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CARDIOLOGY

Aiming at 3 major difficulties and pain points of high blood pressure, play this hard battle!

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“Forward, long-term, harmonious, comprehensive”, this is the new concept of the need to develop prevention and control of hypertension from the individual to the group today and a new realm that needs to be developed. We are facing a globalized hypertension and “cardio-cerebral vascular crisis.” The awareness rate, control rate and treatment rate of hypertension are very low, which is our biggest pain point and difficulty. But it also brings us tremendous room for improvement from today and from the moment. In the era of chronic diseases, on the basis of “simple lifestyle 7”, through the comprehensive intervention of prevention and control and the risk factors of cardiovascular and cerebrovascular diseases, coexisting with chronic diseases such as hypertension, it is a new concept that needs to be developed and needs to be developed. New realm. Some experts and colleagues have repeatedly stressed that in the prevention and control of hypertension, we must “implement the last mile” and “open the last mile.” It should be acknowledged that the original intention is good and correct, but the author believes that the use of words is not appropriate, not scientific. “The last mile”, I don’t know where it came from, but it is easy to bring ambiguity: It seems that we have gone 99 kilometers, and the goal of prevention and control of high blood pressure seems to be very close. Look at this set of data: Canada, the awareness rate, treatment rate and control rate of hypertension have reached 82.5%, 79% and 64.6%, respectively. In China, the best prevention and control data for hypertension: the awareness rate, treatment rate and control rate of hypertension were 51.6%, 45.8% and 16.8%, respectively. The difference is 100,000 miles, not “one kilometer”… The number of hypertensive patients in China is 8 times that of Canada’s total population. The situation of prevention and control of hypertension in China is very serious, far from being “one kilometer”. thing. It’s a long way to go, Long Way To Go… It’s easy to open a high-pressure medicine, but at the individual treatment level, it’s necessary to “long-term, stable” to control the high blood pressure in the ideal range in order to lower the stroke, coronary heart disease, and heart. Depression and renal insufficiency are minimal, and it is not easy. At the individual level, the treatment of high blood pressure is not a “one kilometer” thing, but a very long-term, long-term medication compliance problem. High blood pressure, global cardiovascular and cerebrovascular disease crisis cardiovascular disease (CVD, including heart disease and stroke – in fact, cardiovascular and cerebrovascular diseases, the term “cardiovascular disease in the future” is the first in the world) The cause of death and disability. Currently, CVD has killed more than 18 million people worldwide, accounting for 30% of the world’s total death toll. If the current trend of CVD “popularity” continues, by 2025, 23.3 million people worldwide will die from CVD. Hypertension is an independent cardiovascular and cerebrovascular disease and one of the most important risk factors for other cardiovascular and cerebrovascular diseases such as coronary heart disease. In an aging society and a chronic disease era, as an independent disease, the number of patients with hypertension accounts for 80%-90% of all patients with cardiovascular and cerebrovascular diseases. “Currently, the number of high blood pressure (≥140/90 mmHg) in the world has exceeded 1 billion. According to the current trend, the number of hypertension in the world will exceed 1.5 billion in less than 2030.” According to the US “Heart Disease and Stroke Statistics” – Updated in 2019, 48% of adults over the age of 20 in the United States have cardiovascular and cerebrovascular diseases, of which hypertension accounts for 39% and other cardiovascular and cerebrovascular diseases account for 9%. According to the 2017 ACC/AHA Guidelines for New Hypertension (≥ 130/80 mmHg), 46% of adults older than 20 years in the United States have hypertension. In China, a sample survey showed that among adults over 18 years old, the prevalence of hypertension (≥140/90 mmHg) was 27.9%, which is the number of patients with hypertension in China with about 300 million patients with cardiovascular disease. Also in the number with 300 million. Cardiovascular and cerebrovascular diseases, high blood pressure, and a huge cardiovascular and cerebrovascular crisis faced by the community of human destiny. The latest “China Cardiovascular Disease Report 2018” speculates that the number of cardiovascular diseases in China is 290 million, and the blood pressure is 245 million, including 13 million strokes and 11 million coronary heart disease.Cardiovascular and cerebrovascular diseases can be largely prevented. The blood pressure of hypertensive patients can also be controlled within a long-term and stable range, thus delaying or suppressing stroke, heart failure, coronary heart disease and renal insufficiency to the utmost extent. Within the scope. Pain points and difficulties in the prevention and control of hypertension in China For many years, Professor Liu Lisheng and Professor Wang Wen (Professor Wang Wen, who has made great contributions to the prevention and control of hypertension in China), and other seniors and colleagues have done a lot of effective hypertension epidemics. Disease investigation and clinical trial work. However, at present, the prevention and control of hypertension in China is still facing an extremely severe situation: even in accordance with the ≧140/90 mmHg standard, the number of hypertensive patients in China is steadily moving toward 300 million. On the road of prevention and control of hypertension in China, there are still many difficulties and pain points. ▎ The biggest pain points and difficulties: awareness rate, treatment rate and control rate According to the standard of ≧140/90 mmHg, the number of patients with hypertension in China is steadily increasing to 300 million. The awareness rate, treatment rate and control rate of hypertension are too low, which is the most important problem facing the prevention and control of hypertension in China, the biggest pain point and difficulty. According to the China Cardiovascular Disease Report 2018, the awareness rate, treatment rate, and control rate of hypertension were 51.6%, 45.8%, and 16.8%, respectively, in adults with hypertension greater than 18 years old. These data point to a more serious fact: the number of adult hypertension in China is between 245 and 300 million; the current awareness rate, treatment rate and control rate of hypertension in China are very low, very low! From 2020, the control rate should reach 25%, and 100 million hypertensive patients should control the target: it is already a sly, awkward, black and white “daydream.” However, this low awareness rate, treatment rate and control rate have also brought us tremendous room for improvement from today and from now on.痛 Pain points and difficulties 2: Localized high-quality evidence-based medical evidence is relatively rare In clinical trials of hypertension, China has conducted clinical studies such as Stone, CNIT, Syst-China and FEVER. The results of the CHIEF study, which has been selected for more than 13,000 patients, have shown that the rate of compliance with hypertension combined with treatment is as high as 80%, which can significantly improve the blood pressure compliance rate of hypertensive patients in China – we can have localized, high Evidence-based medical evidence of quality. However, in the context of the huge population base of 1.4 billion, the evidence of localized, high-quality evidence-based medicine is still insufficient. In contrast to the localized, high-quality evidence-based medical evidence, as of July 25, 2018, there were 535 clinical trials in the domestic hypertension field. Among them, there were 76 trials in phase 1, 23 trials in phase 2, 16 trials in phase 3, 55 trials in phase 4, and 365 trials in other phases. The number is very beautiful, but the research is not established, and the scale is not large. In clinical research, the awareness of Shantouism and small farmers is prominent. More hope to integrate resources, more large-scale, multi-center, high-quality clinical research such as CHIEF.痛 Pain points and difficulties 3: Guides and evidence-based medicine results are difficult to land In China with hundreds of millions of high blood pressure patients, there is no doubt that the main battlefield for prevention and control of hypertension should be in community clinics and not in all major third-class hospitals. However, in China, patients with hypertension go to large hospitals, and the results of guidelines and evidence-based medicine are difficult to land. This is an indisputable fact. Community clinics and community doctors have become synonymous with “low level”, and “community clinics” have been “door-to-door” for a variety of reasons. Among them, excessive encouragement and implementation of certain non-evidence-based medicines are evidence-based medicine. One of the important reasons why evidence-based guidelines are difficult to land at the grassroots level.The main battlefield for prevention and control of hypertension is in the community, but the writing of the guidelines for hypertension does not involve community doctors, village doctors or their representatives from beginning to end. Can such guidelines be implemented? The main battlefield for prevention and control of hypertension is in the community, but most of the people who write guidelines for hypertension do not have long-term high blood pressure in the community. Can such guidelines be well settled? “The experts who write ACC/AHA guidelines for hypertension in the United States are mostly university medical schools or large hospitals.” Yes, but the training process of American medical students and domestic medical students varies greatly. The “homogeneity” of American doctors is very it is good. Open up a new realm: Coexist with chronic diseases such as high blood pressure for a long time. In the “slow disease era”, more than half of our men and more than one-third of our students are destined to suffer from cardiovascular and cerebrovascular diseases. More than 40% of adults eventually die from cardiovascular and cerebrovascular diseases. This is a natural law, a high probability of cardiovascular and cerebrovascular diseases, and doctors are not likely to be exempt. The enormous wealth of social material wealth and the rapid development of contemporary medical science have made our life expectancy longer. In the ever-expanding life process, the risk factors and the advent of disease are inevitable. It is known that most hypertension, hyperlipidemia, diabetes, and tumors are diseases that are affected and regulated by multiple genes, and the environment (including lifestyle and various prevention, treatment, etc.) determines the degree of expression or expression of genes. Whether these chronic diseases occur or not, the outcome is ultimately the result of genetic and environmental interactions. These genes are the result of long-term natural selection in nature. On the one hand, they can cause certain diseases after exposure and expression. On the other hand, they may also be beneficial to the survival of the body under certain conditions. Nature and life are magical, and we know very little about it. For chronic non-communicable diseases such as hypertension, the task of medical science is to delay and reduce the occurrence of death and disabling complications of hypertension to the greatest extent, and not to have the ability to “conquer nature.” How to coexist in a long-term harmonious relationship with cardiovascular and cerebrovascular diseases or risk factors such as hypertension and hyperlipidemia? How to delay the occurrence of chronic disease complications to the maximum extent? This is a concept that needs to be clear and developed, and it is a realm that needs to be developed. The preliminary realistic answer and the increasingly clear concept are the adjustment and change of the two major defense lines of hypertension and atherosclerotic cardiovascular and cerebrovascular diseases. Prevention and treatment of hypertension: advance prevention lines The interpretation of clinical trial results such as SPRINT and ACCORD, and the 2017 ACC/AHA new hypertension guidelines for the definition of hypertension are highly controversial. For most people, blood pressure increases with age, which is a natural phenomenon. However, it is undeniable that blood pressure starts from 115/75 mmHg. For every 20/10mmHg increase, the risk of cardiovascular and cerebrovascular diseases is doubled or more. Based on a certain blood pressure level, cardiovascular events increase with the increase of blood pressure. It is a fact and the main evidence for intervention in blood pressure. The US “ACC/AHA 2017 Hypertension Guide”, based on the results of SPINT clinical trials, defines ≧130/80 mmHg as hypertension, which is highly controversial in the industry, but it is undeniable that it emphasizes the advancement of prevention and control. Flash point. The guidelines for Canada, Europe, and China, although inconsistent with the definition of hypertension in the United States and the ACC/AHA guidelines in the United States, in the prevention and control of hypertension, this point is consistent in concept, this is the pre-control Move and move forward. For adults, our country’s guidelines for hypertension (below) and the main guidelines for hypertension in China and abroad emphasize that blood pressure is 130/80 mmHg. It is necessary to pay attention to at least lifestyle intervention; because this blood pressure interval is more than 50% for adults. It will become a patient with hypertension (≧140/90 mmHg). For lipid metabolism disorders, etc., it also emphasizes primary prevention—preventing downstream cardiovascular and cerebrovascular events from the upstream. The concept of getting clearer and clearer – the line of defense of chronic diseases moves forward. Prevention and control of cardiovascular and cerebrovascular diseases, comprehensive line of defense Hypertension is one of the important risk factors for atherosclerotic cardiovascular disease.The five most visible and obvious risk factors that trigger the global cardiovascular crisis are smoking (2.9 OR), diabetes (2.4 OR), hypertension (1.9 OR), hyperlipidemia (1.9 OR), and obesity (1.1). OR). (Remarks: OR refers to the “odds ratio”, also known as the hazard ratio. Taking hypertension as an example, 1.9 OR means: in patients who already have atherosclerotic cardiovascular and cerebrovascular disease, the number of people with high blood pressure is 1.9 times in the same age group. Today, the control of a single risk factor for cardiovascular disease has reached its utmost or can be maximized, but we still face a huge residual risk of cardiovascular disease. There is a synergy between risk factors for cardiovascular disease. That is, if someone has both hypertension and hyperlipidemia, the risk of future atherosclerotic cardiovascular and cerebrovascular disease is not only 1.9 + 1.9 = 3.8, but greater than 3.8. The assessment of risk factors for cardiovascular disease and the intervention of risk factors all have synergistic effects, namely 1 + 1 > 2 effect, which is the comprehensive prevention and control of cardiovascular disease risk factors. In the past, many guidelines based on rigorous evidence-based medical evidence, such as hypertension, cardiovascular risk assessment, lifestyle, overweight and obesity, and cholesterol, basically covered hypertension treatment and atherosclerotic heart from different angles. Nearly all the hot topics of primary prevention of cardiovascular disease, such as cerebrovascular disease risk assessment, cholesterol management and aspirin use, but the content of these primary preventions is just a discrete point in the sub-professional guidance, not the line. With the face. The 2019 ACC/AHA Guidelines for the Primary Prevention of Cardiovascular Diseases fully integrates the evidence-based evidence and concepts of primary prevention and control advancement in various sub-professional areas, further clarifying: the basis of “simple lifestyle 7” Construct a comprehensive and synergistic cardiovascular disease prevention line. Advance: It is necessary to pay attention to lifestyle from blood pressure ≧120/80 mmHg; long-term: long-term, stable control of blood pressure within a safe range, in order to minimize the possibility of downstream events of hypertension; Harmony: Most hypertension And most of the chronic diseases are the result of the interaction between multi-gene regulation, genetics and the environment. Without going to the roots, learning to coexist harmoniously with chronic diseases, without end.
Comprehensive: Control high blood pressure and other risk factors, and build a comprehensive and coordinated defense against downstream cardiovascular and cerebrovascular events. “Forward, long-term, harmonious, “comprehensive”, this is the new concept of the need to develop prevention and control of hypertension from the individual to the group today and the new realm that needs to be developed. The above content is only authorized for exclusive use by 39 Health Net, without authorization from the copyright party. Please do not reprint.

ouyangshaoxia

The author ouyangshaoxia