Hao-min Cheng, M.D., Ph.D.
Director, Center for Evidence-based Medicine, Taipei Veterans General Hospital;
Department of Medical Education, Taipei Veterans General Hospital Division of Cardiology, Taipei Veterans General Hospital;
Faculty of Medicine, National Yang-Ming University, Taiwan;
Institute of Public Health, National Yang-Ming University, Taiwan
Hao-min Cheng was graduated from Faculty of Health Science, The University of Adelaide, Australia and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan with the outstanding award among Graduate. He holds a doctorate degree in Medicine from University of Adelaide, Australia. He has been a cardiologist for more than 15 years with the sub-speciality of interventional cardiology and cardiovascular hemodynamics. As a professor in National Yang-Ming University, he has been granted the awards of excellence in Clinical and Internship Teaching numerous times. He is currently the director of Centre for Evidence-based Medicine in Taipei Veterans General Hospital, and his research has been focusing on cardiovascular hemodynamics, hypertension management, and evidence-based health care with more than 200 articles published in peer-reviewed journals and several patents in US, Japan, and Taiwan. Meanwhile, he is an editor in BMC Cardiovascular Disorders, JBI evidence synthesis, Frontiers in Cardiovascular Medicine and has been involved in editorial and peer-review work of many international SCI listed journals. To achieve the goal of evidence-based health care, he has developed the innovative techniques relating to cardiovascular hemodynamics and endeavoured to facilitate the technology transfer from research to industrialisation.
From 2020 Home BP Consensus to 2022 TSOC/THS Hypertension Guideline
Hao-min Cheng, M.D., Ph.D 1,2,3
1 Center for Evidence-based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2 Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
3 Institute of Public Health and Cardiovascular Research Center, National Yang Ming Chiao
Tung University College of Medicine, Taipei, Taiwan
Background: Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Numerous epidemiological studies and pharmacological intervention trials have demonstrated that lower and lowering blood pressures (BP) are associated with fewer CV events and lower mortality. Despite the positive
correlations between BP levels and later CV events are continuous since BP levels as low as 90/60 mmHg in almost all large-scale epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years (since the release of the Fifth Report of the Joint National Committee [JNC 5] on high BP in 1993). The publication of both the SPRINT and the STEP trials (comprising >8,500 Caucasian/African and Chinese participants, respectively) provides enough evidence to shake this 140/90 mmHg dogma. In both trials, lowering systolic BP (SBP) to <130 mmHg, compared to the traditional SBP
target of <140 (130-139) mmHg, was consistently associated with a 25-30% relative risk reduction in CV events. Another dogma regarding hypertension management is “office (or clinic) BP measurements” Although standardized office BP measurement has been widely recommended, the practice of office BP measurements is hard to be or has never been ideal
in real-world practice. Further, the debate regarding the numerical equivalence between automated office BP (AOBP) measurements adopted in the SPRINT trial and office BP measurements has never been settled. The variations of office BP readings and the differences between office BP and home BP readings bewilder not only patients, but also healthcare
professionals. On the other hand, out-of-office BP monitoring receives growing attention in contemporary hypertension guidelines. Home BP monitoring (HBPM) and ambulatory BP monitoring (ABPM) are two recognized approaches to obtaining out-of-office BP. HBPM is easy-to-use, more likely to be free of environmental and/or emotional stress (such as whitecoat effect), feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events.
Methods/Results: The Taiwan Hypertension Society (THS) and the Taiwan Society of Cardiology (TSOC) jointly issued the Consensus Statement on HBPM in 2020. The “722” protocol to standardize HBPM has been advocated by both Societies and widely accepted by healthcare professionals. In the 2022 Taiwan Hypertension Guidelines, we break the dogma
of “office BP-based management strategy” and further expand the role of HBPM to the whole hypertension management process, from diagnosis to long-term follow-up. The Task Force considers that, to improve the quality of long-term management of all chronic diseases including hypertension, patients themselves should take an active role and HBPM is the right tool to achieve this goal, regardless of many other advantages of HBPM. This approach is of particularly importance in the post-COVID era and can bridge the management with artificial intelligence technologies.
Conclusion: To facilitate implementation of the guidelines, a series of flowcharts to encompass assessment, adjustment, and HBPM-guided hypertension management are provided.