After using 3 or more antihypertensive drugs (including diuretics) at the optimal dose or maximum tolerated dose, and excluding pseudo-refractory hypertension, drug-induced hypertension and secondary hypertension, Office blood pressure remained >140/90 mmHg.

① Improvement of health behaviors and lifestyle;

② Optimize the use of diuretics;

③ For patients with serum potassium < 4.5 mmol/L and eGFR > 45 ml/(min·1.73m2), spironolactone can be considered as the fourth drug;

④ (Ideal standard) Patient management is performed by professionals.

High blood pressure due to specific causes.

①The age of onset of hypertension is <30 years old and there are no risk factors;

②Refractory hypertension;

③Recent sudden high blood pressure that is difficult to control;

④ Hypertensive emergency;

⑤ There are clinical clues of secondary factors.

Past hypertension;

pregnancy-induced hypertension;

Preeclampsia;

Eclampsia;

HELLP syndrome.

①Basic standards

②Ideal standard

① Mild hypertension: If the blood pressure persists >150/95 mmHg, drug treatment should be given, with methyldopa, beta-blockers and dihydropyridine CCB being the first choices.

② Severe hypertension: systolic blood pressure > 170 mmHg and/or diastolic blood pressure > 110 mmHg, intravenous labetalol, oral methyldopa or dihydropyridine CCB, avoid sodium nitroprusside.

③ Delivery of patients with gestational hypertension or preeclampsia: Asymptomatic patients at 37 weeks of pregnancy can deliver; if Patients with visual impairment and abnormal coagulation function should expedite delivery.

Sudden and significant increase in blood pressure, accompanied by acute target organ damage, generally requires emergency intravenous antihypertensive treatment. If there is no acute target organ damage, it is not considered a hypertensive emergency.

malignant hypertension;

Hypertensive encephalopathy;

Hypertensive thrombotic microangiopathy;

Stroke, acute coronary syndrome and other manifestations.

① Blood pressure should be lowered as soon as possible to avoid or delay the occurrence of target organ damage;

② Most of the current recommendations are based on expert consensus and lack strong evidence;

③The type of acute target organ damage is the main determinant of the preferred treatment option;

④ Labetalol and nicardipine are safe for all hypertensive emergencies.

① The population with the onset of hypertension and target organ damage is younger, has a higher incidence of refractory hypertension and nocturnal hypertension, and has a higher risk of kidney disease, stroke, heart failure and death;

②Physiological characteristics include RASS inhibition, changes in renal sodium excretion function, enhanced cardiovascular reactivity and premature vascular aging.

①Adults over 18 years old should be screened for high blood pressure every year;

②Adjust lifestyle;

③Use a single-pill compound preparation in the first line.

④ ARB is the first choice for RASS blocker.

①Patients with hypertension are more likely to be salt sensitive and have mild obesity;

② More susceptible to stroke and non-ischemic heart failure;

③Morning hypertension and nighttime hypertension are more common than in European populations.