing evidence quality,and using the Evidence to Decision framework to formulate clinical recommendations,thereby minimizing bias and increasing transparency of the CPG development process.We used the Reporting Items for practice Guidelines in HealThcare(RIGHT)statement and Appraisal of Guidelines for Research and Evaluation II(AGREE II)as reporting and conduct guides to ensure the guideline’s completeness and transparency.Results:This CPG comprises 46 recommendations concerning prevention,screening,diagnosis,treatment,and surveillance of CRC.In these recommendations,we have indicated protective and risk factors for CRC and made recommendations for chemoprevention.We proposed a suitable screening program for CRC based on the Chinese context.We also provided normative statements for the diagnosis,treatment,and surveillance of CRC based on existing clinical evidence and guidelines.Conclusions:The 46 recommendations in this CPG are formed with consideration for stakeholders’values and preferences,feasibility,and acceptability.Recommendations are generalizable to resource-limited settings with similar CRC epidemiology pattern as China.

Guideline on prevention and treatment of chronic hepatitis B in China (2005)

Chronic hepatitis B is one of the most common epidemic diseases in China and has become a majorhealth issue. To help standardize the prevention, diagnosis, and treatment of chronic hepatitis B, the Guideline on prevention and treatment of chronic hepatitis B （abbr. Guideline） was created by a group of appropriate experts belonging to the Society of Hepatology and the Society of Infectious Disease, the Chinese Medical Association according to the principles of evidence-based medicine using the latest clinical research data. The evidence used to formulate the recommendation has been classified into 3 classes and 5 grades, which are indicated by Roman numerals in brackets.

Hypertension in Adolescent

Hypertension in adolescents is, as in other patients, one of the important cardiovascular risk factors, associated with hypertension in adults and with appearance of cardiovascular complications later in life. In recent years it is in increase, in parallel with occurrence of overweight in this age group. There is mostly essential or obesity-related hypertension. It is often asymptomatic, therefore it holds true also for adolescents, that it has to be actively searched, especially in risk groups such as overweight adolescents, adolescents with positive family history or some of the other classical cardiovascular risk factors. If we have normal-weight adolescent with important hypertension or symptomatic adolescent without positive family history, the possibility of secondary hypertension has to be thinking of and extended, on possible cause focused and stepwise diagnostics performed. In this case, the treatment is etiological. Otherwise, the first-line treatment in adolescents comprises nonpharmacological treatment measures. Sometimes, because of poor nonpharmacological treatment compliance and presence of hypertensive-target organ damage, antihypertensive medications have to be introduced. However, preventive actions represent the most important task, in the form of primary and primordial prevention. In this article, diagnostic approach, prevention and treatment strategies in adolescents are shortly presented.

Guideline of Prevention and Treatment for Chronic Hepatitis B (2nd Version)

This guideline is established to standardize the prevention,diagnosis and antiviral therapy of chronic hepatitis B(CHB).For other treatment regimens and methods involving CHB,please refer to relevant guidelines and consensuses.The Chinese Society of Hepatology,Chinese Medical Association(CMA)and the Society of Infectious Diseases,CMA organized relevant native experts to establish this Guideline of Prevention and Treatment for Chronic Hepatitis B(1st version)in 2005,and made the first revision in 2010.In the past 5 years,great progress has been made in the native and foreign fundamental and clinical research with respect to CHB,necessitating additional revision of this guideline.

Guidelines for the Prevention and Treatment of Chronic Hepatitis B(version 2022)

To facilitate the achieving of the goal of“eliminating viral hepatitis as a major public health threat by 2030”set by the World Health Organization,the Chinese Society of Hepatology together with the Chinese Society of Infectious Diseases(both are branches of the Chinese Medical Association)organized a panel of experts and updated the guidelines for prevention and treatment of chronic hepatitis B in China(version 2022).With the support of available evidence,this revision of the guidelines focuses on active prevention,large scale testing,and expansion of therapeutic indication of chronic hepatitis B with the aim of reducing the hepatitis B related disease burden.

Guidelines for Prevention and Treatment of Chronic Hepatitis B

To achieve the goal of the World Health Organization to eliminate viral hepatitis as a major public health threat by 2030,the Chinese Society of Infectious Diseases and the Chinese Society of Hepatology convened an expert panel in 2019 to update the guidelines for the prevention and treatment of chronic hepatitis B(CHB).The current guidelines cover recent advances in basic,clinical,and preventive studies of CHB infection and consider the actual situation in China.These guidelines are intended to provide support for the prevention,diagnosis,and treatment of CHB.

Guidelines for the Prevention and Treatment of Chronic Hepatitis B(Version 2022)

To facilitate the achieving of the goal of“eliminating viral hepatitis as a major public health threat by 2030”set by theWorld Health Organization,the Chinese Society of Hepatology together with the Chinese Society of Infectious Diseases(both are branches of the ChineseMedical Association)organized a panel of experts and updated the guidelines for prevention and treatment of chronic hepatitis B in China(version 2022).With the support of available evidence,this revision of the guidelines focuses on active prevention,large-scale testing,and expansion of therapeutic indication of chronic hepatitis B with the aim of reducing the hepatitis B–related disease burden.

Comprehensive approach to esophageal variceal bleeding:From prevention to treatment

Esophageal variceal bleeding is a severe complication often associated with portal hypertension,commonly due to liver cirrhosis.Prevention and treatment of this condition are critical for patient outcomes.Preventive strategies focus on reducing portal hypertension to prevent varices from developing or enlarging.Primary prophylaxis involves the use of non-selective beta-blockers,such as propranolol or nadolol,which lower portal pressure by decreasing cardiac output and thereby reducing blood flow to the varices.Endoscopic variceal ligation(EVL)may also be employed as primary prophylaxis to prevent initial bleeding episodes.Once bleeding occurs,immediate treatment is essential.Initial management includes hemodynamic stabilization followed by pharmacological therapy with vasoactive drugs such as octreotide or terlipressin to control bleeding.Endoscopic intervention is the cornerstone of treatment,with techniques such as EVL or sclerotherapy applied to directly manage the bleeding varices.In cases where bleeding is refractory to endoscopic treatment,transjugular intrahepatic portosystemic shunt may be considered to effectively reduce portal pressure.Long-term management after an acute bleeding episode involves secondary prophylaxis using betablockers and repeated EVL sessions to prevent rebleeding,complemented by monitoring and managing liver function to address the underlying disease.In light of new scientific evidence,including the findings of the study by Peng et al,this editorial aims to review available strategies for the prevention and treatment of esophageal varices.

Updating the diagnostic criteria of COVID-19 “suspected case” and “confirmed case” is necessary

On 6 February 2020,our team had published a rapid advice guideline for diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infection,and this guideline provided our experience and make well reference for fighting against this pandemic worldwide.However,the coronavirus disease 2019(COVID-19)is a new disease,our awareness and knowledge are gradually increasing based on the ongoing research findings and clinical practice experience;hence,the strategies of diagnosis and treatment are also continually updated.In this letter,we answered one comment on our guideline and provided the newest diagnostic criteria of"suspected case"and"confirmed case"according to the latest Diagnosis and Treatment Guidelines for COVID-19(seventh version)that issued by the National Health Committee of the People’s Republic of China.

基于“治未病”理念的中医药全周期防治高血压策略

将“治未病”理念与高血压的中医药全周期防治相结合,从“未病先防、既病防变、已变防衰”三方面强化高血压全周期干预的3级中医药防治策略,从而早期干预高血压前期、阻断高血压进展、保护靶器官,预防并发症,提高患者的生活质量,充分发挥中医药在高血压防治方面的特色和优势,为中医药在高血压防治中的应用提供理论依据。

厦门市老年人高血压防治行为与健康素养的相关性研究

目的 了解厦门市老年人高血压防治相关行为与健康素养现况及两者的相关性。方法 采用多阶段分层随机抽样方法,抽取厦门市60岁以上老年人913名开展入户问卷调查。结果 2020年厦门市老年人的健康素养水平为9.63%,规律服药行为形成率为86.83%;“高血压会引起脑卒中或冠心病”的知晓率最高(88.07%),“吸烟的危害”的知晓率最低(43.50%)。不同性别、文化程度、家庭年收入的老年人健康素养水平差异有统计学意义(P<0.05)。多因素logistic回归分析显示,文化程度和家庭总收入是老年人健康素养的影响因素;防治高血压行为中,摄盐口味与规律运动与老年人的健康素养水平相关。结论 厦门市老年人的健康素养水平有待提高;防治高血压与自我管理行为现况不容乐观,应加强科学摄盐及规律运动等健康素养知识的教育。

中国乙型肝炎病毒母婴传播防治指南(2024年版)

中华医学会感染病学分会制定的《中国乙型肝炎病毒母婴传播防治指南(2019年版)》(简称2019版《指南》)对国内乙型肝炎病毒母婴传播阻断流程的规范化起到了良好的指导作用。临床实践指南和共识需要随新研究证据的出现,及时更新以更好地指导临床实践和研究。中国医师协会感染科医师分会和中华医学会感染病学分会联合多学科专家,基于国内外最新研究进展,结合临床实践,对2019版《指南》进行了更新和补充,为临床医师和妇幼保健工作人员提供指导和参考。