How to overcome the “last mile” in hypertension prevention and control? | A seminar on hypertension treatment strategies, themed “Optimizing Collaboration and Focusing on Achieving Targets,” was held in Yueyang – Tencent News

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Wang Zengwu reviewed the evolution of guidelines for combination therapy. When first mentioned in 1972, the guideline recommendation was "possibly appropriate"; by JNC7, it was explicitly stated that "when blood pressure exceeds the target value by 20/10 mmHg, initiating two antihypertensive drugs should be considered";

and after 2017, initiating combination therapy and single-pill combination therapy (SPC) have been recommended for hypertension treatment by domestic and international guidelines. However, Wang Zengwu pointed out that although SPC has multiple advantages such as "stronger efficacy, faster speed, fewer adverse reactions, and better compliance, " and the guidelines' "attitude" has changed, clinical practice has lagged significantly behind. He stated that in terms of the proportion of combination therapy, it still only accounts for about one-third. Among these, traditional fixed-dose combination therapy accounts for more than 60%, while the usage rate of new SPC based on modern evidence-based medicine differs significantly from the guideline recommendations. In Wang Zengwu's view, the key issue is not that doctors have chosen the wrong drug, but that the transformation from "starting with a single drug and gradually increasing the dosage" to "starting with combination therapy and achieving the target as quickly as possible" has not yet been completed. He stated that the treatment philosophy should shift "from gradually increasing the dosage step by step to rationally prioritizing and achieving the target as quickly as possible. " Chen Xiaoping, Director of the Hypertension Center at West China Hospital of Sichuan University, pointed out that with the 2024 domestic and international guidelines recommending a lowered blood pressure target of 130/80 mmHg under tolerable conditions, single-drug therapy is almost impossible to achieve the target, making combination therapy an inevitable trend. SPC (Sustained-Cycle Angiotensin II Receptor Blocker) has become the optimal strategy for achieving sustainable blood pressure control. However, combination therapy is not a simple matter of piecing things together;

the treatment plan must be tailored to the individual patient's characteristics. Chen Xiaoping explained the mechanistic advantages of the A+C combination: angiotensin II receptor antagonists (ARBs) inhibit the renin-angiotensin system, while calcium channel blockers (CCBs) dilate peripheral blood vessels. The mechanisms of these two drugs are complementary, resulting in synergistic effects. Furthermore, ARBs can effectively reduce peripheral edema caused by CCBs. The Emerald study in Greece showed that after 1-4 months of A+C SPC treatment, systolic/diastolic blood pressure significantly decreased, with the reduction being greater at higher baseline levels. The Russian AVANGARD study showed that the A+C SPC (Aortic and Cholesterol-Controlled Surgery) further improved the target blood pressure achievement rate in patients with hypertension who did not achieve their blood pressure goals with other treatments. Chen Xiaoping pointed out that the A+C SPC is suitable for a wide range of patients, including those with uncomplicated hypertension, as well as those with hypertension complicated by diabetes, chronic kidney disease, stroke, metabolic syndrome, peripheral vascular disease, and elderly patients. Furthermore, Chen Xiaoping introduced that azisartan-amlodipine can reduce the average office blood pressure (SBP) by more than 20 mmHg in patients who do not respond well to amlodipine monotherapy, making it a preferred antihypertensive regimen for hypertension patients. The panel discussion was moderated by Cui Zhaoqiang, Director of the Hypertension Ward at Zhongshan Hospital, Fudan University. The participating experts discussed optimizing combination therapy strategies. Many experts believed that the timing of initiating combination therapy should be more proactive. One expert explicitly suggested: "Combination therapy can be initiated when systolic blood pressure is >150 mmHg and accompanied by 1-2 risk factors;

it doesn't necessarily have to exceed 160 mmHg. " Regarding the choice between A+C and A+D regimens, experts favored individualized decision-making rather than a one-size-fits-all approach. "Lowering blood pressure is the fundamental goal; the choice of combination should be based on the patient's specific situation. " The advantage of A+C is its wider applicability and fewer concerns about side effects;

A+D still has value in salt-sensitive hypertension, but uric acid and serum potassium levels need to be monitored. In addition to rationally selecting medication regimens, multidisciplinary collaboration is also a key aspect of hypertension prevention and control. Some experts have pointed out that "the current subspecialty classification is too detailed, and hypertension patients are often distributed in sub-departments of cardiology. However, non-hypertension specialists do not pay enough attention to blood pressure management, and medication is used more 'arbitrarily'. " Other experts have suggested that the importance of blood pressure control should be popularized in cardiology. Taking coronary intervention as an example, the effectiveness of interventional treatment will be greatly affected if blood pressure is poorly controlled. The use of dual antiplatelet drugs may increase the risk of cerebral hemorrhage. "Participants unanimously agreed that standardized hypertension diagnosis and treatment training should cover more non-hypertension specialists and extend to the county and even township levels. Furthermore, regarding information technology infrastructure, several experts pointed out that the current lack of data interoperability between different hospitals and systems has created fragmented data silos. Patient out-of-hospital blood pressure data cannot be automatically uploaded, hindering intelligent management. Future efforts should focus on continuously strengthening information technology infrastructure. (Physician's Daily News, Media Reporter Jia Weiwei) The prevalence of hypertension in my country has increased by 8% compared to ten years ago, while the control rate remains low at 12.9%. Faced with this reality, Wang Zengwu, Director of the Community Prevention and Treatment Department of the National Center for Cardiovascular Diseases and Fuwai Hospital of the Chinese Academy of Medical Sciences, cited the conclusions of a US scientific statement, stating bluntly: 'The core reason for the current unsatisfactory global control of hypertension is not that the drugs are not good enough, but rather that the treatment strategies are inappropriate. '" On June 13th, the "Optimizing Combined Treatments and Focusing on Achieving Targets—Hypertension Treatment Strategy Seminar, " hosted by the *Physician's Daily*, was held in Yueyang. This seminar, bringing together nearly 20 experts in the field of hypertension from across the country, aimed to find a breakthrough in the "last mile" of hypertension prevention and control, given the significant gap between guidelines and reality. With the global number of people suffering from hypertension exceeding 1.4 billion, and with intensive blood pressure reduction to 130/80 mmHg becoming the new standard, are our tools sufficient?

Are our strategies appropriate? The meeting was chaired by Zhang Yanping, Executive President and Executive Editor-in-Chief of the *Physician's Daily*. The participating experts engaged in a lively discussion on optimizing pathways for hypertension prevention and control and the selection of combined drug treatment strategies. In his summary, Wang Zengwu pointed out that hypertension prevention and control is a systematic project, and improving awareness requires investment and support from public health policies;

the low treatment and control rate is closely related to insufficient expansion of clinical concepts. He also suggested leveraging the reach and influence of the media to establish channels for expert advice and suggestions, improve the service level and capabilities of medical personnel, enhance the sense of responsibility of primary caregivers for residents' health, and jointly contribute to the national health cause.