Chinese Physicians' Perspectives on the 2017 American College of Cardiology/American Heart Association Hypertension Guideline: A Mobile App-Based Survey.

Abstract

Hypertension is a leading global risk factor for death and disability. Seeking new ways to prevent and treat hypertension is a priority for scientists and healthcare professionals worldwide. In November 2017, the American College of Cardiology (ACC) and the American Heart Association (AHA) issued a new hypertension guideline shifting the definition of hypertension from 140/90mmHg to 130/80mmHg for systolic/diastolic blood pressure. This new diagnostic threshold of hypertension has sparked a lively discussion worldwide over whether it should be applied in clinical settings to diagnose and treat hypertension. China, the world's most populous country, is facing a hypertension crisis. According to the 140/90mmHg guideline, China has an estimated 244.5 million population aged ≥18 years with hypertension, and another 435.3 million with pre-hypertension. If the new guideline is adopted, the prevalence of hypertension in China would double. This change would significantly impact patients, healthcare professionals, scientists, and policy makers in terms of the delivery of care and needed resources. This study aims to investigate whether Chinese physicians will use the 130/80mmHg threshold to diagnose hypertension in clinical practice. In March 2018, we launched a mobile app-based survey to study 253 Chinese physicians' perspectives on the ACC/AHA Guideline. A total of 253 physicians from 21 Chinese provinces completed the survey. Nearly 80% of the participants had already noticed the ACC/AHA guideline change. The proportion of participants who said they would use the new threshold to diagnoses hypertension was 41%, while 59% said they would not use the new threshold. The primary reason for those who said "yes" was that they believed early diagnosis of hypertension can trigger early actions to prevent the increasing blood pressure. For those who said "no", they argued that their decision was based on the fact that the Chinese Hypertension Prevention Guideline had not yet changed the diagnostic threshold from 140/90 to 130/80mmHg. Different understanding of hypertension prevention and treatment exists among Chinese physicians. It is an emergent need to form an evidence-based authoritative answer to guide Chinese physicians' future clinical practice.