Hypertension League & WHL Strategic Planning

1. Hypertension League & WHL Strategic Planning

2. History of WHL June 22, 1984 WHL was established in Geneva with 15 country members In 2004, 79 country members, 11 supporting members In 2009, 86 country members WHL is part of ISH

3. President and Past Presidents Tony Amery (Belgium) 1984-1990 Detlev Ganten (Germany) 1990-1995 Peter Sleight (UK) 1995-2000 Claude Lenfant (USA) 2000-2006 刘力生 （China）2006-

4. Purpose of WHL (1/2) To develop or promote health by educating and instructing health care professionals and the public on preventative and curative measures for hypertension To promote and conduct research related to the prevention and treatment of hypertension

5. Purpose of WHL (2/2) To promote the detection, control and prevention of hypertension in the population through joint efforts of all national leagues and societies To liaise with the national bodies, promoting the exchange of information among them, and offering internationally applicable methods and programs for hypertension control

6. WHL Strategic Planning Strengthen hypertension awareness, capacity building worldwide particularly in LMIC Advocacy…salt reduction etc Goal oriented project, worksite project Partner with other organizations promote prevention & control of HT

7. Implementation Science in CVD Control and Prevention Research PerspectiveLiu Lisheng World Hypertension League

8. Globalization Demographic Change Globalization WIDER SOCIETY Social Determinants BiologicalRisk FAMILY INDIVIDUAL DETERMINANTS Health Inequities Behavioral Risk NEIGHBORHOOD, COMMUNITY Education Cultural and Social Norms Institute of Medicine. 2010. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.

9. POLICY APPROACHES (Global; National; Local) Globalization Trade Financial Legal Regulatory Environment To Enable Individuals To Make and Maintain Healthy Choices Demographic Change Globalization WIDER SOCIETY Social Determinants BiologicalRisk FAMILY INDIVIDUAL DETERMINANTS Health Inequities Behavioral Risk NEIGHBORHOOD, COMMUNITY Education Cultural and Social Norms Institute of Medicine. 2010. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.

10. POLICY APPROACHES (Global; National; Local) Globalization Trade Financial Legal Regulatory Environment To Enable Individuals To Make and Maintain Healthy Choices Demographic Change Globalization WIDER SOCIETY Social Determinants BiologicalRisk FAMILY INDIVIDUAL DETERMINANTS Health Inequities Behavioral Risk NEIGHBORHOOD, COMMUNITY Education Enhancement of Knowledge, Motivation, and Skills of Individuals Cultural and Social Norms Media Community Interventions Settings Based HEALTH COMMUNICATION Institute of Medicine. 2010. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.

11. POLICY APPROACHES (Global; National; Local) Globalization Trade Financial Legal Regulatory Health Workforce Environment To Enable Individuals To Make and Maintain Healthy Choices Demographic Change Globalization Drugs & Technologies WIDER SOCIETY Social Determinants BiologicalRisk FAMILY INDIVIDUAL HEALTH CARE DELIVERY DETERMINANTS Health Inequities Quality of Care Behavioral Risk NEIGHBORHOOD, COMMUNITY Access to Care Education Enhancement of Knowledge, Motivation, and Skills of Individuals Cultural and Social Norms Systems Infrastructure Media Community Interventions Settings Based HEALTH COMMUNICATION Institute of Medicine. 2010. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.

12. IOM Recommendations for Local Solutions with Global Support: • Implement Policies to Promote CVD Health • Improve National Coordination for Chronic Diseases Institute of Medicine. 2010. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.

13. Implementation of Hypertension Control In China: • Training of young physicians (MD) & researchers (PhD) • Finding solutions and therapeutic outcomes through clinical trials • Implementing best practices at the community level • Developing locally relevant Clinical Practice Guidelines • Translating experiences to local and national policies

14. Training: • Since 1970 we trained: physicians 25,000 in GL implication, 30,000 in HCC, 10,000 in CHIEF Trial, nurses 5,000 • Special emphasis on Community doctors & community health workers.

16. Clinical Trials: • Since late 80s we participated in a large number of clinical trials in hypertension and related diseases • Engaged in several communitycontrol projects • Most recently on the “One Million Hypertensive” project

17. Clinical Trials in China Hypertension RCTs done only in China: • Syst.-China • PATS • FEVER • STONE • Participating International Trials • PROGRESS • ADVANCE • HYVET

18. Experience (1/3) Easier to recruit participants from clinics or communities Concommitant drug treatment are less. large simple trials are feasible in China

19. Experience (2/3) CHL was established on top of Syst.-China & PATs Collaborative group (31 medical universities) in 1989 & continuing on organizing RCTs both nationally & internationally

20. Experience (3/3) Established good relationship with world well known RCT Centers, implicating RCT results in Chinese population successfully. For ex. CCB based tr. used widely in ISH, captopril in post MI after Syst.-China & CCS1 trials.

21. Translational medicine is a two-way street Drive to cure should be complemented by going back from bedside to laboratory with observations made in human studies

22. Pharmacogenetics & individualized medicine Warfarin dosage in Asian people Can folic acid preventstroke ? China Stroke Primary Prevention Trial

23. “Certain single nucleotide polymorphisms in the VKORC1 gene (especially the -1639G>A allele) have been associated with lower dose requirements for warfarin”.

24. Description of current changes to the Crestor label In a pharmacokinetic study involving a diverse population of Asians residing in the United States, rosuvastatin drug levels were found to be elevated approximately 2-fold compared with a Caucasian control group. As a result of these findings, the “Dosage and Administration” section of the label now states that the 5 mg dose of Crestor should be considered as the start dose for Asian patients and any increase in dose should take into consideration the increased drug exposure in this patient population. Results of this pharmacokinetic study are further discussed under the “Clinical Pharmacology” and “Precautions” section of labeling. Ethnically Different Dose Recommendation

25. RCTs and Chinese Guidelines Studies involve only Chinese population as well as international collaborated RCTs that involved Chinese patients have provided evidence for Chinese Guidelines

26. Community Control Projects • INTERPREVENT based at Worksites • Implementation of Guidelines at the community level • Neurologists • Endocrinologist • Cardiologists • Nephrologists

28. Worksite Based Hypertension control Project in Beijing (Yao CH)Hypertension community control project in Shanghai(Zhu DL)Hypertension community control project in Guangzhou (Feng JZH)

29. Implication of12Guidelines for Hypertension and Related Diseases in Communities MQ Zhang, PG Kuang et al Coalition of CVD Prevention Program Chinese Senior Professor Society

30. Hypertension Control in Type2 DM Patients in 15 Beijing Communities Qin MZ, Yuan SY Endocrinology Society

31. Partnerships • Ministry of Health • National CDC • Health Bureaus from Beijing, Shanghai, and Guangzhou • Provincial CDCs • Professional Societies

32. World Hypertension Day Activities Theme of Hypertension Day Healthy food Healthy Blood Pressure Measure your blood pressure at home Know your numbers Reduce salt intake

33. Patient Education • WHO/WHL Patient Education Project (PEP) • National Hypertension Control in Community (HCC)

34. National Hypertension Control in Community (HCC) Zengwu WANG NCCD, Fu Wai Hospital

35. 黑龙江 黑龙江 吉林 吉林 辽宁 辽宁 北京 内蒙古 北京 新疆 内蒙古 天津 天津 新疆 河北 河北 山西 山西 山东 山东 宁夏 宁夏 江苏 青海 青海 陕西 江苏 甘肃 河南 甘 肃 河南 安徽 陕西 安徽 上海 上海 湖北 西藏 西藏 浙江 浙江 湖北 四川 江西 四川 江西 湖南 福建 福建 湖南 贵州 贵州 广东 广东 云南 广西 云南 广西 台湾 台湾 海南 海南 Map of the Site, HCC On going Others

36. Successful Implementation Requires—（PPP）: • Patience • Persistence • Partnership

37. Summary The burden of chronic disease increases more and faster in resources limited settings Chronic non-communicable diseases need proactive and continued care Capacity building in the primary care in developing countries is crucial for controlling chronic diseases The worksite based community intervention programmes were effective and feasible in China, it should be promoted in LMIC.

38. Thank You!