Skip to main content
SpringerLink
Log in

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

  • Original article
  • Published:
High Blood Pressure & Cardiovascular Prevention Aims and scope Submit manuscript

Abstract

Introduction

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 140/90 mm Hg to 130/80 mm Hg 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 140/90 mm Hg 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.

Aim

This study aims to investigate whether Chinese physicians will use the 130/80 mm Hg threshold to diagnose hypertension in clinical practice.

Methods

In March 2018, we launched a mobile app-based survey to study 253 Chinese physicians’ perspectives on the ACC/AHA Guideline.

Results

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 130/80 mm Hg.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lim SS, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet Lond Engl. 2012;380(9859):2224–60.

    Article  Google Scholar 

  2. Neal B, et al. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet. 2000;356(9246):1955–64.

    Article  CAS  PubMed  Google Scholar 

  3. Psaty BM, et al. Health outcomes associated with antihypertensive therapies used as first-line agents—a systematic review and meta-analysis. Jama-J Am Med Assoc. 1997;277(9):739–45.

    Article  CAS  Google Scholar 

  4. Wang J-G, Liu L. Global Impact of 2017 American College of Cardiology/American Heart Association Hypertension Guidelines: a Perspective From China. Circulation. 2018;137(6):546–8.

    Article  PubMed  Google Scholar 

  5. Whelton PK, et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertens. Dallas Tex 1979. 2017.

  6. New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. American College of Cardiology. http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017. Accessed 24 Nov 2018.

  7. Khera R, et al. Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China: nationally representative cross sectional study. BMJ. 2018;362:k2357.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Crawford C. AAFP Decides to Not Endorse AHA/ACC Hypertension Guideline. https://www.aafp.org/news/health-of-the-public/20171212notendorseaha-accgdlne.html. Accessed: 07 May 2018.

  9. Lu J, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017;390(10112):2549–58.

    Article  PubMed  Google Scholar 

  10. Chobanian AV, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertens Dallas Tex 1979. 2003;42(6):1206–52.

    CAS  Google Scholar 

  11. Wang Z, et al. Status of hypertension in China: results from the China hypertension survey, 2012–2015. Circulation. 2018;137:2344–56.

    Article  PubMed  Google Scholar 

  12. Garies S, et al. Prevalence of hypertension, treatment, and blood pressure targets in Canada Associated With the 2017 American College of Cardiology and American Heart Association Blood Pressure Guidelines. JAMA Netw Open. 2019;2(3):e190406.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tocci G, et al. Reclassification of hypertensive outpatients according to New US Guidelines on High Blood Pressure. Am J Hypertens. 2019;32(1):77–87.

    Article  PubMed  Google Scholar 

  14. Kibria GMA, et al. Estimated change in prevalence of hypertension in Nepal following application of the 2017 ACC/AHA guideline. JAMA Netw Open. 2018;1(3):e180606.

    Article  PubMed  PubMed Central  Google Scholar 

  15. WeChat: number of users 2018. Statista. https://www.statista.com/statistics/255778/number-of-active-wechat-messenger-accounts/. Accessed 14 Jan 2019.

  16. Tarrant C, Angell E, Baker R, et al. Developing and piloting the questionnaires (pilots 1 and 2). In: Responsiveness of primary care services: development of a patient-report measure – qualitative study and initial quantitative pilot testing. Health Services and Delivery Research, No. 2.46. Southampton, UK: NIHR Journals Library; 2014.

    Google Scholar 

  17. Babbie E. The logic of sampling. In: Howard E, editor. The practice of social research, Chap 7. 10th ed. Belmont: Wadsworth/Thomson; 2004.

    Google Scholar 

  18. Sheu S-J, Wei I-L, Chen C-H, Yu S, Tang F-I. Using snowball sampling method with nurses to understand medication administration errors. J Clin Nurs. 2009;18(4):559–69.

    Article  PubMed  Google Scholar 

  19. Saldana J. The coding manual for qualitative researchers. Thousand Oats: SAGE; 2015.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Nursing, Duke University, 307 Trent Drive, Durham, North Carolina, 27710, USA

    Zhao Ni, Jiepin Cao & Qing Yang

  2. West China Hospital, Sichuan University, Chengdu, China

    Juan He

  3. The Shanghai Institute of Hypertension, Shanghai, China

    Ji-Guang Wang

  4. Rory Meyers College of Nursing, New York University, New York, USA

    Bei Wu

  5. Duke Mobile App Gateway, Duke University, Durham, USA

    Ryan Jeffrey Shaw

  6. School of Nursing, Health Innovation Lab, Duke University, Durham, USA

    Ryan Jeffrey Shaw

  7. School of Medicine, Center for Applied Genomics and Precision Medicine, Duke University, Durham, USA

    Ryan Jeffrey Shaw

Authors
  1. Zhao Ni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Juan He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ji-Guang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiepin Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qing Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bei Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ryan Jeffrey Shaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhao Ni.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Appendices

Appendix 1. The 11 Questions of the Online Survey

Question item

Variable name

Annotation

1. How old are you (year)?

Age

 

2. What is your highest educational degree?

Education

 

3. What is your professional title?

Title

 

4. The name of the hospital that you are working at?

Hospital level, Hospital location

 

5. Which hospital department you are working at?

Department

 

6. What is your diagnostic threshold of hypertension?

Diagnosis

 

7. 2017 ACC/AHA hypertension guideline changed the definition of hypertension from 140/90 to 130/80 mm Hg for systolic/diastolic blood pressure. Did you notice this change?

Notice

 

8. [If answered ‘Yes’ to question 7] How did you notice the 2017 ACC/AHA new hypertension guideline (You can choose more than one answer)?

Approaches

 

9. [All participants can answer this question] Will you follow the 2017 ACC/AHA hypertension guideline and use 130/80 mm Hg as diagnostic threshold of hypertension in clinical practice?

Use

 

10. [If answered ‘Yes’ to question 9] Please explain and give rationale of why you will follow the 2017 ACC/AHA hypertension guideline’s diagnostic threshold of hypertension

[If answered ‘No’ to question 9] Please explain and give rationale of why you will not follow the 2017 ACC/AHA hypertension guideline’s diagnostic threshold of hypertension

 

Qualitative data

11. If you have any other thoughts that you want to tell us, please type in the blank space

 

Qualitative data

Appendix 2. Different Approaches to New Guideline (N = 164)

Approaches

N

n

%

WeChat

164

82

50

Journal

164

91

55.49

Colleague

164

59

35.98

Web

164

46

28.05

App

164

40

24.39

News

164

35

21.34

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ni, Z., He, J., Wang, JG. et al. Chinese Physicians’ Perspectives on the 2017 American College of Cardiology/American Heart Association Hypertension Guideline: A Mobile App-Based Survey. High Blood Press Cardiovasc Prev 26, 247–257 (2019). https://doi.org/10.1007/s40292-019-00321-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40292-019-00321-9

Keywords

Search

Navigation