Who set the 140/90 for high blood pressure? Diagnostic-procedure rules, three thresholds that cannot be mixed, and how the 29.5% is calculated, 2026

TL;DR The line Hong Kong uses to diagnose high blood pressure is office blood pressure ≥140/90 mmHg, set by the Hong Kong Reference Framework for Hypertension Care for Adults (Revised Edition 2021; the publisher on the bibliographic entry is the Primary Healthcare Commission of the Health Bureau), not by the Hospital Authority. The same document states that a diagnosis cannot rest on one set of readings at a single visit: it takes the average of readings taken "on two or more separate occasions", with three readings at each visit (the third only if the first two differ by more than 10 mmHg) and the last two averaged; only grade three hypertension (≥180/110) with clear organ damage may be diagnosed at a single visit. The 29.5% the media quote is from Part II of the Department of Health's Population Health Survey 2020-22, its age band is 15 to 84 (not "adults"), and it is a composite: 17.4% self-reported as diagnosed by a doctor plus 12.1% with no reported history whose blood pressure was raised at the physical examination. The same report has a measurement-only figure: 15.0% age-standardised for ages 18 to 84 (crude rate 19.4%), roughly half the headline. The biggest misconception is taking a rise in that figure to mean the disease is getting worse. Across three rounds of the same survey series the undiagnosed proportion runs 15.1% → 13.2% → 12.1%, falling throughout; the diagnosed proportion runs 12.1% → 14.6% → 17.4%, rising throughout. The total rose from 27.2% to 29.5% mainly because more is being found. And one thing Hong Kong has said itself but few people quote: Hong Kong's official document states expressly that there is at present no cardiovascular risk assessment tool designed for Chinese populations, and that the American Pooled Cohort Equations calibrate poorly for Hong Kong Chinese. This article reports what each guideline says, who published it and when. It will not decide for you whether to take medication, which one, or what your blood pressure target is — those are for a doctor. Nor does it give a symptom list to judge yourself by.

#What is high blood pressure, and why is it called "silent"?

Blood pressure is a continuously fluctuating value, and high blood pressure is defined as being persistently above the line, not once above it.

A blood pressure reading has two numbers. The upper is systolic blood pressure, the highest pressure as the heart contracts and pumps; the lower is diastolic blood pressure, the lowest pressure as the heart relaxes. The unit is millimetres of mercury (mmHg).

The Chinese page of the Department of Health's Elderly Health Service puts it directly: high blood pressure means the upper reading is persistently at or above 140 mmHg, or the lower reading persistently at or above 90 mmHg [Note 1] — the key word is "persistently".

On causes, the same page says the great majority of cases of high blood pressure (90 per cent) are "primary", that is of unknown cause, while the other 10 per cent are "secondary", caused by other diseases or bodily changes such as kidney disease or endocrine disturbance [Note 2]. Note the words "such as": the list of secondary causes is an example, not a complete list. The Centre for Health Protection's health topic page writes that "no clear cause can be identified in over 90% of cases of high blood pressure". Both statements come from the Department of Health system, the figures are not identical, and this article gives both.

The same page lists seven risk factors: smoking, overweight and obesity, lack of exercise, too much salt in the diet, excessive drinking, increasing age, and a first-degree relative with high blood pressure. Those seven are the complete list published on that page. ⚠ But it must not be taken as a closed list: where the patient version says the same thing, its lead-in is "factors arising at different stages of life affect the risk of developing high blood pressure, for example:" — an "for example", and its own table adds "unhealthy eating habits" and puts "older age" first. Both are current official documents.

The word "silent" has an official basis. The Health Bureau's Hong Kong Reference Framework for Hypertension Care for Adults [patient version] (revised July 2022) says that because most patients have no obvious symptoms, they become aware of the condition only when blood pressure is measured. The first and second items of that document's section on common misconceptions are at [Note 3] in full — the second states that most patients have no symptoms, so relying on symptoms alone to tell whether one has the condition is not reliable; the first states that practising a healthy lifestyle, and reducing salt above all, can reduce the risk of developing high blood pressure.

Put together, those two say: you cannot feel it, but you can affect it.

This has to be pushed all the way: symptoms cannot be used to rule high blood pressure out, and cannot be used to confirm it either. No headache, no dizziness and no discomfort bear no necessary relation to whether blood pressure is high. Any inference of the form "I feel nothing, so I am probably fine" is the opposite of what the official documents say.

⚠ If you have never had your blood pressure measured and feel "I'm fine, really": the only conclusion in this section is that comfort is not information, and the reading on the monitor is.

#Who set Hong Kong's 140/90, and why that number?

Not the Hospital Authority — the Hong Kong Reference Framework for Hypertension Care for Adults in the Health Bureau system, and it states itself that it was written with reference to the World Health Organization and the European societies.

The document's full name is Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings, and the dates on its own cover are: Revised Edition 2021 / First published: 2010 / Last review date: 2021.

"Who publishes it" and "who is responsible for updating it" are two different things, and each has its own source. On the publisher, item 5 of the reference list in the Centre for Health Protection's Non-Communicable Diseases Watch of May 2025 reads 「香港特別行政區：醫務衞生局基層醫療署。二零二一年修訂版。香港高血壓參考概覽—成年患者在基層醫療的護理。」 — that is, it names the Primary Healthcare Commission of the Health Bureau as the publisher of the revised edition of the Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings (our translation from the Chinese original).

As for who updates it, the document's own preface to the first edition is more specific than the bibliographic entry: the Working Group on Primary Care was re-established under the Health and Medical Development Advisory Committee, chaired by the Secretary for Food and Health; the working group set up four task forces, one of them the Task Force on Conceptual Model and Preventive Protocols; that task force is responsible for promulgating and revising, and for recommending strategies to promote, the model and frameworks adopted; and it set up two clinical advisory groups to review and update the reference frameworks regularly, whose members serve in a personal capacity rather than as representatives of their organisations [Note 4]. The preface is signed by the task force convenor, Professor Cindy Lam.

In one sentence: what appears in the bibliographic entry is the publisher, not the updater. On the document's own account, what reviews and updates this framework regularly are the two clinical advisory groups under the Task Force on Conceptual Model and Preventive Protocols. Reading that bibliographic line as "some department is now responsible for updating it" takes a publishing credit for an allocation of duties.

⚠ The Chinese and English texts of that sentence differ in one respect: the English says "promulgating, maintaining and revising", while the Chinese says 「發佈、修訂」, promulgating and revising. The English has maintaining as a third item and the Chinese does not. This article quotes the Chinese and records the divergence.

The blood pressure classification table in chapter seven states its own source in the table heading: 「表2. 診間血壓分類註1〔根據世界衞生組織(WHO)的聲明1a及歐洲心臟病學會（ESC）和歐洲高血壓學會（ESH）聯合制定的指南1b編寫而成〕和相應的覆診相隔時間及行動的建議」 — that is, a table of the classification of office blood pressure, written with reference to the World Health Organization's statement and the guidelines jointly developed by the European Society of Cardiology and the European Society of Hypertension, together with the corresponding recommendations on follow-up intervals and actions (our translation from the Chinese original).

In one sentence: Hong Kong uses 140/90 because Hong Kong follows the World Health Organization and Europe, not the United States. That is the direct answer to "why does Hong Kong not use 130/80", written by the document itself and needing no inference. (The Hospital Authority is not the source of this classification; formulations found elsewhere labelling it as part of a Hospital Authority chronic disease management programme do not match the document.)

⚠ If you have read foreign coverage and feel Hong Kong's standard is the more relaxed one: the difference is not one of strictness but of which organisation is followed — and the Hong Kong document says which.

#Why does one measurement not count? The diagnostic procedure is the least-known part

The reference framework states that a diagnosis of hypertension should not rest on one set of readings at a single visit.

The full text of note 1 to chapter seven is at [Note 5]. In one sentence: three readings at a visit (the third only if the first two differ by more than 10 mmHg), the last two averaged; then repeated "on two or more separate occasions" before your blood pressure level counts as estimated.

The exception note 1 writes for itself is set out more specifically in note 5 on the same page: for grade three hypertension, where there is clear evidence of hypertension-mediated organ damage (hypertensive retinopathy with exudates and haemorrhages, left ventricular hypertrophy, or vascular or renal impairment, for example), a diagnosis of hypertension may be made at a single visit [Note 6].

Another requirement few people have heard of is that both arms must be measured. Note 4 on the same page of the same document has three points: if the readings from the two arms differ by more than 15 mmHg, measure again; if the second measurement still differs by more than 15 mmHg, use the arm with the higher reading thereafter; and a difference of 15 mmHg or more between the arms can identify patients at high risk of asymptomatic peripheral vascular disease (subclavian artery stenosis, for example) and of death, who may benefit from further assessment [Note 7].

The third point is the key one, and it does not usually travel with the first two. The first two tell you how to measure; the third says what a difference means once measured: a difference of 15 mmHg or more between the arms is itself a signal identifying someone at high risk. In other words, "keep measuring the higher arm" is not where this rule ends — the difference itself is information to be given to a doctor.

The professional module of the same document (Module 2, item xvii; that module exists only in English) writes one sentence about the number of visits that is quoted just as rarely: the number of visits and the time interval between visits varies according to the severity of the hypertension, and is inversely related to the severity of hypertension [Note 8]. The same item also states that a diagnosis may be made either by markedly raised blood pressure plus organ damage, or by confirming persistently raised blood pressure over repeated visits. That is, "two or more separate occasions" is not a uniform waiting period — the higher the blood pressure, the shorter the interval should be.

Why this section matters: "the clinic measured 150 last time" is not a diagnosis of hypertension, and "it was 130 last time" is not the absence of one. The procedure is itself part of the diagnosis.

⚠ If a high reading at a shopping centre, a pharmacy or in a health check report has you worried straight away: what you have is one reading, not a diagnosis.

#Office, home and 24-hour: three different lines that cannot be mixed

The same person on the same day has three different lines under three ways of measuring; use the wrong line and you reach the wrong conclusion.

The professional module of the reference framework (Module 2, Blood Pressure Measurement) publishes the correspondence. ⚠ That module exists only in English: on the Health Bureau's site the Chinese page's "download full document" link points to the English PDF, and all nine professional modules resolve to /en/ paths in the Chinese language file. This article therefore quotes the English original (at [Note 9]), with the English elsewhere used as explanation rather than inside quotation marks.

Home measurement: persons with an average blood pressure of 135/85 mmHg measured at home are generally considered to be hypertensive. ⚠ That is a diagnostic threshold, not a "control target". Treating 135/85 as a home blood pressure control target takes a diagnostic threshold for a treatment target. The treatment target is elsewhere, and it does have a Chinese version — see the next section.

Ambulatory blood pressure monitoring (ABPM): the values are on average lower than office values; a 24-hour average ≥130/80, a daytime average ≥135/85 and a night-time average ≥120/70 are all equivalent to an office reading of ≥140/90.

On "white coat hypertension", Module 2 of the reference framework says only that emotional factors including white coat hypertension can be addressed by 24-hour ambulatory monitoring and home self-monitoring [Note 10]. Hong Kong's official documents publish no magnitude for the white coat effect — that is, figures of the kind "the clinic reads 10 to 20 mmHg higher than home" have no source in the Hong Kong material this article relies on, and this article therefore does not state one.

#Home blood pressure monitors: how detailed is the official Chinese version?

The Health Bureau's patient version is the one Hong Kong government document cited here that sets out the steps of home measurement in Chinese, and it has more detail than the versions that circulate informally, including one rule those versions do not have.

The preparations before measuring and the points to note while measuring are at [Note 11] in full. On recording, it states: record the average of two measurements; if the two differ by more than 5 millimetres of mercury, measure again and take the average; record the reading every time so as to monitor blood pressure continuously; and bring the blood pressure record to follow-up for healthcare staff [Note 12].

In other words, the official version is: measure twice and average; if the two differ by more than 5 mmHg, measure a third time and then average. That "more than 5 mmHg" rule is often missing from the step lists that circulate informally.

⚠ How long between the two is answered not in the recording paragraph but in the last point of the paragraph above it, on measuring: after the first measurement, loosen the cuff completely and record the reading; rest and measure again, with at least 1 minute between the two measurements [Note 13]. Without that interval, "measure twice and average" cannot do what it is meant to do. Module 2 section 4.2 is more specific still (that module exists only in English): two consecutive measurements are taken, at least 1 to 2 minutes apart, with the person seated, and blood pressure is recorded twice daily [Note 14].

On choosing a monitor: ordinary electronic monitors may be used on the upper arm or the wrist, and because the upper-arm type is more accurate it is the more suitable, while finger monitors are not recommended; the cuff width should cover two thirds of the length of the upper arm and its length should be enough to encircle the arm completely, and people with thicker arms or who are obese may need a larger cuff [Note 15].

The passage on accuracy has three points, and the middle one is the one most often lifted out on its own. The whole passage is: choose a clinically validated monitor, and read the instructions carefully before operating it; the monitor should be serviced and calibrated regularly; and readings taken at home may differ from those taken at a doctor's clinic, so if in doubt you may bring your home monitor to an appointment and let the doctor help check its accuracy [Note 16].

So: the first criterion in choosing a monitor is that it be clinically validated, not whether it is an upper-arm or wrist type; and the question "how do I know whether my machine is accurate" has an official answer: take the machine to a follow-up appointment and let the doctor check it.

On maintenance the official wording is that the monitor "should be serviced and calibrated regularly", with no period stated. So formulations such as "calibrate every 1 to 2 years" have no source in Hong Kong's official documents and this article does not adopt them; but "no period" is not "ignore it" — the sentences before and after in the same passage already set out what to do. Module 2 section 4.2 has a sentence to the same effect: home measurement devices should be checked regularly.

How many consecutive days? This one appears only in the English professional module: initial assessment or the assessment of treatment effects should be for a 7-day period, with recordings performed in the morning and evening, and the average of the readings taken as the home blood pressure level [Note 17].

⚠ Note that the official wording is to take the average of all the readings, with nothing about discarding the first day and using only the middle 5 days. The commonly seen "average the middle 5 days" is not a Hong Kong rule.

At the opening of the same section, the document lists the disadvantages of home measurement, not only its advantages. The table at Module 2 section 4.1 has two columns: the advantages are information on the response to antihypertensive drugs, improved adherence, and the ability to identify white coat and masked hypertension; the disadvantages are only two — reporting bias, and unsupervised alteration of medication. The second is one of only two warnings the document places in that section: buying a monitor and measuring yourself, and adjusting your own medication by the readings, are two different things in that document, and the second is listed as a disadvantage of home measurement.

The treatment target — this one does have a Chinese version, in the patient version: for people with high blood pressure alone, blood pressure should be below 140/90 mmHg, and where their condition allows, the target should be set at 130/80 mmHg or below; for people with high blood pressure and another chronic disease such as diabetes, blood pressure should be below 130/80 mmHg [Note 18]. That is the document's statement of targets to healthcare staff and patients. Your own target is decided by a doctor on your overall condition, and this article does not step into that.

⚠ The same target carries a caution in the professional module that the patient version does not include. Module 7 (English only), having given <140/90, 130/80 and <130/80 for diabetes or kidney disease, writes immediately after: for patients with coronary artery disease, blood pressure should be lowered slowly, and caution is advised in inducing falls of diastolic blood pressure below 60 mmHg if the patient also has diabetes mellitus or is over the age of 60 years [Note 19].

That is: the targets written in the same document are not "press it down as far as possible" — for someone who already has coronary artery disease, and also diabetes or is over 60, it says to go slowly and to watch that the lower reading does not fall through 60. That sentence is the one most easily stopped short of after "130/80".

#How much does medication actually help? The figures for both arms, including the trials that did not succeed

The benefit of blood pressure lowering treatment is real in the large trials; but "the lower the better" was not confirmed in diabetic patients in the trials that actually compared an intensive target with a standard one.

Take first the one most directly relevant to Hong Kong readers. All the participants in the STEP trial (N Engl J Med 2021;385:1268-1279, PMID 34491661) were Chinese, aged 60 to 80. The intensive group's target systolic pressure was 110 to <130 and the standard group's 130 to <150. At one year the actual mean systolic pressures were 127.5 mmHg in the intensive group and 135.3 mmHg in the standard group. Over a median follow-up of 3.34 years, primary endpoint events occurred in 147 people in the intensive group (3.5%, n=4243) and 196 in the standard group (4.6%, n=4268), hazard ratio 0.74 (95% confidence interval 0.60–0.92, P=0.007). The abstract describes safety as: no significant difference between the groups in safety or renal outcomes, except a higher incidence of hypotension in the intensive group.

On the shape of the side effects, SPRINT is the clearest: serious adverse events overall were almost identical between the groups — 1793 people (38.3%) in the intensive group against 1736 (37.1%) in the standard group, P=0.25; and injurious falls did not increase either (105 people, 2.2%, against 110, 2.3%). The increases were concentrated in particular categories: acute kidney injury or renal failure 193 (4.1%) against 117 (2.5%); hypotension 110 (2.4%) against 66 (1.4%); electrolyte abnormality 144 (3.1%) against 107 (2.3%); syncope 107 (2.3%) against 80 (1.7%). ACCORD-BP is the same: serious adverse events attributed to antihypertensive medication numbered 77/2362 (3.3%) in the intensive group and 30/2371 (1.3%) in the standard group, P<0.001.

The BPLTTC cell in the table above cannot be read on its own. The hazard ratio of 0.99 (0.87–1.12) in the group aged 85 and above is one cell in that paper's results section; the next sentence of the same section, and the conclusion section immediately after, say the opposite. The original is at [Note 20]: absolute risk reductions for major cardiovascular events varied by age and were larger in older groups (adjusted p for interaction = 0·024); pharmacological blood pressure reduction is effective into old age, with no evidence that relative risk reductions for prevention of major cardiovascular events vary by systolic or diastolic blood pressure levels at randomisation, down to less than 120/70 mmHg; and pharmacological blood pressure reduction should therefore be considered an important treatment option regardless of age, with the removal of age-related blood pressure thresholds from international guidelines.

In one sentence: that 0.99 says the relative risk reduction per 5 mmHg did not reach statistical significance within the small cell of those aged 85 and above (4,788 people, 1.3% of the whole); the conclusion the authors draw from the whole analysis is that blood pressure lowering remains effective into old age, and that because older people are at higher risk to begin with, the same relative reduction converts into a larger absolute benefit. The paper reports the test of interaction by age as adjusted p for interaction = 0·050 — that is, the paper does not itself treat the difference between age groups as established. Any inference that "after 85 there is no need to take it" is the opposite of what this paper recommends.

Do the arithmetic once: how close the benefit and the harm are.

⚠ This passage is about an intensive blood pressure target compared with a standard one, that is the question of how low blood pressure should be pushed; it is not about whether antihypertensive drugs work at all, and not about the ≥140/90 diagnostic line.

The Lancet pooled analysis of individual participant data in 2025 (six trials, n=80,220, 82.6% Asian) compares exactly an intensive target with a standard one, and reports benefit and harm on the same ruler. It reports an absolute risk reduction in cardiovascular events of 1.73% and an absolute risk increase in adverse events of 1.82%.

The number needed to treat is 1 divided by 0.0173, or 57.8, and the paper reports 58. The number needed to harm is 1 divided by 0.0182, or 54.9, and the paper reports 55.

That is: for every 58 people given intensive blood pressure lowering, one more avoids a cardiovascular event; for every 55, one more has an adverse event as the paper defines it. The paper's own overall conclusion is that the net effect is positive (1.14, 95% credible interval 1.03–1.25), but the two figures are very close together, and that is the real cost of the "lower is better" formulation.

⚠ If you are already on medication and have heard that "the lower you get it the better": the three trials are not asking the same question. ACCORD-BP is the real "intensive target against standard target" trial, and in diabetic patients its primary endpoint gave P=0.20, confirming no benefit. HYVET asked whether to treat at all above 80 (against placebo), and its primary endpoint gave P=0.06, not significant — but all-cause mortality fell by 21% (P=0.02) and heart failure by 64% (P<0.001) in the same trial, both significant, so it cannot be used to say that lowering blood pressure in the very old does not work. BPLTTC estimates the effect per 5 mmHg, and in the group aged 85 and above (4,788 people, 1.3% of the whole) the confidence interval crosses 1 — but the same paper concludes that blood pressure lowering remains effective into old age, that the absolute benefit is larger in the older groups, and it expressly recommends removing age-related blood pressure thresholds from international guidelines. Not one of the three trials supports "old age means no need to lower blood pressure". These are matters to discuss with a doctor, not reasons to adjust a dose yourself.

#Should blood pressure be checked, and how often? Three official documents say different things

The reference framework recommends at least once every two years from age 18; but for older people the recommendation is annual, and close to half of Hong Kong adults do not meet even the most relaxed of these.

chapter seven of the reference framework recommends measuring blood pressure at least once every two years for all adults aged 18 or above (the "A" at the end of the sentence is the document's own grade of recommendation). But two other official documents say different things.

Three documents, three formulations. They are not contradictory (older means more often), but "once every two years" cannot be taken as a statement that holds at every age, and the line at "75" appears only in the patient version and on the Elderly Health Service page, not in the professional version's table.

And all three documents carry the same sentence beside the same passage: the interval can be adjusted. The appendix to the patient version says 「十八歲或以上成年人應至少每兩年量度血壓一次(75歲以上的人士，每年檢查一次)。量度血壓的頻密程度，需要因應血壓水平、年齡、患冠心病的綜合風險以及醫生的建議而調整。」 — adults aged eighteen or above should have blood pressure measured at least once every two years, and once a year above that age; how often blood pressure is measured needs to be adjusted according to the blood pressure level, age, the overall risk of coronary heart disease and the doctor's advice (our translation from the Chinese original). Note 3 to table 2 of chapter seven of the reference framework, and footnote 1 below the table on the Elderly Health Service's hypertension page, say the same thing. So the inference "I am 40, once every two years is enough" misses half of it: two years is a floor, not an arrangement fixed by age, and one of the grounds for adjustment is whether there are other cardiovascular risk factors.

What is the actual coverage? Part I of the Department of Health's Population Health Survey 2020-22 measured against the reference framework's recommendation: among people aged 18 or above, 52.3% had had their blood pressure measured within two years (women 54.3%, men 50.0%). That is: close to half (47.7%) do not meet the government's own most relaxed recommendation. The figure is officially published and rarely quoted.

⚠ If you are between 30 and 50 and feel "I have no symptoms, why go and be tested": prevalence in this age band jumps from 15.7% (35 to 44) to 34.0% (45 to 54), and within the 45 to 54 band 17.2% have no reported history and were found to have raised blood pressure only at the physical examination — that is, more than half of the 45 to 54 band (17.2% out of 34.0%) did not know; and of the 18.3 percentage points by which it jumps from 35 to 44, 5.8 percentage points come from the undiagnosed group.

#What happens after a measurement? The classification table and the actions it sets

The reference framework's classification table does not only grade; for each grade it states a follow-up interval and an action — and that is the point of the table.

One classification rule is easily missed: where systolic and diastolic fall into different categories, the higher category is used (note 1).

But there are two further notes below the table, and they change how the whole table is read. In the document, the "recommended follow-up interval" column of table 2 carries markers for notes 2 and 3: note 2 provides that where systolic and diastolic fall into different categories, blood pressure may be rechecked at the shorter follow-up interval; note 3 provides that the follow-up interval may be adjusted according to past blood pressure readings, the presence of other cardiovascular risk factors, or the presence of target organ disease [Note 21].

In one sentence: the "two years / one year / six months / two months" in the table above are not fixed. More than one document says this: footnote 1 below the same table on the Elderly Health Service's hypertension page says the same, and the appendix to the patient version says how often blood pressure is measured needs to be adjusted according to the blood pressure level, age, the overall risk of coronary heart disease and the doctor's advice. Three Hong Kong official documents each write the same sentence beside the same table, and that sentence does not usually travel with the table.

⚠ For "features of malignant hypertension" in the last row, the reference framework points to its own "box 2". This article will not list any set of symptoms in place of that box, for reasons set out in "matters on which this article makes no statement" at the end. Only one thing is said here: the urgency stated in the table (within one week, within one month, within two months) is a time limit the document sets itself, not "when you get round to it".

A contrast: two Hong Kong official documents describe 120–139/80–89 differently. The Centre for Health Protection's health topic page (page's own date 11 May 2023) calls systolic 120 to 139, or diastolic 80 to 89, "prehypertension", one category; the reference framework (Revised Edition 2021) splits the same span into two categories: normal at 120–129 / 80–84 and high-normal at 130–139 / 85–89.

Both are current, and both belong to the Department of Health and Health Bureau system. The Centre for Health Protection page is newer (2023 against 2021) but is a simplified public-facing formulation; the reference framework is the clinical reference document, and it is what drives the follow-up intervals and actions. This article gives both without reconciling them — because seeing different formulations on different official pages is not a mistake on your part.

(A commonly seen informal formulation compresses the three categories into one line of "normal-high 120–139/80–89". "Normal / normal-high" is not the reference framework's naming, and a diastolic category of 80–89 does not exist in the reference framework.)

#What does the 29.5% actually contain?

It is two different things added together: 17.4% self-reported as diagnosed by a doctor, plus 12.1% with no reported history whose blood pressure was raised at the physical examination. The same report has a measurement-only figure of 15.0%.

The full Chinese summary of Part II of the Department of Health's Population Health Survey 2020-22 is at [Note 22]. The same report has a passage reporting the measurement-only figure, at [Note 23].

Three things to remember.

One, the age band is 15 to 84, not "adults". The lower bound includes 15 to 17-year-olds and the upper bound stops at 84. Calling it an "adult prevalence" is inaccurate.

Two, 29.5% is a composite. Of it, 17.4% is a questionnaire self-report of having been diagnosed by a doctor, and 12.1% is raised blood pressure measured at the physical examination (systolic ≥140 or diastolic ≥90). Note: how many measurements the survey took at the physical examination is not stated in the part of the report cited here, so this article does not write "a single measurement". 17.4 plus 12.1 is 29.5.

Three, the measurement-only figure is 15.0% (ages 18 to 84, age-standardised; crude rate 19.4%) — roughly half the headline. That figure and the 29.5% measure different things and cannot substitute for one another.

The distribution by age (that table is published in full): 4.9% at 15 to 24, 6.8% at 25 to 34, 15.7% at 35 to 44, 34.0% at 45 to 54, 38.4% at 55 to 64, and 57.4% at 65 to 84.

The Chinese page of the Department of Health's Elderly Health Service uses a formulation the English page does not: 「患病情況隨年齡增長而上升，每二十名15至24歲人士才有一名患高血壓，而65至84歲人士每二十名就有十二名患有高血壓。」 — that is, prevalence rises with age, put as one in every twenty in the youngest band and twelve in every twenty in the oldest (our translation from the Chinese original). The English page gives only percentages for the same sentence.

Another point that easily confuses: Part I of the Population Health Survey 2020-22 reports a self-reported diagnosis rate of 19.5%, while Part II reports 17.4%. Both are "self-reported as diagnosed by a doctor", and the difference is in the population: Part I covers people aged 15 or above with no upper limit, while Part II covers ages 15 to 84 and only those who took part in the physical examination. The one that pairs with 29.5% is 17.4%.

#The figure is rising, but is it the disease or the finding?

Three time points in the same survey series show the undiagnosed proportion falling throughout and the diagnosed proportion rising throughout. The total rises, and it is mainly a story about detection.

⚠ The age band in the 2003/04 row is 15 or above with no upper limit, which is not exactly equivalent to the 15 to 84 of the other two rows. The calculation below should be read with that limit.

Do the arithmetic once: where the rise comes from. From 2003/04 to 2020-22, self-reported diagnosis rose from 12.1% to 17.4%, a rise of 5.3 percentage points; those with no history found at examination fell from 15.1% to 12.1%, a fall of 3.0 percentage points; and the composite rose from 27.2% to 29.5%, a rise of 2.3 percentage points.

And 5.3 minus 3.0 is 2.3. That is, the whole of the headline rise equals "more diagnosed" minus "fewer undiagnosed". Over those eighteen years, undetected high blood pressure fell from 15.1% to 12.1%.

(The 2014/15 components, 14.6% plus 13.2%, come to 27.8%, differing from the published composite of 27.7% by 0.1 of a percentage point through rounding; the report itself notes that "Figures may not add up to the total due to rounding". This article therefore does not use 2014/15 for the same decomposition.)

Treatment coverage has also risen a great deal. In 2003/04, among those diagnosed, "about three-quarters (73.4%) had taken doctor-prescribed medicines". In Part I of 2020-22, 93.6% of those diagnosed were taking prescribed medication.

⚠ A figure that does not exist officially: the survey does not publish "what percentage of patients do not know they have it". What is published is 12.1%, and the denominator of that 12.1% is the whole population aged 15 to 84, not patients. To use patients as the denominator you have to work it out yourself: 722,600 divided by 1,759,300 is 41.1% (and correspondingly, 1,036,600 self-reported as diagnosed divided by 1,759,300 is 58.9%). Those two proportions are calculated from the published components, not figures the survey published, and should be read as calculations.

⚠ If you have seen a headline that "high blood pressure in Hong Kong is getting worse": the comparable series says that detection has improved, that the treatment rate has risen from 73.4% to 93.6%, and that the undetected part has been shrinking throughout. But one further figure in the same report should not be dropped: within that 17.4% already diagnosed, 6.9% still measured 140/90 or above at the physical examination — that is, among those already diagnosed, about 40% (6.9 divided by 17.4 is 39.7%) still do not have their blood pressure controlled. "Being found" and "being controlled" are two different things, and the figure for the second is not encouraging.

#Why does Hong Kong not follow the American 130/80? And Europe is not of one mind either

The divergence over the diagnostic line (140/90 against 130/80) is wider than the divergence over the treatment threshold; and "Europe" is not a single position.

Three things are worth making clear.

One, the American document has been replaced. The guideline of AHA, ACC and 13 societies published on 16 September 2025 states expressly that it retires and replaces the 2017 one. The diagnostic category of 130/80 has not changed, but the drug treatment threshold has moved from "a ten-year Pooled Cohort Equations risk ≥10%" to "a PREVENT risk ≥7.5%" — a different threshold and a different calculation tool. Citing "the 2017 American standard" as the current American position is no longer accurate.

Two, the two European societies are fourteen months apart and say different things. The ESH 2023 recommendation against drug treatment has a scope: what it restates is that patients at low to moderate risk whose blood pressure is in the high-normal range (130–139/85–89) should not have drug treatment started actively, not a universal rule that "nobody below 140/90 needs medication". The same guideline also states that if a patient already has a history of cardiovascular disease (principally coronary heart disease), drug treatment is recommended even with blood pressure still in the high-normal range (systolic ≥130 or diastolic ≥80) — in other words, without the risk stratification spelled out, "no drug treatment" is misread as applying to everyone below 140/90. ESH 2023 also has a recommendation against actively going below 120/70; ESC 2024 abolishes the category of "normal blood pressure", creates "Elevated BP" at 120–139/70–89, prescribes at ≥130/80 where the ten-year risk is ≥10%, and sets the treatment target at 120–129/70–79. So "Europe still uses 140/90" describes only the diagnostic half.

Three, diagnosis and treatment are two different things. The honest statement is: on the diagnostic threshold, Hong Kong, the World Health Organization, both European societies, the United Kingdom and China are all at 140/90, and the United States at 130/80; but on the drug treatment threshold you have to look more closely: ESC 2024 is generally 140/90 and only 130/80 at high risk; while the 2025 American guideline (section 5.2.2, class of recommendation 1) states that even for someone without cardiovascular disease and with a PREVENT ten-year risk below 7.5%, drug treatment is recommended if, after 3 to 6 months of lifestyle intervention, the average systolic pressure is still ≥130 or the diastolic still ≥80. So the American 2025 drug treatment threshold is in substance 130/80 — immediately for those at high risk, and after a lifestyle trial for everyone else — rather than 140/90.

⚠ If you have a health check report reading 130/85 and have seen online that the American standard is 130/80: the same reading has different names under different guidelines — in Hong Kong it is "high-normal blood pressure" (recheck every six months), in the 2025 American guideline it is stage one hypertension, and in ESC 2024 it is "Elevated BP". A different name does not mean one of them is telling you that you are ill and the other that you are not.

A contrast: of the seven guidelines in the table above, only the United Kingdom requires confirmation outside the clinic. NICE NG136 makes ambulatory or home blood pressure confirmation a required step before a diagnosis can be made. Hong Kong's requirement is the average of readings "on two or more separate occasions", but it does not require confirmation outside the clinic. That is a real institutional difference. ⚠ The scope of that sentence is the seven guidelines listed above, not "the United Kingdom alone in the world"; and whether NG136 makes separate provision for special situations such as very high blood pressure is not something this article states.

#Are cardiovascular risk calculators accurate in Hong Kong Chinese?

Hong Kong's own official document states that there is at present no tool designed for Chinese populations, and no recalibrated version available for local use.

Module 9 of the reference framework (English only) states that there is currently no tool specifically designed for Chinese populations; that it has been suggested the Framingham equation can be applied to the Hong Kong Chinese population but requires recalibration in men because it overestimates the risk; and that there is currently no recalibrated tool available for local use. Table 2 of the same document, in the "Remarks" column for the Pooled Cohort Equations (the American risk equations), reads "Poor Calibration for Hong Kong Chinese". The three English originals are at [Note 24].

The sentence immediately after those three is the most important in this section, and it changes the conclusion that "if it cannot be calculated there is no answer". The document writes at once: it has to be emphasised that estimation of the cardiovascular risk is not necessary for individuals with known very high or high risk conditions, and lipid lowering therapy should be considered for these individuals unless contraindicated [Note 25].

Table 1 of the same document defines who falls into those two categories: very high risk is established coronary artery disease, atherosclerotic cerebrovascular disease, aortic aneurysm or peripheral artery disease; diabetes mellitus with chronic kidney disease; and familial hypercholesterolaemia. High risk is moderate to severe chronic kidney disease (estimated glomerular filtration rate below 60 ml/min/1.73 m²); and diabetes mellitus without the vascular disease or chronic kidney disease above.

In one sentence: for those people, the fact that "Hong Kong has no accurate risk calculator" is not an unresolved problem — the document says they do not need to go down the calculator route at all. This passage is written to draw a line, not to let readers classify themselves: whether you fall into those two categories, and whether you need medication, is for a doctor to judge on your full history.

⚠ Another point easily stretched too far: "no tool designed for Chinese populations" is not "nothing has ever been done in Asian or Chinese populations". The same page lists immediately above three Framingham versions already recalibrated for Asian populations — the Framingham risk score adopted in Singapore (adjusted for its local Chinese, Malay and Indian populations), the Asia Pacific Cohort Studies Collaboration (Japanese, Korean, Singaporean and Chinese cohorts), and the China Multi-provincial Cohort Study (a mainland Chinese cohort). What the document says is that there is no recalibrated version available for local use, and the scope of that is "local", not "Chinese".

Why this finding matters so much: in the table in the previous section, several guidelines set their drug treatment threshold as "a ten-year risk above some percentage" — ESC 2024 at ≥10%, NICE at ≥10%, and the United States in 2025 at a PREVENT risk ≥7.5%. Those thresholds presuppose that the risk figure is accurate. And what the Hong Kong official document says is precisely that there is no locally validated tool.

One line has to be drawn: the new American guideline of 2025 no longer uses the Pooled Cohort Equations, having moved to PREVENT. How PREVENT calibrates for Hong Kong Chinese is nowhere recorded in the material this article relies on — the reference framework's criticism of the older tool cannot be assumed to apply automatically to the new one, nor to be inapplicable.

⚠ If you are minded to enter your age, blood pressure and cholesterol online, work out a "ten-year risk" and decide from that whether to take medication: whether calculators of that kind apply locally is a question Hong Kong's own official document has not answered. But the same document also states that for people with known very high or high risk conditions, risk estimation is not needed at all — so "it cannot be calculated" is not a dead end for that group. Whether you are in those two categories is for a doctor to judge on your full history, not something to identify by checking yourself against a list.

#What does treating high blood pressure in the public system actually cost, and how long is the wait?

Drug costs first: the commonly used antihypertensive drugs are "general drugs" on the Hospital Authority Drug Formulary, that is 5 dollars per drug per four weeks at a family medicine clinic.

The Drug Formulary has four categories. The definitions of the first two have to be read together, because the difference readers care about lies between them: general drugs are drugs with proven efficacy and safety for the relevant clinical conditions and available for general use, and public hospitals and clinics charge a standard fee when providing them; special drugs are drugs used under specific clinical conditions with the special authorisation of a specialist, and where such a drug is prescribed under those specific clinical conditions public hospitals and clinics charge the standard fee, while a patient who chooses to use a special drug outside those specific clinical conditions must pay for the drug themselves [Note 26].

Note a condition inside the definition of "special drugs" that discussions of charges usually omit: it takes the special authorisation of a specialist — that is, "pay a bit more and you can have it" is not how that category works.

On the search made in the Drug Formulary tool on 2 August 2026: amlodipine, lisinopril, losartan, indapamide and metoprolol are all listed under "general drugs". valsartan is listed only under "special drugs", and the fixed-dose combination products found (amlodipine plus valsartan, losartan plus hydrochlorothiazide, for example) are also "special drugs". nifedipine appears in both the general and the special columns. (Those are the individual drugs searched that day, not the whole formulary.)

⚠ Two commonly outdated formulations: the service name "general outpatient clinic" no longer exists — from 1 January 2026 it was merged into the family medicine outpatient service, at a uniform 150 dollars per attendance and 5 dollars per drug. And the specialist outpatient distinction between "135 dollars for a first attendance and 80 dollars for a follow-up" has also been abolished, replaced by a uniform 250 dollars per attendance.

Do the arithmetic once: a person attending a family medicine clinic for follow-up and taking three general drugs daily, for a year of public drug and consultation costs. Using the figures in the table: consultation fees for four follow-ups a year times 150 dollars is 600 dollars; drug costs at 5 dollars per drug per four weeks, with 52 weeks a year divided by 4 giving 13 charging units, and 3 drugs times 13 units times 5 dollars is 195 dollars; the total is 600 plus 195, or 795 dollars for the year.

Against an annual cap of ten thousand dollars, spending of this kind on long-term medication is a long way from the cap. That is: in the public system, the "cost of medication" that many people worry about essentially does not exist for standard antihypertensive drugs; what will actually reach the cap are the individual drugs and combination products this article found listed as "special drugs" (valsartan, amlodipine plus valsartan, losartan plus hydrochlorothiazide), and self-financed drugs (which carry a further administrative fee of 130 dollars an item).

⚠ "Special drugs" is a charging category in the Drug Formulary, and it is not the same thing as what is clinically called a "second-line drug" (a concept about treatment strategy); the two cannot be equated. This article did not find any systematic list matching "second-line drugs" against "special drugs" item by item, only the classification of the individual drugs above in the search tool that day; whether a drug is clinically second-line, and whether it is provided at the standard charge on the formulary, are two different questions.

⚠ On self-financed drugs, the definition on the same formulary page has a sentence that should not be read apart from what precedes it. The definition of category 3, "self-financed items with safety net", ends by stating that the relevant funds provide a safety net for patients who need these drugs and are in financial difficulty [Note 27]. That is the least-quoted sentence in the passage. It means that "self-financed" and "necessarily borne by you alone" are two different things: the safety net that page points to is the Samaritan Fund and the Community Care Fund. Category 4 (self-financed items without safety net) has no such sentence, and that page defines it as drugs of marginal benefit or lifestyle drugs. Which category an antihypertensive drug falls into is for a doctor to decide on your clinical situation; this article reports only the classification and the charging structure.

(This calculation uses four follow-ups as an illustrative assumption, not anyone's actual follow-up arrangement; the number of attendances is decided by a doctor.)

Specialist waits: on the Hospital Authority's open data (reporting period 1 July 2025 to 30 June 2026), the median waiting time for "stable" new medicine cases ranged across the seven clusters from 27 to 65 weeks (Hong Kong West 27, Kowloon Central 65), and the longest waiting times from 50 to 98 weeks (Hong Kong West 50, Kowloon Central 98). Over the same period, stable cases made up 75% of new medicine cases (124,072), semi-urgent 18% and urgent 6% (with a median wait for urgent cases of "less than one week" to "one week").

A subsidised route for those not yet diagnosed: the Chronic Disease Co-Care Pilot Scheme is for people aged 45 or above who have not been diagnosed with diabetes or hypertension; in the screening stage the family doctor charges only a one-off co-payment of 120 dollars or less, covering all consultations, laboratory tests, diagnosis and the drawing up of a management plan in that stage. After a diagnosis of hypertension the treatment stage follows, with up to 6 subsidised consultations per "personal scheme year" (the table on the scheme's web page makes clear that this 6 is the cap for the disease category "hypertension and/or diabetes"; other categories are 4 or fewer), a government-recommended consultation co-payment of currently 150 dollars, and the cost of blood pressure drugs on the scheme's "specified drug list" already included in the co-payment.

The same page has two further arrangements written next to the co-payment that are rarely quoted alongside it. First, from the second scheme year, a participant who has reached the specified health indicators may have up to $150 deducted from the co-payment at their first subsidised consultation of the following scheme year. Second, recipients of Comprehensive Social Security Assistance, recipients of the Old Age Living Allowance aged 75 or above, and holders of a valid medical fee waiver certificate who wish to join the scheme may be arranged through a District Health Centre or Station to receive the relevant preventive screening services at a designated Hospital Authority family medicine clinic [Note 28].

That is: the "one-off 120 dollars" is the price of the general route, not the only route. This is the point at which it is easiest to stop after "screening costs 120 dollars" — and those shut out when one stops there are exactly the people least able to afford it.

⚠ If you are putting off seeing a doctor because you fear the cost of long-term medication: in the public system standard antihypertensive drugs are "general drugs", charged at 5 dollars per drug per four weeks; what is genuinely expensive are the individual drugs this article found listed as "special drugs" (valsartan and the two combination products above) and self-financed drugs — and "second-line drug" is a clinical concept, not the same thing as the charging category "special drug".

#Lifestyle: the items on which Hong Kong has figures of its own

Hong Kong's official documents have local figures for salt and potassium, but publish no figure at all for "how much less salt equals how many mmHg lower".

Part II of the Population Health Survey 2020-22: people aged 15 to 84 consumed on average 8.4 grams of salt a day (women 7.4 grams, men 9.5 grams; the age-standardised mean for ages 18 to 84 was 8.5 grams). 83.9% exceeded the World Health Organization's recommended upper limit (men 91.5%, women 77.1%). Analysed by how often people ate out, those eating out less than once a week had a high-salt intake proportion of 80.6% and a daily average of 7.6 grams; those eating out six times a week or more rose to 88.5% and 9.3 grams a day.

The units are easily confused, and the Centre for Health Protection's Non-Communicable Diseases Watch of May 2022 is the clearest: the World Health Organization recommends that a healthy adult consume less than 2 grams of sodium (or less than 5 grams of salt) a day, whereas people aged 15 to 84 in Hong Kong consume on average 8.8 grams of salt a day; and increasing potassium intake helps people with high blood pressure lower it, with the World Health Organization recommending that a generally healthy adult consume at least 3.5 grams of potassium a day, whereas people aged 15 to 84 in Hong Kong consume on average only 2.3 grams [Note 29].

That is: less than 2 grams of sodium, or less than 5 grams of salt. (Note that the "5 grams" is salt and the "2 grams" is sodium; the two units are easily transposed.)

⚠ Two salt figures have now appeared: the 8.8 grams is data from the 2014/15 survey (see Non-Communicable Diseases Watch, May 2022), and the 8.4 grams is the crude average from the 2020-22 survey. That is, salt intake has fallen slightly rather than risen. When quoting, say which survey.

Potassium is the part few people mention: the Centre for Health Protection treats raising potassium and cutting sodium together, and Hong Kong people average 2.3 grams a day against the World Health Organization's recommended minimum of 3.5 grams.

The Chinese version of the Department of Health Elderly Health Service's management recommendations is at [Note 30] in full, and has nine items: take medication as the doctor directs and attend follow-up regularly; monitor blood pressure regularly oneself; practise a healthy lifestyle; stop smoking; keep to an ideal weight and waist circumference (body mass index below 23 kg/m², waist below 90 cm for men and below 80 cm for women); build healthy eating habits; take moderate and sustained exercise (at least 10 minutes of moderate-intensity aerobic activity each time, accumulating at least 150 minutes a week; or at least 75 minutes a week if vigorous); do not drink alcohol; and manage stress and keep a cheerful outlook.

Two points are worth pointing out. First, the specific formulation "eat less salt, soy sauce and preserved food" appears only in the Chinese version; the English version of the same passage says only to reduce salt intake. For Hong Kong eating habits, naming soy sauce and preserved foods is a great deal more useful. Second, the exercise wording is at least 150 minutes a week of moderate intensity or at least 75 minutes of vigorous, and it mentions "at least 10 minutes each time". (The commonly seen upper bound of "150 to 300 minutes" has no source in the Hong Kong hypertension material this article relies on.)

On the same subject the patient version puts it differently, and adds one item. Its section on regular physical activity says: it is best to spend 30 minutes a day on moderate (brisk walking, for example) or vigorous aerobic physical activity, which may be accumulated in bouts of at least 10 minutes each; and do muscle-strengthening activity on at least 2 days a week (not consecutive) [Note 31].

That is: Hong Kong's hypertension documents do contain a strength training recommendation — at least two days a week, on non-consecutive days, doing muscle-strengthening activity — it is simply in the patient version rather than in the Elderly Health Service's. The two documents also use different units for aerobic exercise: the Elderly Health Service speaks of accumulating 150 minutes a week, and the patient version of 30 minutes a day (accumulable in bouts of at least 10 minutes). Both are current official documents, and this article gives both.

On diet the patient version is also more specific than the Elderly Health Service: avoid excessive salt, with a recommendation of no more than 1 teaspoon of salt (about 5 grams) a day; use less soy sauce, oyster sauce, fermented bean paste, fermented bean curd, tomato sauce and salt; and choose fresh meat and vegetables, eating less processed, preserved and high-salt food such as preserved mustard greens, fermented bean curd, ham and sausage. That conversion of "1 teaspoon of salt is about 5 grams" translates the World Health Organization's 5 grams into a unit you can measure in a kitchen.

On alcohol, note the framing. That column of the patient version is headed "avoid alcohol", and the whole passage is at [Note 32]: it opens by saying you should stay away from alcohol, and "men should drink no more than 2 standard drinks a day and women no more than 1" hangs beneath "if you choose to drink alcoholic drinks, be moderate so as to minimise alcohol-related harm" — it is a harm-reduction ceiling, not a recommended intake. One standard drink unit is 10 grams of pure alcohol, equivalent to about 250 millilitres of beer at 5% alcohol, a small glass (100 millilitres) of wine at 12% alcohol, or a bar-standard measure (30 millilitres) of spirits at 40% alcohol. The Elderly Health Service's version puts the same thing in two words: 「不飲酒」, do not drink alcohol (our translation from the Chinese original).

⚠ If you are an office worker who eats out often: the survey counted by how often people ate out — those eating out six times a week or more had a high-salt intake proportion of 88.5% and a daily average of 9.3 grams of salt, against 80.6% and 7.6 grams for those eating out less than once a week. And what the Chinese official recommendation names is salt, soy sauce and preserved food.

The patient version has one further recommendation that is rarely quoted: have a seasonal influenza vaccination every year, on the ground that people with chronic disease are at higher risk of complications and death if they catch influenza.

#After a diagnosis: what the official documents say

Two things: do not stop the medication on your own, and have an assessment once a year.

On stopping, the patient version states that blood pressure medication must be taken long term, and that even if blood pressure returns to the normal range after a period on medication it must not be stopped automatically, or blood pressure will silently rise to a dangerous level and cause complications such as stroke [Note 33]. The fifth misconception in the same document also states that high blood pressure is a chronic disease which medication can control but not cure, and that patients must receive continuing treatment as the doctor directs [Note 34].

The fourth item, immediately above it, is about a different group of people, and it does not usually get quoted alongside the fifth. The fourth is headed 「我有高血壓，醫生說如果開始服用血壓藥的話，便須服用一輩子我還是不開始服藥為妙」 — I have high blood pressure, and the doctor says that if I start taking blood pressure medication I will have to take it for life, so I had better not start (our translation from the Chinese original); and the "fact" column says that the fact of having high blood pressure will not change because you refuse medication, but that not taking medication as the doctor directs greatly increases the chance of complications or of a shortened life [Note 35]. (The punctuation of that heading is as in the original.)

The fifth item speaks to people already taking medication, and the fourth to people who will not start because they fear having to take it for life. The two address opposite decisions, and the second usually goes missing in the versions that circulate informally.

On the annual assessment, the patient version says to have a physical examination every year, with recommended items including body mass index and waist circumference, blood glucose, blood pressure, blood lipids and kidney function tests (including urine protein) [Note 36]. ⚠ That list is introduced with "including", an example rather than a closed list; the actual arrangement is a doctor's.

What has to be achieved at an annual assessment for control to count as good? The patient version does not say, but Module 8 of the same framework (English only) sets out a definition for the annual assessment: to ensure satisfactory control over the year, meaning an average of the most recent three readings below 140/90 mmHg [Note 37]. Note that it uses the average of the most recent three, not the most recent one. One reading of 145 at a follow-up is not a conclusion, and the same document says so throughout.

On the tests that may be arranged during diagnosis, the patient version says: the simplest diagnostic method is measuring blood pressure with a monitor; in addition, after taking a history and a detailed physical examination, the doctor will arrange other tests for patients who need them, such as blood tests, urine tests, electrocardiogram, chest X-ray and fundus examination — again "such as", an example rather than a complete list.

#What to do next

1. First establish whether what you have is a reading or a diagnosis. One reading is not a diagnosis. Hong Kong's diagnostic procedure is three readings at a visit (the third only if the first two differ by more than 10 mmHg), the last two averaged, repeated on "two or more separate occasions".
2. When measuring, measure both arms once. A difference of 15 mmHg or more between the arms is itself a signal to give a doctor, not merely a reason to "use the higher arm from now on".
3. Use the right line. Office 140/90, home average 135/85, ABPM 24-hour 130/80. Treating the home 135/85 as a "control target" takes a diagnostic threshold for a treatment target.
4. Choose a monitor on "clinically validated" first, not on upper arm against wrist. Finger monitors are not recommended. If you think the machine is inaccurate, the official course is to bring it to a follow-up for the doctor to check.
5. Measure at home the official way: two measurements averaged, a third if they differ by more than 5 mmHg; at least 1 minute between the two; and for an initial assessment measure for 7 days, morning and evening, averaging all the readings. Do not discard the first day.
6. Do not adjust your own medication by the readings. The document lists "unsupervised alteration of medication" as one of the disadvantages of home measurement.
7. If you are 45 or above and not yet diagnosed, look once at the Chronic Disease Co-Care Pilot Scheme. The screening stage is a one-off co-payment of 120 dollars or less. And if you are on Comprehensive Social Security Assistance, receive the Old Age Living Allowance at 75 or above, or hold a valid medical fee waiver certificate, there is a further route through a District Health Centre or Station to a Hospital Authority family medicine clinic.
8. Do not stay away because you fear the drug costs. Commonly used antihypertensive drugs are "general drugs" on the formulary, at 5 dollars per drug per four weeks at a family medicine clinic; and there is a further annual cap of ten thousand dollars with no means test.
9. If you have acute symptoms, seek medical attention at once rather than checking a list first. Blood pressure cannot be judged by feel, and this article offers no symptom list — the reason is in the statement of what it does not state, below.

#Frequently asked questions

I measured 138/88 at home — do I have high blood pressure?

The diagnostic threshold for home measurement is an average of 135/85 (Module 2 of the reference framework, English only), which is not the same line as the office 140/90. But the reference framework states that a diagnosis should not rest on one set of readings at a single visit, and takes the average of readings "on two or more separate occasions"; the official home method is two measurements averaged, a third if they differ by more than 5 mmHg, and an initial assessment over 7 days, morning and evening, averaging all readings. Those readings are the material a doctor uses to judge; the judgement itself is the doctor's.

My blood pressure is normal on medication — can I stop?

The Health Bureau's patient version is direct: high blood pressure is a chronic disease which medication can control but cannot cure, and even if blood pressure returns to the normal range it must not be stopped automatically; patients must receive continuing treatment as the doctor directs and be checked regularly.

Hong Kong uses 140/90 — is that a more relaxed standard?

The reference framework's classification table states itself that it was written with reference to the World Health Organization's statement and the ESC and ESH guidelines, so Hong Kong follows the World Health Organization and Europe. The World Health Organization (2021), ESH (2023), ESC (2024), NICE and the Chinese 2024 revision all set the diagnostic threshold at 140/90 as well; the new American guideline of 2025 sets it at 130/80. On the drug treatment threshold, ESC 2024 is generally 140/90 and only 130/80 at high risk; while the United States in 2025 is 130/80 — immediately for those at high risk, and for those at lower risk if blood pressure is still 130/80 after 3 to 6 months of lifestyle intervention.

Which is right, 29.5% or 15.0%?

Both are published in the same report and measure different things. 29.5% is the composite for ages 15 to 84 of self-reported diagnosis by a doctor (17.4%) plus raised blood pressure at the physical examination (12.1%); 15.0% is the age-standardised prevalence for ages 18 to 84 counting measurement only (crude rate 19.4%). When quoting, give the definition with the figure.

Is treating high blood pressure in the public system expensive?

From 1 January 2026, a family medicine clinic charges 150 dollars per attendance and 5 dollars per drug (in units of four weeks); amlodipine, lisinopril, losartan, indapamide and metoprolol and other commonly used antihypertensive drugs are listed on the formulary as "general drugs", that is provided at the standard charge. valsartan, and the two fixed-dose combination products found here (amlodipine plus valsartan, losartan plus hydrochlorothiazide), are listed as "special drugs", provided at the standard charge only under specific clinical conditions (this does not mean every fixed-dose combination product is a "special drug" — nifedipine appears in both the general and the special columns). There is also an annual cap of ten thousand dollars with no means test (excluding self-financed drugs and appliances).

I am 45 and not diagnosed — is there a subsidised route?

The Chronic Disease Co-Care Pilot Scheme is for people aged 45 or above who have not been diagnosed with diabetes or hypertension; in the screening stage there is a one-off co-payment of 120 dollars or less, covering all consultations, laboratory tests, diagnosis and the drawing up of a management plan in that stage. If hypertension is diagnosed, the treatment stage allows up to 6 subsidised consultations per "personal scheme year" (that being the cap for the "hypertension and/or diabetes" category), with a government-recommended co-payment currently of 150 dollars and the cost of blood pressure drugs on the scheme's "specified drug list" included. Separately, recipients of Comprehensive Social Security Assistance, recipients of the Old Age Living Allowance aged 75 or above, and holders of a valid medical fee waiver certificate may be arranged through a District Health Centre or Station to receive the relevant preventive screening services at a designated Hospital Authority family medicine clinic.

I am in my 80s — does that mean I need not lower my blood pressure?

Not one of the three trials cited here supports that conclusion. In BPLTTC's age-stratified analysis, the hazard ratio per 5 mmHg in the group aged 85 and above is 0.99 (0.87–1.12), a confidence interval crossing 1 — but that cell has only 4,788 people, 1.3% of the whole, and the same paper concludes that blood pressure lowering remains effective into old age, that the absolute benefit is larger in the older groups, and it expressly recommends removing age-related blood pressure thresholds from international guidelines. In HYVET (aged 80 or above) the primary endpoint of stroke fell by 30% without reaching significance (P=0.06), but all-cause mortality fell by 21% (P=0.02) and heart failure by 64% (P<0.001) in the same trial, both significant. The European Society of Hypertension's 2023 guideline sets the drug treatment threshold for those aged 80 or above at a systolic pressure ≥160, but the same guideline also states that a lower threshold between 140 and 159 may be considered (a class II recommendation), and that for frail or debilitated patients the threshold should be individualised rather than that fixed figure applied (a class I recommendation). Whether to treat, with what, and to what target, are decided by a doctor on your overall condition, and this article does not step into that.

#Notes: the official texts

[Note 1] Department of Health Elderly Health Service, Chinese page:

High blood pressure means the upper reading is persistently at or above 140 mmHg, or the lower reading persistently at or above 90 mmHg. (our translation from the Chinese original)

Chinese original:

「高血壓是指上壓持續地處於或高於140 mmHg，或下壓持續地處於或高於90 mmHg。」

[Note 2] The same page:

The great majority of cases of high blood pressure (90 per cent) are "primary", that is of unknown cause, and are generally associated with the risk factors described below. 10 per cent are "secondary", caused by other diseases or bodily changes such as kidney disease or endocrine disturbance. (our translation from the Chinese original)

Chinese original:

「高血壓的成因絕大部分(百分之九十)屬「原發性」，即原因不明，一般與以下所描述的風險因素有關」 「百分之十屬「繼發性」，即由其他疾病或身體變化所引起，例如腎病、內分泌失調等」

The Centre for Health Protection's health topic page:

No clear cause can be identified in over 90% of cases of high blood pressure. These cases are all diagnosed as primary hypertension. (our translation from the Chinese original)

Chinese original:

「超過90%的高血壓個案無法確定明確的病因。這些個案均診稱為原發性高血壓。」

[Note 3] Hong Kong Reference Framework for Hypertension Care for Adults [patient version] (revised July 2022), the first and second items of the section on common misconceptions:

1. High blood pressure cannot be prevented / Fact: practising a healthy lifestyle, and reducing salt above all, can reduce the risk of developing high blood pressure. 2. People with high blood pressure feel headache and fatigue / Fact: most people with high blood pressure have no symptoms, so relying on symptoms alone to tell whether one has the condition is not reliable. Blood pressure needs to be measured regularly. (our translation from the Chinese original)

Chinese original:

「1. 高血壓是無法預防的／事實︰實踐健康生活模式，尤其是減少食鹽，可以減低患上高血壓的風險。」 「2. 患高血壓的人會覺得頭痛及疲倦／事實：大多數高血壓患者都沒有症狀，因此，單靠症狀來識別是否患病並不可靠。有需要定期量度血壓。」

The same document also carries 「由於大部份患者沒有明顯病徵，直至量度血壓時才察覺患病」 — because most patients have no obvious symptoms, they become aware of the condition only when blood pressure is measured (our translation from the Chinese original).

[Note 4] Hong Kong Reference Framework for Hypertension Care for Adults, preface to the first edition, Chinese version:

The Health and Medical Development Advisory Committee re-established the Working Group on Primary Care (the working group), chaired by the Secretary for Food and Health, to examine proposals for strengthening and developing Hong Kong's primary care strategy. The working group has now set up four task forces to study the specific proposals set out in the healthcare reform consultation document, one of them the Task Force on Conceptual Model and Preventive Protocols (the task force). The task force is also responsible for promulgating and revising, and for recommending strategies to promote, the model and frameworks adopted. The task force has set up two clinical advisory groups to review and update the reference frameworks regularly. The clinical advisory groups comprise experts from academia, professional bodies and the public and private primary care sectors, and patient organisations, who serve as members in a personal capacity rather than as representatives of their organisations. (our translation from the Chinese original)

Chinese original:

「健康與醫療發展諮詢委員會重新成立基層醫療工作小組（工作小組），並由食物及衞生局局長擔任主席，以探討加強和發展本港基層醫療策略的建議。」 「工作小組現已成立四個專責小組，負責研究醫療改革諮詢文件所載列的具體建議，其中之一是基層醫療概念模式及預防工作常規專責小組（專責小組）。」 「專責小組亦負責發佈、修訂、及建議策略以推廣所採用的模式及概覽。」 「專責小組成立了兩個臨床諮詢小組，定期檢討及更新參考概覽。臨床諮詢小組由來自學術界、專業團體、公私營基層醫療界別的專家及病人組織組成，他們以個人名義擔任小組成員，而並非以所屬的機構作為代表。」

[Note 5] The same document, chapter seven, note 1:

The classification of blood pressure is based on office blood pressure measured while seated. Where the systolic and diastolic levels fall into different categories, the higher category should be used as the classification of the blood pressure level. Three seated office blood pressure measurements should be recorded, each 1-2 minutes apart, with an additional third measurement taken only where the first two readings differ by more than 10 mmHg. The blood pressure recorded is the average of the last two readings. A diagnosis of hypertension should not be based on one set of blood pressure readings at a single visit, unless blood pressure is markedly raised (grade three hypertension, for example) with clear evidence of hypertension-mediated organ damage. 1b Use the average of two or more blood pressure readings obtained on two or more separate occasions to estimate an individual's blood pressure level. 6 (our translation from the Chinese original)

Chinese original:

「血壓的分類是基於坐著量度的診間血壓。如收縮壓和舒張壓水平在不同的分類， 類別較高的分類應被使用為血壓水平的分類。應該紀錄三次坐著量度的診間血壓，每次量度應相隔 1-2 分鐘，並且僅當頭兩次的血壓讀數相差 >10 mmHg 時才進行額外第三次的量度。血壓的記錄為最後兩次血壓讀數的平均值。高血壓的診斷不應基於單次就診時的一組血壓讀數，除非血壓顯著升高（例如高血壓三級），並且有明確證據表明有高血壓已造成的器官損傷。1b 使用由兩次或以上的不同情況獲得的兩次或以上的血壓讀數平均值來估計個人的血壓水平。6」

[Note 6] The same document, note 5:

For grade three hypertension, where there is clear evidence of hypertension-mediated organ damage (hypertensive retinopathy with exudates and haemorrhages, left ventricular hypertrophy, or vascular or renal impairment, for example), a diagnosis of hypertension may be made at a single visit. (our translation from the Chinese original)

Chinese original:

「對於高血壓三級，如果明確證據表明有高血壓已造成的器官損傷（例如有滲出液和出血的高血壓性視網膜疾病、左心室肥厚或有血管或腎功能損害），則在單次就診時即可確診為高血壓。」

[Note 7] The same document, note 4:

When a diagnosis of hypertension is being considered, blood pressure should be measured in both arms separately. If the readings from the two arms differ by more than 15 millimetres of mercury (mmHg), measure both arms again. If the second measurement of both arms still differs by more than 15 millimetres of mercury (mmHg), the arm with the higher reading should be used thereafter. A difference of 15 millimetres of mercury (mmHg) or more between the arms can identify patients at high risk of asymptomatic peripheral vascular disease (subclavian artery stenosis, for example) and of death, who may benefit from further assessment. (our translation from the Chinese original)

Chinese original:

「當考慮診斷為高血壓時，應分別於雙臂量度血壓 ● 若量得雙臂的血壓讀數相差多於15毫米水銀柱(mmHg)，需再次量度雙臂血壓。 ● 若第二次量度雙臂的血壓讀數仍然相差超過 15 毫米水銀柱(mmHg)，以後應量度較高血壓讀數的手臂。 ● 雙臂的血壓讀數相差15毫米水銀柱(mmHg)或以上，可以識別為有高風險患有無症狀的周邊血管疾病（例如鎖骨下動脈狹窄）和死亡的患者，這些患者可能會從進一步評估中受益。」

[Note 8] Module 2 of the same framework, item xvii (English only):

The number of visits and the time interval between visits varies according to the severity of the hypertension, and is inversely related to the severity of hypertension.

[Note 9] Module 2 (English only), on home measurement:

Persons with an average BP 135/85 mmHg measured at home are generally considered to be hypertensive

On ambulatory blood pressure monitoring:

The values are, on average, lower than office BP values, and the diagnostic threshold for hypertension is ≥ 130/80 mmHg over 24 h, ≥ 135/85 mmHg for the daytime average, and ≥ 120/70 for the night time average (all equivalent to office BP ≥ 140/90 mmHg).

[Note 10] The same module:

Emotional factors including white coat hypertension: 24-hour ambulatory blood pressure monitoring and self BP monitoring at home can be used to address the white coat effect.

[Note 11] The patient version, Chinese (extract):

The following points should be considered when measuring blood pressure: measure at about the same time each day; choose a quiet environment; do not measure when feeling unwell, cold, anxious, stressed, in pain or needing to pass urine. Before measuring: for the 30 minutes before measuring, do not exercise, smoke, eat or drink caffeinated drinks (tea or coffee, for example); wear loose, comfortable clothing; relax and rest for 5 minutes, without distracting activities (such as watching television) during that time. (our translation from the Chinese original)

Chinese original:

「量度血壓時，應考慮以下幾點： 每天差不多同一時間量度。 選擇一個寧靜的環境。 不要在感到不適、寒冷、焦慮、壓力、疼痛或憋尿時量度。 量度血壓前： 在量度血壓前的30分鐘，不要運動、吸煙、進食或飲用含咖啡因的飲料（例如茶或咖啡）。 穿着鬆身、舒適的衣服。 放鬆休息5分鐘，期間不要做分心的活動（如看電視）。」

[Note 12] The same document:

Recording blood pressure readings: record the average of two measurements. If the two differ by more than 5 millimetres of mercury (mmHg), measure again and take the average. Record the reading every time blood pressure is measured, so as to monitor blood pressure continuously. Bring the blood pressure record to follow-up for healthcare staff. If in any doubt, ask a doctor or nurse. (our translation from the Chinese original)

Chinese original:

「記錄血壓度數: 應記錄兩次量度得出的平均度數。倘若兩者相差超過5毫米水銀柱(mmHg)，應再量度一次然後取其平均數。 每次量度血壓都要記錄度數以持續監測血壓。 覆診時，攜同血壓紀錄以供醫護人員參考。 如有任何疑問，應請教醫生或護士。」

[Note 13] The same document, at the end of the paragraph on measuring:

After the first measurement, loosen the cuff completely and record the reading. Rest and then measure again. There should be at least 1 minute between the two measurements. (our translation from the Chinese original)

Chinese original:

「在首次量度血壓後，把袖帶完全鬆開，並記錄度數。」 「休息後再量度血壓一次。兩次量度之間最少相隔1分鐘。」

[Note 14] Module 2, section 4.2 (English only):

Two consecutive measurements are taken, at least 1-2 minutes apart and with the person seated and blood pressure is recorded twice daily

The same section also carries: "Home measurement devices should be checked regularly."

[Note 15] The patient version, Chinese:

Ordinary electronic blood pressure monitors may be used on the upper arm or the wrist. Because the upper-arm type is more accurate, it is the more suitable. Finger monitors, on the other hand, are not recommended. The width of the cuff should cover two thirds of the length of the upper arm, and the length of the cuff should be enough to encircle the arm completely. People with thicker arms or who are obese may need a larger cuff. (our translation from the Chinese original)

Chinese original:

「一般電子血壓計可用於手臂或手腕。由於手臂式血壓計比較準確，所以較為合用。另外，手指式血壓計便不建議採用。」 「袖帶的寬度應覆蓋手臂長度三分之二，袖帶的長度則應足夠完全圍繞手臂。手臂較粗或肥胖的人士可能需要使用尺寸較大的袖帶。」

[Note 16] The same document, the whole passage:

Choose a clinically validated blood pressure monitor, and read the instructions carefully and follow them before operating it. The monitor should be serviced and calibrated regularly. Readings taken at home may differ from those taken at a doctor's clinic. If in doubt, you may bring your home monitor to an appointment and let the doctor help check the accuracy of the monitor you use. (our translation from the Chinese original)

Chinese original:

「應選用經臨床驗證的血壓計。並於操作血壓計前，仔細閱讀說明書和按照指示操作。 血壓計應作定期保養維修及進行校對。 在家量度的血壓度數可能會與於醫生診所量度的結果有出入。如有疑問，可攜同家用血壓計應診，讓醫生協助檢視你所用血壓計的準確度。」

[Note 17] Module 2 (English only):

Initial assessment or the assessment of treatment effects should be for a 7-day period, with recordings performed in the morning and evening. The average of the readings is taken as the home BP level.

[Note 18] The patient version:

For people with high blood pressure alone, blood pressure should be below 140/90mmHg, and where their condition allows the blood pressure target should be set at 130/80mmHg or below / for people with high blood pressure and another chronic disease such as diabetes, blood pressure should be below 130/80mmHg (our translation from the Chinese original)

Chinese original:

「對於只患有高血壓的人士，血壓應低於 140/90mmHg，如身體狀況許可，血壓目標應定於 130/80mmHg 或以下／患有其他慢性病如糖尿病的高血壓人士，血壓應低於 130/80mmHg」

[Note 19] Module 7 of the same framework (English only):

While for patients with coronary artery disease, the blood pressure should be lowered slowly, and caution is advised in inducing falls of diastolic blood pressure below 60 mmHg if the patient also has diabetes mellitus or is over the age of 60 years.

That is: for patients with coronary artery disease blood pressure should be lowered slowly, and caution is advised in letting diastolic pressure fall below 60 mmHg where the patient also has diabetes or is over the age of 60.

[Note 20] Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;398:1053-1064 (PMID 34461040):

Absolute risk reductions for major cardiovascular events varied by age and were larger in older groups (adjusted pinteraction=0·024).

Pharmacological blood pressure reduction is effective into old age, with no evidence that relative risk reductions for prevention of major cardiovascular events vary by systolic or diastolic blood pressure levels at randomisation, down to less than 120/70 mm Hg. Pharmacological blood pressure reduction should, therefore, be considered an important treatment option regardless of age, with the removal of age-related blood-pressure thresholds from international guidelines.

[Note 21] Hong Kong Reference Framework for Hypertension Care for Adults, chapter seven, notes 2 and 3 to table 2:

Note 2. Where the classifications of the systolic and diastolic pressures differ, blood pressure may be rechecked at the shorter follow-up interval. Note 3. The follow-up interval may be adjusted according to past blood pressure readings, the presence of other cardiovascular risk factors or the presence of target organ disease. (our translation from the Chinese original)

Chinese original:

「註2. 如收縮壓和舒張壓的分類有別，可按較短的覆診相隔時間覆檢血壓。」 「註3. 調整覆診相隔時間可根據有關過往血壓度數、有否其他心血管疾病風險因素或有否目標器官疾病等而定。」

Footnote 1 on the Department of Health Elderly Health Service's hypertension page:

A doctor may adjust the follow-up interval according to past blood pressure readings, the presence of other cardiovascular risk factors or the presence of target organ disease. (our translation from the Chinese original)

Chinese original:

「醫生可根據有關過往血壓度數、有否其他心血管疾病風險因素或有否目標器官疾病等而調整覆診相隔時間。」

[Note 22] The Chinese summary of Part II of the Department of Health's Population Health Survey 2020-22:

Among people aged 15 to 84, the prevalence of raised blood pressure or hypertension was 29.5% (women 26.2%, men 33.2%), comprising people who self-reported having been diagnosed by a doctor with hypertension and people with no self-reported history whose blood pressure was raised at the physical examination. The prevalence of raised blood pressure or hypertension rose continuously with age, from 4.9% at 15 to 24 to 57.4% at 65 to 84. Among people aged 15 to 84, 12.1% (women 9.8%, men 14.7%) had no self-reported history but had raised blood pressure at the physical examination. 17.4% of people aged 15 to 84 (women 16.4%, men 18.5%) self-reported having been diagnosed by a doctor with hypertension, including 6.9% (women 5.9%, men 8.0%) whose systolic pressure measured at the physical examination was 140 mmHg or above, or whose diastolic pressure was 90 mmHg or above. (our translation from the Chinese original)

Chinese original:

「15－84 歲人士中，血壓升高或高血壓的患病率為29.5%（女性為26.2%，男性為33.2%），當中包括自述經醫生診斷患有高血壓或沒有自述病史但在身體檢查時血壓升高的人士。血壓升高或高血壓的患病率隨年齡增長而持續上升，比例由15－24 歲的4.9%，上升至65－84 歲的57.4%。在15－84 歲人士當中，有12.1%（女性為9.8%，男性為14.7%）沒有自述病史但在身體檢查時血壓升高。17.4% 的15－84 歲人士（女性為16.4%，男性為18.5%）自述經醫生診斷患上高血壓，包括6.9%（女性為5.9%，男性為8.0%）在身體檢查時量度的收縮壓達 140 mmHg 或以上，或舒張壓達 90 mmHg 或以上。」

[Note 23] The same report:

The age-standardised prevalence of hypertension among people aged 18 to 84 (that is, a systolic pressure of 140 mmHg or above, or a diastolic pressure of 90 mmHg or above, regardless of known hypertension history) was 15.0% (crude rate 19.4%). The age-standardised mean systolic pressure among people aged 18 to 84 was 116.0 mmHg (crude mean 119.8 mmHg). (our translation from the Chinese original)

Chinese original:

「18－84 歲人士的年齡標準化高血壓患病率（即收縮壓達140 mmHg 或以上，或舒張壓達90 mmHg或以上，不論已知的高血壓病史）為15.0%（粗略率為19.4%）。18－84 歲人士的年齡標準化收縮壓平均值為116.0 mmHg（粗略平均值為119.8 mmHg）。」

[Note 24] Module 9 of the Hong Kong Reference Framework for Hypertension Care for Adults (English only):

There is currently no tool specifically designed for Chinese populations.

It had been suggested that Framingham equation can be applied to the Hong Kong Chinese population but requires recalibration in men due to overestimation of the risk. There is currently no recalibrated tool available for local use

And the Remarks column for the Pooled Cohort Equations in table 2 of the same module: "Poor Calibration for Hong Kong Chinese".

[Note 25] The same module, immediately after the first quotation:

It has to emphasise that estimation of the cardiovascular risk is not necessary for individuals with known very high or high risk conditions (Table 1). Lipid lowering therapy should be considered for these individual unless contraindicated.

[Note 26] The Hospital Authority Drug Formulary categories, in the Chinese original. General drugs:

Drugs with proven efficacy and safety for the patients' relevant clinical conditions and available for general use. Public hospitals and clinics charge a standard fee when providing them. (our translation from the Chinese original)

Chinese original:

「經證實對病人有關臨床情況適用和有效，並可供一般使用的藥物。公立醫院和診所提供這類藥物時，會收取標準費用。」

Special drugs:

Drugs used under specific clinical conditions with the special authorisation of a specialist. Where such a drug is prescribed under those specific clinical conditions, public hospitals and clinics charge a standard fee. Where an individual patient chooses to use a special drug outside those specific clinical conditions, the patient must pay for the drug themselves. (our translation from the Chinese original)

Chinese original:

「在特定臨床應用下經專科醫生特別授權使用的藥物。如這類藥物是在特定的臨床應用下處方，公立醫院和診所會收取標準費用。如個別病人在特定臨床應用以外選擇使用專用藥物，便需自行支付藥物的費用。」

[Note 27] The same source, category 3, self-financed items with safety net:

Very expensive drugs of proven significant efficacy that are beyond the scope of what the Hospital Authority's generally subsidised services can provide. These drugs are not among the items provided at the standard charge by public hospitals and clinics. Patients who need these drugs and can afford them must purchase them themselves. However, the relevant funds provide a safety net for patients who need these drugs and are in financial difficulty. (our translation from the Chinese original)

Chinese original:

「經證實有顯著療效，但超出醫管局一般資助服務範圍所能提供的非常昂貴藥物。這些藥物不屬公立醫院和診所標準收費提供的項目。需要使用這些藥物而有能力負擔費用的病人須自費購買。然而，相關基金會為需要這些藥物而經濟上有困難的病人提供安全網。」

[Note 28] The Chronic Disease Co-Care Pilot Scheme web pages:

From the second scheme year, a scheme participant who has reached the specified health indicators may have up to $150 deducted from the co-payment (the government's recommended co-payment) at their first subsidised consultation of the following scheme year. To meet the health service needs of disadvantaged groups, the government is piloting preventive screening and care services for disadvantaged groups at family medicine clinics under the Hospital Authority. Recipients of Comprehensive Social Security Assistance, recipients of the Old Age Living Allowance aged 75 or above, and holders of a valid medical fee waiver certificate who wish to join the scheme may be arranged through a District Health Centre or Station to receive the relevant preventive screening services at a designated Hospital Authority family medicine clinic. (our translation from the Chinese original)

Chinese original:

「由第二個計劃年度開始，如計劃參加者已達到指定健康指標，將可於下一個計劃年度第一次接受資助診症時，獲扣減最高$150共付額（政府建議的共付額）。」 「為照顧弱勢社群的健康服務需要，政府於醫院管理局（醫管局）轄下的家庭醫學診所試行為弱勢社群提供預防篩查及護理服務。綜合社會保障援助計劃受助人、75歲或以上長者生活津貼受惠人，或持有有效醫療費用減免證明書者，如有意參與計劃，可透過地區康健中心／站安排到指定的醫管局家庭醫學診所接受相關的預防篩查服務。」

[Note 29] Centre for Health Protection, Non-Communicable Diseases Watch, May 2022, Chinese version:

Research shows that the higher the sodium intake, the greater the risk of developing high blood pressure. The World Health Organization recommends that a healthy adult consume less than 2 grams of sodium (or less than 5 grams of salt) a day. However, people aged 15 to 84 in Hong Kong consume too much sodium, averaging 8.8 grams of salt a day. Research indicates that increasing potassium intake helps people with high blood pressure lower it. For good blood pressure control, the World Health Organization recommends that a generally healthy adult consume at least 3.5 grams of potassium a day. However, people aged 15 to 84 in Hong Kong consume too little potassium, averaging 2.3 grams a day. (our translation from the Chinese original)

Chinese original:

「研究顯示，鈉攝取量愈高，患上高血壓的風險愈大。根據世界衞生組織（下稱「世衞」）的建議，健康的成年人每日應攝取少於2 克鈉（或少於5 克鹽）。然而，本港15 至84 歲人士攝取過多鈉，平均每日攝取8.8 克鹽。」 「研究指出，增加鉀攝取量有助高血壓患者降低血壓。為妥善控制血壓，世衞建議一般健康的成年人每日應攝取至少3.5 克鉀。然而，本港15 至84 歲人士攝取過少鉀，平均每日攝取2.3 克鉀。」

[Note 30] The full Chinese management recommendations of the Department of Health Elderly Health Service:

Take medication as the doctor directs and attend follow-up regularly / monitor blood pressure regularly oneself / practise a healthy lifestyle / stop smoking / keep to an ideal weight and waist circumference (body mass index below 23 kg/m², waist below 90 cm for men and below 80 cm for women) / build healthy eating habits: eat lightly, with less salt, soy sauce and preserved food; eat more vegetables and fruit / take moderate and sustained exercise. Each time do at least 10 minutes of moderate-intensity aerobic activity, such as jogging, walking, tai chi or swimming, so as to reach a target of at least 150 minutes accumulated a week. For vigorous aerobic exercise, accumulate at least 75 minutes a week. If you are at risk of cardiovascular disease, seek the advice of healthcare staff first. / Do not drink alcohol / manage stress and keep a cheerful outlook (our translation from the Chinese original)

Chinese original:

「按醫生指示服藥及定期覆診／自我定期監察血壓／實踐健康生活模式／停止吸煙／保持理想體重及腰圍（體重指數少於23公斤／米2，男性腰圍少於90厘米，女性腰圍少於80厘米）／養成健康飲食習慣：飲食要以清淡為主，少吃鹽、豉油及醃製食物；多進食蔬菜水果／要有適量及持之以恆的運動。每次進行至少 10分鐘中等強度的帶氧體能活動，例如緩步跑、步行、太極、游泳等，以達至每周累積最少150分鐘的目標。如果進行高強度的帶氧運動，則每周累積最少75分鐘。如有心血管疾病的風險，請先徵詢醫護人員的意見。／不飲酒／管理壓力、保持心境開朗」

[Note 31] The patient version, the section on regular physical activity:

It is best to spend 30 minutes a day on moderate (brisk walking, for example) or vigorous aerobic physical activity. Aerobic physical activity may be accumulated in bouts of at least 10 minutes each / do muscle-strengthening activity on at least 2 days a week (not consecutive) (our translation from the Chinese original)

Chinese original:

「每天最好能用 30 分鐘進行中等 ( 例如急步行 ) 或劇烈強度的帶氧體能活動。帶氧體能活動可以最少每次 10 分鐘的方式來累積進行／每周至少2 天( 非連續的) 進行肌肉強化活動」

[Note 32] The patient version, the whole "avoid alcohol" passage:

Alcoholic drinks can cause many diseases, and excessive drinking not only seriously affects a person's physical health but also affects mental health, social health and performance at work, so you should stay away from alcohol. If you choose to drink alcoholic drinks, be moderate so as to minimise alcohol-related harm. Recommendation: men should drink no more than 2 standard drinks a day / women no more than 1 standard drink / one standard drink unit (see the note below) is equivalent to: about 250 millilitres of beer at 5% alcohol / a small glass (100 millilitres) of wine at 12% alcohol / a bar-standard measure (30 millilitres) of spirits at 40% alcohol (our translation from the Chinese original)

Chinese original:

「酒精飲品可引致多種疾病，過量飲酒不但嚴重影響個人的生理健康，更會影響心理健康、社交健康和工作表現，因此你應該遠離酒精。若你選擇飲用酒精飲品，應多加節制以盡量減少與酒精相關的危害。建議: 男性每天不應飲多於2 個標準酒量／女性則不多於1 個標準酒量／一個標準酒量單位 (註一) 相等於 : 約 250 毫升 ) 含 5% 酒精的啤酒／一小杯 (100 毫升 ) 含 12% 酒精的葡萄酒／一杯酒吧標準容器 (30 毫升 ) 含 40% 酒精的烈酒」

(Note: one standard drink unit is 10 grams of pure alcohol. The bracket in the fourth line quoted above is as in the original.)

[Note 33] The patient version:

Blood pressure medication must be taken long term, so that blood pressure does not rise again. Even if blood pressure returns to the normal range after a period on medication it must not be stopped automatically, or blood pressure will silently rise to a dangerous level and cause complications such as stroke (our translation from the Chinese original)

Chinese original:

「血壓藥必須長期服用，以免血壓再次升高。即使在服藥一段時間後，血壓回復正常範圍也不可自動停藥，否則血壓會無聲無息地升高至危險的水平，引起中風等併發症」

[Note 34] The same document, misconception five:

5. Once blood pressure returns to normal, medication is no longer needed / Fact: high blood pressure is a chronic disease which medication can control but cannot cure. Patients must therefore receive continuing treatment as the doctor directs, adjust their lifestyle, and be checked regularly thereafter to follow up their condition. (our translation from the Chinese original)

Chinese original:

「5. 血壓回復正常後，便不再需要服藥／事實︰高血壓是一種慢性疾病，雖能透過藥物控制，但並不能治癒。因此，患者須按醫生指示接受持續治療，調整生活模式，並在往後的日子定期進行檢查，以跟進身體狀況。」

[Note 35] The same document, misconception four:

4. I have high blood pressure, and the doctor says that if I start taking blood pressure medication I will have to take it for life, so I had better not start / Fact: the fact of having high blood pressure will not change because you refuse medication. But not taking medication as the doctor directs greatly increases the chance of complications or of a shortened life. (our translation from the Chinese original)

Chinese original:

「4. 我有高血壓，醫生說如果開始服用血壓藥的話，便須服用一輩子我還是不開始服藥為妙／事實︰患高血壓的事實，不會因你拒絕服藥而改變。但是，若不依照醫生的指示服藥的話，會大大增加出現併發症或縮短壽命的機會。」

[Note 36] The same document:

Have a physical examination every year, and pay attention to your condition at other times too, watching for complications such as stroke. Recommended examination items include: body mass index and waist circumference; blood glucose; blood pressure; blood lipids; kidney function tests (including urine protein) (our translation from the Chinese original)

Chinese original:

「每年接受身體檢查，平時也要注意身體狀況，留意是否出現併發症如中風。建議檢查項目包括: » 體重指標及腰圍 » 血糖 » 血壓 » 血脂 » 腎功能檢查（包括尿液蛋白檢查）」

And on diagnostic tests:

The simplest diagnostic method is measuring blood pressure with a blood pressure monitor. In addition, after taking the patient's history and a detailed physical examination, the doctor will arrange other tests for patients who need them, such as blood tests, urine tests, electrocardiogram, chest X-ray and fundus examination, to find the cause of the raised blood pressure and any complications. (our translation from the Chinese original)

Chinese original:

「最簡易的診斷方法是利用血壓計量度血壓。此外，醫生在聽取病人的病歷及作詳細身體檢查後，會為有需要的病人安排其他檢查，例如血液檢驗 、尿液檢驗、心電圖、胸肺X 光照片檢查及眼底檢查，以找出引致血壓高的病因及其併發症等。」

[Note 37] Module 8 of the same framework (English only):

to ensure satisfactory control over the year (average of most recent three readings of <140/90 mmHg)

That is: control over the year counts as satisfactory where the average of the most recent three readings is below 140/90 mmHg.

#Matters on which this article makes no statement

• A list of emergency symptoms. For the grade three hypertension row, the reference framework hands "features of malignant hypertension" to its own "box 2", and the content of that box is outside the material this article relies on. This article therefore lists no emergency symptoms of its own. There is a more fundamental reason for that: any symptom list can be read as "my situation is not on the list, so I am fine". Whether blood pressure is high cannot be judged by feel — the Health Bureau's patient version says itself that most patients have no symptoms at all. Where a reading reaches ≥180/110, what the reference framework prescribes is further assessment and treatment within one week, with immediate referral to hospital if features of malignant hypertension appear; and anyone with acute symptoms should seek medical attention at once rather than checking a list first.
• The magnitude of the white coat effect. Hong Kong's official documents acknowledge that white coat hypertension exists and recommend ambulatory or home measurement to address it, but publish no magnitude in mmHg. Figures of the kind "the clinic reads 10–20 mmHg higher than home" have no source in the Hong Kong material this article relies on.
• A calibration interval for blood pressure monitors. The official wording is only that a monitor "should be serviced and calibrated regularly", with no period. "Every 1 to 2 years" has no source. (The sentences before and after in the same passage give a course of action rather than a period: choose a "clinically validated" monitor, and if in doubt bring it to an appointment for a doctor to check — both set out in the body.)
• NICE NG136's arrangements for special situations such as very high blood pressure. This article states only NG136's diagnostic confirmation requirement; whether that guideline makes separate provision for special situations is not something this article states, and the full text of its recommendations is outside the material this article relies on.
• Averaging "the middle 5 days" of a 7-day home measurement. The Hong Kong document says to take the average of all the readings, discarding no day.
• The effect of lifestyle change in mmHg. "How many grams less sodium lowers how many mmHg", "regular exercise lowers 5–8 mmHg", "each 1 kilogram lost lowers 1 mmHg" — the Hong Kong documents this article relies on (including the issue of Non-Communicable Diseases Watch devoted to sodium, potassium and blood pressure) publish none of them. The Hong Kong documents treat sodium as a risk factor for the disease rather than as an effect expressed in mmHg.
• The upper bound of 150 to 300 minutes a week. The Elderly Health Service's hypertension page says at least 150 minutes a week accumulated at moderate intensity, or 75 minutes at vigorous intensity, with no upper bound. ⚠ An earlier version of this article stated in this same item that the Hong Kong hypertension material also "has no strength training recommendation", and that statement was not correct: the Hong Kong Reference Framework for Hypertension Care for Adults [patient version], in its section on regular physical activity, states 「每周至少2 天( 非連續的) 進行肌肉強化活動」 — do muscle-strengthening activity on non-consecutive days, at least twice a week (our translation from the Chinese original). That recommendation is now set out in the body; the original incorrect statement is preserved here for traceability.
• The price of home blood pressure monitors. The Consumer Council tested 27 home electronic blood pressure monitors in 2013, but neither language version of that press release publishes prices; nor do the Council's buying tips page, the Elderly Health Service page or the medical device division's web pages. This article therefore gives no "usual price".
• The criteria for referral to cardiology. A list of six situations for cardiology referral circulates informally. The Hong Kong documents this article relies on publish no such list, and this article therefore does not carry one.
• "Calcium channel blockers are particularly effective in Chinese people and are often first choice". Nothing in the material this article relies on contains any such statement by a Hong Kong document. This article reports only the formulary's charging categories, and does not compare the merits of drug classes.
• "X% of patients do not know they have it". What the survey publishes is 12.1% of the whole population, not of patients. The 41.1% and 58.9% in the body are results calculated from the published numbers of people, not figures the survey published.
• The breakdown of adverse events in STEP and HYVET. The safety breakdown tables of those two trials are not published in the abstracts available. This article therefore reports only the conclusions their abstracts state (STEP: no significant difference between the groups in safety or renal outcomes, except more hypotension in the intensive group; HYVET: fewer serious adverse events in the active treatment group, 358 against 448).
• The raw sample size of the Population Health Survey 2020-22. The report publishes weighted population estimates (5,959,700) and coefficients of variation (3.7% for the 29.5%), and does not publish the number of respondents or of people examined. The 2014/15 survey's lipid testing sample was 2,347 people (Non-Communicable Diseases Watch, August 2019).
• How the PREVENT risk equations perform in Hong Kong Chinese. The 2025 American guideline moves to PREVENT, and the Hong Kong documents say nothing about PREVENT. The reference framework's criticism of the Pooled Cohort Equations cannot be taken as automatically applying, or automatically not applying, to PREVENT.

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This article is health education information only and is not any form of pharmaceutical advertising. This platform does not promote or recommend the use of any particular drug, treatment or medical device for the conditions described above.

免責聲明 本文僅供一般資訊用途，並不構成醫療建議。如需診斷或治療，請諮詢合資格的香港註冊醫生。

Disclaimer This article is for general information only and does not constitute medical advice. Consult a qualified Hong Kong-registered doctor for diagnosis or treatment.

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#Sources

• Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings (Revised Edition 2021), Primary Healthcare Commission, Health Bureau, Chapter 7 (the office blood pressure classification table, follow-up intervals, note 1 on the diagnostic procedure; note 2 on rechecking at the shorter interval where the systolic and diastolic classifications differ; note 3 on adjusting the follow-up interval by past readings, other cardiovascular risk factors or target organ disease; note 4's three points on measuring both arms, including the one on a difference of 15 mmHg or more identifying high risk; note 5 on single-visit diagnosis in grade three hypertension): https://www.healthbureau.gov.hk/phcc/rfs/src/pdfviewer/web/pdf/hypertensioncareforadults/tc/coredocument/10_tc_hypertension_care_chapter7.pdf (retrieved: 3 August 2026)
• The same document, preface to the first edition, Chinese version (the working group chaired by the Secretary for Food and Health, the four task forces, the task force responsible for promulgating and revising, the two clinical advisory groups reviewing and updating regularly, and the convenor Professor Cindy Lam): https://www.healthbureau.gov.hk/phcc/rfs/src/pdfviewer/web/pdf/hypertensioncareforadults/tc/coredocument/01_tc_hypertension_care_Preface_to_the_First_Edition.pdf (retrieved: 3 August 2026; the English version of the same passage reads "promulgating, maintaining and revising", and the Chinese version has no item for "maintaining")
• The same document, full English text (Module 2 on blood pressure measurement: home 135/85, ABPM 130/80, daytime 135/85, night-time 120/70, the 7-day measurement, two consecutive measurements 1–2 minutes apart with morning and evening recording, home devices to be checked regularly, the table of advantages and disadvantages of home measurement at section 4.1, and item xvii on the number of visits and intervals being inversely related to severity; Module 9 on risk assessment tools, on risk estimation being unnecessary for very high and high risk individuals and table 1 defining them, and on the Framingham versions already recalibrated for Asian populations; Module 7 on treatment targets and the caution about diastolic pressure below 60 mmHg in coronary artery disease with diabetes or age over 60; Module 8 on the annual assessment definition of control as an average of the most recent three readings below 140/90): https://www.healthbureau.gov.hk/phcc/rfs/src/pdfviewer/web/pdf/hypertensioncareforadults/en/13_en_RF_HT_full.pdf (retrieved: 3 August 2026. All nine professional modules resolve to the English PDF path in the Health Bureau site's Chinese language file)
• The same document, Chapter 1 (2014/15 survey data, table 1): https://www.healthbureau.gov.hk/phcc/rfs/src/pdfviewer/web/pdf/hypertensioncareforadults/tc/coredocument/04_tc_hypertension_care_chapter1.pdf (retrieved: 2 August 2026)
• Hong Kong Reference Framework for Hypertension Care for Adults [patient version] (revised July 2022), Health Bureau (the measurement frequency including the rule at 75 and the appendix's "needs to be adjusted according to the blood pressure level, age, the overall risk of coronary heart disease and the doctor's advice"; the risk factor list introduced with "for example"; the home measurement steps and recording rules including at least 1 minute between two measurements; the three points on choosing a monitor including "clinically validated" and bringing it to an appointment; the treatment targets of 140/90 and 130/80; not stopping medication on one's own; misconceptions 1, 2, 4 and 5; the annual assessment items; physical activity including muscle-strengthening activity on at least 2 non-consecutive days a week; diet including 1 teaspoon of salt being about 5 grams; the whole "avoid alcohol" column; and influenza vaccination): https://www.healthbureau.gov.hk/phcc/rfs/src/pdfviewer/web/pdf/educationalresources/tc/05_tc_c_hypertension_care_patient.pdf (retrieved: 3 August 2026)
• Hong Kong Reference Framework for Preventive Care for Older Adults in Primary Care Settings (Revised Edition 2021), summary of recommendations (annual hypertension screening for older people): https://www.healthbureau.gov.hk/phcc/rfs/src/pdfviewer/web/pdf/preventivecareforolderadults/tc/02_coredocument/03_tc_ref_framework_adults_SUMMARY_OF_RECOMMENDATIONS.pdf (retrieved: 2 August 2026)
• Report of the Population Health Survey for the three years to 2022 (Part II), Non-Communicable Disease Branch, Centre for Health Protection, Department of Health, 2023 (29.5% / 17.4% / 12.1%, the age distribution, the age-standardised measured prevalence of 15.0%, mean blood pressures, salt intake, coefficients of variation): https://www.chp.gov.hk/files/pdf/dh_phs_2020-22_part_2_report_chi_rectified.pdf (retrieved: 2 August 2026)
• The same survey (Part I) (the self-reported diagnosis rate of 19.5%, the 93.6% on medication, the 52.3% measured within two years): https://www.chp.gov.hk/files/pdf/dh_phs_2020-22_part_1_report_eng_rectified.pdf and the Chinese version https://www.chp.gov.hk/files/pdf/dh_phs_2020-22_part_1_report_chi_rectified.pdf (retrieved: 2 August 2026)
• Report on Population Health Survey 2003/2004, Department of Health (2003/04: 12.1% self-reported, 15.1% measured, 73.4% on medication; what this article cites is the English report published by the Centre for Health Protection): https://www.chp.gov.hk/files/pdf/report_on_population_health_survey_2003_2004_en.pdf (retrieved: 2 August 2026)
• Centre for Health Protection health topic — hypertension (page date 11 May 2023; "prehypertension" at 120–139/80–89, over 90 per cent primary): https://www.chp.gov.hk/tc/healthtopics/content/25/35390.html (retrieved: 2 August 2026)
• Department of Health Elderly Health Service — hypertension (90% primary and 10% secondary, the seven risk factors, the management recommendations including "eat less salt, soy sauce and preserved food" and the waist targets, the "of every twenty… twelve" formulation, and footnote 1 below the measurement table that "a doctor may adjust the follow-up interval according to past blood pressure readings, the presence of other cardiovascular risk factors or the presence of target organ disease"): https://www.elderly.gov.hk/tc_chi/health_information/hypertension_heart_disease/hypertension.html (retrieved: 3 August 2026)
• Non-Communicable Diseases Watch, May 2022, "Sodium, potassium and hypertension" (the World Health Organization's less than 2 grams of sodium or less than 5 grams of salt a day, the 2014/15 average of 8.8 grams of salt, and potassium at 2.3 grams against a recommended 3.5 grams): https://www.chp.gov.hk/files/pdf/ncd_watch_may_2022_chin.pdf (retrieved: 2 August 2026)
• Non-Communicable Diseases Watch, May 2023 (republishing the 2020-22 survey's age and sex distribution): https://www.chp.gov.hk/files/pdf/ncd_watch_may_2023_chin.pdf (retrieved: 2 August 2026)
• Non-Communicable Diseases Watch, May 2025 (29.5%, measuring blood pressure regularly; item 5 of its reference list gives the reference framework's publisher as the Primary Healthcare Commission of the Health Bureau): Chinese version https://www.chp.gov.hk/files/pdf/ncd_watch_may_2025_tc.pdf and English version https://www.chp.gov.hk/files/pdf/ncd_watch_may_2025_en.pdf (retrieved: 3 August 2026)
• Hospital Authority "Fees and Charges" (effective 1 January 2026: family medicine clinic 150 dollars plus 5 dollars per drug, specialist 250 dollars plus 20 dollars, accident and emergency 400 dollars, the four-week charging unit, the administrative fee for self-financed drugs): https://www.ha.org.hk/visitor/ha_view_content.asp?Content_ID=10045&Lang=CHIB5 (retrieved: 2 August 2026)
• Hospital Authority "Annual Spending Cap" (ten thousand Hong Kong dollars a year, no means test, excluding self-financed drugs and appliances): https://www.ha.org.hk/visitor/ha_view_content.asp?Content_ID=281820&Lang=CHIB5 (retrieved: 2 August 2026)
• Hospital Authority press release annex of 25 March 2025 (general outpatient clinics merged into the family medicine outpatient service, the specialist first-attendance and follow-up charges abolished): https://www.ha.org.hk/haho/ho/pad/279238_TC.pdf (retrieved: 2 August 2026)
• Hospital Authority Drug Formulary, "Drug formulary categories and charges" (the four categories; the original definitions of general drugs, special drugs and self-financed items with safety net, including that special drugs require the special authorisation of a specialist, and that the Samaritan Fund and the Community Care Fund provide the safety net for self-financed items): https://www.ha.org.hk/hadf/tc/Drug-Formulary/Drug-Formulary-Categories-And-Charges.html (retrieved: 3 August 2026); Drug Formulary search tool (the classifications of amlodipine, lisinopril, losartan, indapamide, metoprolol, valsartan and nifedipine): https://www.ha.org.hk/hadf/en/Others/Search-Result.html (retrieved: 2 August 2026)
• Hospital Authority specialist outpatient stable new case waiting times (reporting period 1 July 2025 to 30 June 2026): https://www.ha.org.hk/opendata/sop/sop-waiting-time-tc.json (retrieved: 2 August 2026)
• Chronic Disease Co-Care Pilot Scheme frequently asked questions and scheme introduction (aged 45 or above, a screening co-payment of 120 dollars or less, up to 6 subsidised consultations per personal scheme year in the treatment stage for the "hypertension and/or diabetes" category while other categories are 4 or fewer, a recommended co-payment of 150 dollars, up to $150 deducted from the co-payment on reaching the specified health indicators, and holders of Comprehensive Social Security Assistance, the Old Age Living Allowance at 75 or above, or a medical fee waiver certificate being able to be arranged through a District Health Centre or Station to a Hospital Authority family medicine clinic for preventive screening, and the specified drug list): https://www.primaryhealthcare.gov.hk/cdcc/tc/gp/faq.html and https://www.primaryhealthcare.gov.hk/cdcc/tc/gp/introduction.html (retrieved: 3 August 2026)
• Consumer Council press release, "Testing the accuracy of home electronic blood pressure monitors — CHOICE magazine issue 439", 15 May 2013 (27 models tested, no prices published): https://www.consumer.org.hk/tc/press-release/20130515 (retrieved: 2 August 2026)
• Zhang W, and others. Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. N Engl J Med 2021;385:1268-1279 (the STEP trial; PMID 34491661, DOI 10.1056/NEJMoa2111437)
• SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015;373:2103-2116 (PMID 26551272, DOI 10.1056/NEJMoa1511939)
• ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575-1585 (PMID 20228401, DOI 10.1056/NEJMoa1001286)
• Beckett NS, and others. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:1887-1898 (HYVET; PMID 18378519, DOI 10.1056/NEJMoa0801369)
• Blood Pressure Lowering Treatment Trialists' Collaboration. Lancet 2021;397:1625-1636 (per 5 mmHg, 0.91 in primary prevention and 0.89 in secondary prevention; PMID 33933205) and Lancet 2021;398:1053-1064 (the hazard ratios by age stratum, 0.99 (0.87–1.12) above 85 and that group's 4,788 people and 1.3%, adjusted pinteraction=0·050, absolute risk reductions larger in older groups (adjusted pinteraction=0·024), and the INTERPRETATION passage on being "effective into old age" and on removing age-related blood pressure thresholds; PMID 34461040, DOI 10.1016/S0140-6736(21)01921-8)
• Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control: an individual participant data analysis of randomised controlled trials. Lancet 2025;406:1009-1019 (number needed to treat 58, number needed to harm 55, 82.6% Asian; PMID 40902616)
• 2025 AHA/ACC and 13 societies, Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. Circulation 2025;152:e114–e218 (DOI 10.1161/CIR.0000000000001356, published 16 September 2025, expressly replacing the 2017 edition)
• 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens 2023;41(12):1874–2071 (DOI 10.1097/HJH.0000000000003480)
• 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024;45(38):3912 ("Elevated BP" at 120–139/70–89, target 120–129/70–79)
• WHO. Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization, 2021 (ISBN 978-92-4-003398-6)
• NICE guideline NG136, Hypertension in adults: diagnosis and management (published 2019, updated 26 February 2026; the mandatory confirmation of office ≥140/90 plus ABPM or HBPM ≥135/85): https://www.nice.org.uk/guidance/ng136
• Chinese Guidelines for the Prevention and Treatment of Hypertension (2024 revision). J Geriatr Cardiol 2025;22:1 (office ≥140/90, measured on three different days)

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#Further reading

• On this platform: Reading laboratory and imaging reports
• On this platform: High cholesterol
• On this platform: The Chronic Disease Co-Care Pilot Scheme (CDCC)
• Centre for Health Protection — hypertension information: chp.gov.hk hypertension
• Centre for Health Protection — Non-Communicable Diseases Watch: chp.gov.hk NCD watch May 2025
• Hong Kong Population Health Survey 2020-22 report: chp.gov.hk PHS 2020-22