For patients with a past medical history of diabetes, acute coronary syndrome, chronic kidney disease, 10-year atherosclerotic cardiovascular disease risk higher than 10% and the elderly people, pharmacotherapy is recommended for patients with systolic blood pressure (SBP) greater than or equal to130 mm Hg; lifestyle modification is recommended for patients in this group with SBP greater than or equal to120 mm Hg or for secondary stroke prevention.3 This lower threshold for the definition of hypertension allows early identification of at-risk individuals and thus earlier intervention before hypertension becomes irreversible or results in further complications.4 The application of the 2017 ACC/AHA guideline is controversial in Hong Kong, because of the increased burden on the healthcare system. Implications for local clinical practice and research The prevalence of hypertension is likely to increase in Hong Kong, owing to the ageing population. ...a more forward-looking approach to the management of hypertension should be adopted in Hong Kong, with more focus on epidemiological issues. The characteristics of patients labelled “stage 1 hypertension” are mostly younger, male, and obese.12 At the early stage, hypertension is easily manageable via lifestyle modifications, particularly in younger patients. ...blood pressure control rates are generally better in younger patients and do not require pharmacological treatment.13 This reduces the risk of serious adverse events such as hypotension or electrolyte disturbances. Considering these factors, further studies are needed to ascertain the appropriate hypertension threshold that is applicable for Hong Kong population. ...the hypertension guideline should be constantly reviewed in the future according to advancements in research findings.