"By 2030, three 80% of hypertension prevention and control will be achieved, that is, the awareness rate of those with elevated blood pressure, the treatment rate of confirmed patients, and the control rate of patients taking medication will all reach 80%!" On October 21, the 2023 Academic Annual meeting of the China Hypertension Alliance and the 25th International Symposium on Hypertension and Related Diseases opened in Beijing. Professor Liu Lisheng, founder of the China Hypertension Alliance and chairman of the seventh China Hypertension Alliance, put forward the future work goals in his speech, and said that in 2011, The United Nations Political Declaration on the Prevention and Control of Chronic Diseases and the 2012 WHO Prevention and Control targets call for a 25 percent reduction in premature deaths from noncommunicable diseases and a 25 percent reduction in the percentage of people with substandard blood pressure by 2025. The Global Sustainable Development Goals recommend that these two targets reach 30% by 2030. The 15 special actions of the Healthy China Action (2019-2030) also put forward clear requirements for the prevention and control of hypertension. The prevention and control of hypertension in China is facing a difficult task, Professor Liu hopes that at this meeting, the past can be examined, the future can be planned, the prevention and control of hypertension can be implemented in reality, and a satisfactory answer paper will be handed over to the public in 2030.

Professor Arun Chocolingumm, former Secretary-General of the World Alliance for Hypertension, pointed out that under the leadership of Professor Liu Lisheng, it not only greatly promoted the development of hypertension prevention and control in China, but also made great contributions to the prevention and control of hypertension in the world.

Zhang Xiangli, Second Inspector, Foundation Division, National Health Commission; Professor Taskeen Khan, Department of NonCommunicable Diseases, World Health Organization; Professor Paul Whelton, Current President of the World Hypertension Alliance; Professor Norm Campbell, Chair of the Preparatory Committee of the Canadian Hypertension Alliance; Professor Salim Yusuf from the Canadian Institute of Population Health, Professor Wang Yongjun, President of the Chinese Stroke Society, Professor Huo Yong, Chairman of the Hypertension Committee of the Chinese Association of Research Hospitals and other guests at home and abroad attended the meeting. The opening ceremony was presided over by Professor Yan Xiaowei from Peking Union Medical College Hospital.

Global experience

Guideline recommendations are seriously decoupled from clinical practice

'We have to do better'

Professor Whelton presented the current global status of hypertension prevention and treatment, noting that hypertension is a widespread problem worldwide, resulting in significant disease and economic burden. Although many methods and criteria for prevention, diagnosis and treatment based on scientific evidence have been developed, implementation is very inadequate, and global treatment and control rates are very low. Suggesting a serious disconnect between trial effectiveness studies, guidelines recommendations and clinical practice, "we must do better."

Professor Whelton said weight loss, a healthy diet, reduced sodium intake, increased dietary potassium intake, physical activity, and alcohol restriction were the most effective non-pharmacological interventions for the prevention and control of high blood pressure that had been scientifically proven.

As for the way forward, Whelton pointed out several ways forward: applying different strategies to prevent, treat and control hypertension, including establishing effective health care delivery systems based on scientific evidence; Second, most adults with high blood pressure have no complications. A standardized approach to team services that is simple and easy to implement may be more effective than a traditional individualized approach. Third, convenient and effective service, easy, cheap and reliable antihypertensive drug guarantee; Fourth, tracking progress and real-time patient management systems; Fifth, in the formulation of guidelines, we should focus on how to implement. Professor Whelton says the HEARTS project and other similar models look promising for now.

The story behind the world's leading high blood pressure compliance rate

Data from 1985-1992 show that Canada's hypertension control rate was 13 per cent, and by 2007-2008, this figure rose to 66 per cent, which is among the best in the world. Professor Norm Campbell introduced the reasons behind: In 1999, Canada began to implement a highly simplified, deeply collaborative hypertension education program emphasizing primary care services, which ushered in a significant reduction in the death rate of stroke, heart failure, acute myocardial infarction and other cardiovascular and cerebrovascular diseases.

In addition, from 2000 to 2017, Canadian hypertension control programs reduced more than 870,000 deaths and 4.6 million hospitalizations. However, there was also a small incident during the period: in 2011, the merger of hypertension related organizations, no longer emphasize the implementation of guidelines, while losing the supervision and relevant financial support of the government, primary health care and social teams, a series of changes resulted in 2016-2017, women's blood pressure control standards dropped from 69% to 49%.

Prof. Norm Campbell summarized lessons learned and proposed the best practices for achieving sustained hypertension control, including strong government support, multidisciplinary engagement and focus on primary care, clear short - and long-term goals and strategic planning, point-of-care based monitoring and evaluation protocols, standardized pathways for screening, diagnosis, and treatment. Repeated and continuous education of staff in primary health care institutions (with emphasis on the responsibility of grassroots in the detection and treatment of hypertension).

In addition, Professor Norm Campbell proposed future reform plans: First, emphasizing the management of hypertension in primary medical institutions, re-establishing cooperation with primary medical institutions, health organizations and professional societies; Second, strongly advocate the HEARTS project; Third, re-establish monitoring and evaluation mechanisms, focusing on the characteristics of groups with high prevalence, underdetection, untreated and under-treated populations, and gaps in their access to health services; Fourth, a renewed emphasis on implementation tools and resources for education and training needs; Fifth, gradually transition to the use of only qualified clinically verified blood pressure monitors.

The race against the silent killer

Professor Taskeen Khan interprets the recent WHO Global Report on Hypertension. The report shows that the number of people with high blood pressure (≥140/90 mmHg or taking anti-blood pressure medication) has doubled globally over the past 30 years, from 650 million in 1990 to 1.3 billion in 2019. However, among people aged 30-79 years with high blood pressure, only 54 percent had been diagnosed with high blood pressure, 42 percent received treatment for hypertension, and 21 percent had it under control.

The report estimates that 76 million deaths, 120 million strokes, 79 million heart attacks and 17 million heart failure events could be avoided between 2023 and 2050 if countries were to increase hypertension control rates to 50 percent.

In addition, the main risk factors for hypertension continue to be unhealthy diets, such as high sodium and low potassium intake, overweight and obesity, alcohol consumption, smoking and physical inactivity, and environmental pollution.

The report not only describes the current status of hypertension control globally and in 194 countries, the burden of death and disability caused by hypertension, the health and economic benefits of effective treatment of hypertension, but also recommends strategies to reverse the situation. The most important of these are the implementation of the HEARTS Toolkit and adult hypertension treatment guidelines to help primary care institutions prevent and control cardiovascular diseases. Thirty-three countries, including China, have implemented the HEARTS program and have seen significant increases in blood pressure control rates and reductions in cardiovascular events.