Is it about time to establish economics of hypertension?

Is it about time to establish economics of hypertension? | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 27 February 2025 V1 Latest version Share on Is it about time to establish economics of hypertension? Author : Chunsong Hu 0000-0002-0590-3909 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.174064702.28694036/v1 437 views 135 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract There are more and more individuals with hypertension in the globe. How to manage and self-manage hypertension with better cost-effectiveness needs economic principles and theories. Herein, in this article, the author suggests to develop a new discipline on economics and hypertension. The author briefly introduces the current status of hypertension in both China and the globe. Since lifestyle links to economics and hypertension, the author proposes that it’s about time to establish the “economics of hypertension” because it contributes to better management and self-management of hypertension not only in China but also in the globe. In fact, many clinical studies and trials have already confirmed the benefits of economic knowledge on management and self-management of hypertension. When people understand and know about related economic principles and theories, they will get more benefits from Economics of Hypertension and better protection of blood pressure with cost-effectiveness. All in all, it’s about time to establish the Economics of Hypertension, since it contributes to better management and self-management of hypertension with better cost-effectiveness. Just like Health in All Policies and Health in All Laws, Health in All Economics should be a novel consensus in the new era, particularly the COVID-19 pandemic and post-COVID-19 era. Review Is it about time to establish economics of hypertension? Running title: Economics of Hypertension Author : Chunsong Hu, MD, PhD Affiliation : From the Department of Cardiovascular Medicine, Nanchang University, Hospital of Nanchang University, Jiangxi Academy of Medical Science, No. 461 Bayi Ave, Nanchang 330006, Jiangxi, China. Tel: (+86) 189 70816800; Email: [email protected] or [email protected] Word count: 1,912 (Main text) + 200 (Abstract) References: 51 Table: 1 Figures: 3 Total pages: 15 Corresponding author: Chunsong Hu, MD, PhD, Department of Cardiovascular Medicine, Nanchang University, Hospital of Nanchang University, Jiangxi Academy of Medical Science, No. 461 Bayi Ave, Nanchang 330006, Jiangxi, China. Tel.: +86-189-7081-6800; fax: N/A. E-mail: [email protected] or [email protected] . ABSTRACT There are more and more individuals with hypertension in the globe. How to manage and self-manage hypertension with better cost-effectiveness needs economic principles and theories. Herein, in this article, the author suggests to develop a new discipline on economics and hypertension. The author briefly introduces the current status of hypertension in both China and the globe. Since lifestyle links to economics and hypertension, the author proposes that it’s about time to establish the “economics of hypertension” because it contributes to better management and self-management of hypertension not only in China but also in the globe. In fact, many clinical studies and trials have already confirmed the benefits of economic knowledge on management and self-management of hypertension. When people understand and know about related economic principles and theories, they will get more benefits from Economics of Hypertension and better protection of blood pressure with cost-effectiveness. All in all, it’s about time to establish the Economics of Hypertension , since it contributes to better management and self-management of hypertension with better cost-effectiveness. Just like Health in All Policies and Health in All Laws , Health in All Economics should be a novel consensus in the new era, particularly the COVID-19 pandemic and post-COVID-19 era. Keywords: Cardiovascular disease COVID-19 Economics of Hypertension Health in All Economics Hypertension Introduction As is well known, blood pressure (BP) is one of the vital life signs in humans. Maintaining normal and stable BP is the foundation for maintaining health. Currently, hypertension is still one of major non-communicable diseases (mNCDs) and a huge challenge and burden of public health in the globe. As a common condition in cardiovascular system and a leading cause of mortality and morbidity, it seriously endangers human health due to major adverse cardio-cerebrovascular events including acute myocardial infarction, chronic heart failure, arrhythmia, and stroke. Herein, effective management and self-management of hypertension are a crucial topic and need good knowledge of economics for better cost-effective treatment. Current status of hypertension in both China and the globe In China, there are hundreds of millions of hypertensive cases [1], which is a huge public health burden and challenge, and cost every year a large amount of public health and medical resources. At present, the “three rates” (awareness, treatment, and control rates) of hypertension in China are not high enough [2], and hypertension is still the leading cause of mortality and disability among Chinese residents. Although there are a large number of medical staffs, experts, scholars and researchers working tirelessly on the front line, there is still a long way to go for prevention and control of hypertension in China and the globe (Table 1). Table 1 Key data of hypertension in adults in both China (aged ≥18 years) and the globe (aged 30–79 years) Total Cases Aware Diagnosed & Treated Under Control (or prevalence) _____________________________________________________________________ Globe 1.28 billion 54% 42% 21% China 27.5% (2018) 51.6% (2015) 45.8% (2015) 16.8% (2015) Source in the globe: https://www.who.int/news-room/fact-sheets/detail/hypertension (16 March 2023). Source in China: Hu S. J Geriatr Cardiol 2023;20:399-430. Building a healthy China and achieving common prosperity are important missions in the new era. China has formulated the outline of “the Healthy China 2030 Plan”. Currently, the prevention and control of mNCDs is an important and arduous task. Hypertension is a common “silent killer”, results from both genetic factors and lifestyle, and the latter closely links to the “Health Essential (HE) 5” including “environment-sleep-emotion-exercise-diet” intervention [3]. For example, this new type of hypertension was referred as to “type C hypertension (CtH)” [4]. Therefore, management and/or self-management of hypertension in clinical should not only rely on drugs, surgery and other treatments, but also improve the unhealthy lifestyle and control the “HE 5” related risk factors at source, since prevention is better than treatment, and early prevention is the best cure. Lifestyle links to economics and hypertension Economic activities can affect human survival, production, and way of life. Lifestyle is highly associated with blood pressure. Thus, there is an inherent connection between economics and management of hypertension for a long time. In the 21st century, there are a series of internal and external factors that are harmful to human health, including BP, for example, survival competition, clash of development, work pressure or over burden, environmental pollution, e-noise [5], staying up late for working or studying, anxiety and depression, sedentary behaviour or physical inactivity, heavy smoking and drinking, excessive nutrition and obesity, or unbalancing diet. These “HE 5” related risk factors (Figure 1) highly link to outcomes of cardiovascular health and major adverse events. Figure 1 Here are the “health essential (HE) 5”. The magic “polypill” consisting of healthy core elements “Environment-Sleep-Emotion-Exercise-Diet” interventions [E(e)SEEDi] lifestyle is like a hexahedral magic cube. The scientific and dreamy combination of these “HE 5” can make people healthier and live longer. Cheer up for health and make it smooth, please practice the healthy “E(e)SEEDi” lifestyle. Here, En, external environment; en, internal environment; S, sleep; Em, emotion; Ex, exercise; D, diet. In fact, it contains six parts of risk factors. Currently, we often emphasize self-management of hypertension in clinical, in particular cases with CtH which links to the unhealthy lifestyle. In fact, good management and/or self-management may improve BP and cardiovascular health due to the control and prevention of the “HE 5” related risk factors. No doubt, economic principles and theories are not only applicable to daily activities, but also very applicable to clinical medicine including management and/or self-management of hypertension, since removing these risk factors will improve BP with less costs. Is it about time to establish economics of hypertension? Currently, the management of hypertension based on drug and non-drug (surgery, lifestyle improvement) is very important and popular. All these strategies (agents, surgery and lifestyle) inextricably link to economics. The so-called investment, cost, benefit, cost-efficiency relationship and so on, are common terms in modern economics. In the field of clinical medicine, the management of mNCDs, such as CVD, diabetes, and cancer, also needs these keywords. Pharmaceutical companies pursue economic benefits, Phase I/II/III clinical trials of new agents focus on endpoint events of the outcomes and patients’ benefit, and ultimately, the survival of the fittest. Herein, on the National Hypertension Day in 2023, the author proposed that the establishment of “Economics of Hypertension” (Figure 2) is necessary and critical to innovate and optimize the management of hypertension, since BP is related to everyone’s health and life. Definitely, establishing the “Economics of Hypertension” aims to improve the management of hypertension. Because we are on the journey of Chinese path to modernization, people want to pursue common prosperity and achieve development of high-quality, therefore, we need to pay more attention to health than ever before. “Shared health is shared prosperity, and shared health is a higher level of shared prosperity”. Health is 1, everything else is 0; “Talents are gross domestic production”; “Health is the first capital” [6]. These new concepts and novel economic theories should be widely known and become a consensus for maintaining health. The prevention and control of mNCDs in the new era requires macroeconomic support, while maintaining cardiovascular health requires microeconomic support from the “Economics of Hypertension”. Figure 2 “Economics of Hypertension (EOH)” is a new interdisciplinary field that combines hypertension and economics. It is a very useful and practical knowledge on how to manage and/or self-manage hypertension with a better cost-effective strategy. Clinical studies and trials confirmed the benefits of economic knowledge Frankly speaking, hypertension is still the leading modifiable risk factor for death, but few cases achieve target BP control. Major challenges include high prevalence of hypertension, over-consumption of cardiovascular agents, low adherence to drug treatment, and resulting uncontrolled BP. Five modifiable risk factors (body-mass index, systolic BP, non-high-density lipoprotein cholesterol, smoking, and diabetes) highly link to CVD and death from any cause [7]. Previous clinical trials showed that home health education [8], self-monitoring blood pressure [9-12], comprehensive screening [13], healthy lifestyle interventions (e.g. diet of dark chocolate) [14-16], and lowering BP agents (e.g., enalapril-folic acid, -sartan and others) [17-19] are the feasibility and effectiveness, may not only reduce BP and cardiovascular mortality and morbidity, but also represents a cost-effective use of health care resources, and are beneficial in the prevention of hypertension and major adverse cardiovascular events (Figure 3). Figure 3 Lifestyle, Blood Pressure (BP), and Economics of Hypertension (EOH). There are a high linkage among these topics. Healthier lifestyle, better BP and cardiovascular health. Herein, EOH is a novel discipline which is very beneficial in cardiovascular system and human health. Current clinical studies are cost-saving interventions for the prevention of stroke and improvement of quality of life in individuals with hypertension, and provide evidence for the effectiveness and safety of these measures in the management of hypertension. Encouragingly, recent clinical trials found that two aldosterone synthase inhibitors baxdrostat and lorundrostat have good effects on treatment-resistant or uncontrolled hypertension [20, 21], and a RNA interference (RNAi) therapeutic agent Zilebesiran has a prolonged duration of action (up to 24 weeks) on hypertension [22]. In addition, endovascular ultrasound renal denervation is the efficacy and safety for reducing BP in patients with mild to moderate and treatment-resistant hypertension [23]. Generally, these clinical trials confirmed that intensive BP treatment is an effective and cost-effective intervention and has more the lifetime health benefits [24, 25], but implementation of intensive BP control in routine clinical practice is challenging. In fact, a multicomponent intervention of hypertension for multiple risk factors is a viable and cost-effective strategy [26-29] for responding to the growing CVD epidemic in rural communities in low-income and middle-income countries. Moreover, comprehensive and self-management of hypertension [30, 31], including pharmacist care, patient education and prescribing, in particular application of novel technologies, such as mobile health technology (WeChat), and community pharmacists, clinical decision support systems, and a plasma renin activity-guided strategy [32-34], is more effective than standard care in treating hypertension. A systolic BP target of <130 mmHg or lower is cost effective in cases who have had a stroke/transient ischaemic attack [35], and Gu D, et al. reported in 2015 that low-cost essential antihypertensive agents have the potential to prevent about 800,000 CVD events annually [36]. In fact, comparative studies [37] may tell us which agent is better, and the famous SPRINT study [38, 39] had confirmed the benefits of antihypertensive agents. Socioeconomic status (such as insurance coverage, health care access, and neighborhood-level socioeconomic disadvantage) [40, 41] links to management of cardiovascular risk factors, long-term outcomes and mortality. Intensive blood pressure management is cost-effective even with substantially higher adverse event rates [42]. In fact, cardiovascular trials on surgical treatment vs medical therapy should assess not only clinical outcomes but also cost-effectiveness and quality of life [43]. Some innovative strategies (such as a digital health intervention using remote monitoring, gamification, and social incentives) may reduce cardiovascular risk by modification of lifestyle [44]. Lastly, since angiotensin-converting enzyme inhibitor (ACEI) but not angiotensin receptor blocker (ARB) can reduce the bacterial killing ability of neutrophils, there is at increased risk of infection among individuals receiving ACEI treatment [45]. In addition, agents from the same class could have very different adverse drug events [46] or ineffective control of hypertension [47] among individuals due to genetic variants, new technology for genetic variant detection (e.g., a cationic conjugated polymer-based multistep fluorescence resonance energy transfer technique) and personalizing therapy is crucial to the safety and efficacy. Hence, when we understand and know about related economic principles and theories, BP in the globe will have more and better protection. Conclusions and future perspectives Since we still need financial investment and favourable policies [48] for high-quality and high-value care as well as the basic public health services due to the increase in hypertension and COVID-19 lasting, just like Health in All Policies and Health in All Laws [49-51], Health in All Economics should be a novel consensus in the new era, in particular the pandemic and post-COVID-19 era. All in all, it’s about time to establish the “Economics of Hypertension”, since it contributes to better management and self-management of hypertension in both China and the globe. When we understand and know about related economic principles and theories, BP of individuals in the globe will have better protection. CRediT authorship contribution statement C.H. contributed to the conception and design of the work, the acquisition of data, the analysis and interpretation of the data, drafting and revision of the manuscript, and critical review of the manuscript, and, as guarantor of the article, takes responsibility for the content of the manuscript, including the data and analysis. Declaration of competing interest The author has no conflicts of interest to disclose. Acknowledgments The reviewers and editors are gratefully acknowledged for critical review. No funding for this study was received. References 1. The Writing Committee Of The Report On Cardiovascular Health And Diseases In China. Hu SS. Report on cardiovascular health and diseases in China 2021: an updated summary. J Geriatr Cardiol 2023;20:399-430. 2. Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet 2017;390:2549-58. 3. Hu C. Grants supporting research in China. Eur Heart J 2018;39:2342-4. 4. Hu C. C-type Hypertension. Eur Heart J 2019;40:715. 5. Hu C, Wu Y, Li J, et al. Hypertension associated with unhealthy lifestyle and marked by serum cortisol levels. Res Sq (preprint). 26 Aug, 2021. https://www.researchsquare.com/article/rs-824235/v1 6. Hu CS, Tkebuchava T. E-noise: An increasingly relevant health risk. J Integr Med 2019;17:311-4. 7. Hu C. Health is the first capital– A new concept from CHINA. Manuscript in Submission. 8. Global Cardiovascular Risk Consortium; Magnussen C, Ojeda FM, Leong DP, et al. Global Effect of Modifiable Risk Factors on Cardiovascular Disease and Mortality. N Engl J Med 2023;389:1273-85. 9. Jafar TH, Islam M, Bux R, et al. Hypertension Research Group. Cost-effectiveness of community-based strategies for blood pressure control in a low-income developing country: findings from a cluster-randomized, factorial-controlled trial. Circulation 2011;124:1615-25. 10. McManus RJ, Little P, Stuart B, et al. HOME BP investigators. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial. BMJ 2021;372:m4858. 11. Monahan M, Jowett S, Nickless A, et al. Cost-Effectiveness of Telemonitoring and Self-Monitoring of Blood Pressure for Antihypertensive Titration in Primary Care (TASMINH4). Hypertension 2019;73:1231-9. 12. Boubouchairopoulou N, Karpettas N, Athanasakis K, et al. Cost estimation of hypertension management based on home blood pressure monitoring alone or combined office and ambulatory blood pressure measurements. J Am Soc Hypertens 2014;8:732-8. 13. Kaambwa B, Bryan S, Jowett S, et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis. Eur J Prev Cardiol 2014;21:1517-30. 14. Søgaard R, Diederichsen ACP, Rasmussen LM, et al. Cost effectiveness of population screening vs. no screening for cardiovascular disease: the Danish Cardiovascular Screening trial (DANCAVAS). Eur Heart J 2022;43:4392-402. 15. Li KC, Huang L, Tian M, et al. Cost-Effectiveness of a Household Salt Substitution Intervention: Findings From 20 995 Participants of the Salt Substitute and Stroke Study. Circulation 2022;145:1534-41. 16. Henry A, Arnott C, Makris A, et al. Blood pressure postpartum (BP 2 ) RCT protocol: Follow-up and lifestyle behaviour change strategies in the first 12 months after hypertensive pregnancy. Pregnancy Hypertens 2020;22:1-6. 17. Zomer E, Owen A, Magliano DJ, Liew D, Reid CM. The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model. BMJ 2012;344:e3657. 18. Zhang T, Liang Z, Lin T, et al. Cost-effectiveness of folic acid therapy for primary prevention of stroke in patients with hypertension. BMC Med 2022;20:407. 19. Maniadakis N, Ekman M, Fragoulakis V, Papagiannopoulou V, Yfantopoulos J. Economic evaluation of irbesartan in combination with hydrochlorothiazide in the treatment of hypertension in Greece. Eur J Health Econ 2011;12:253-61. 20. Grosso AM, Bodalia PN, Macallister RJ, Hingorani AD, Moon JC, Scott MA. Comparative clinical- and cost-effectiveness of candesartan and losartan in the management of hypertension and heart failure: a systematic review, meta- and cost-utility analysis. Int J Clin Pract 2011;65:253-63. 21. Freeman MW, Halvorsen YD, Marshall W, et al. BrigHTN Investigators. Phase 2 Trial of Baxdrostat for Treatment-Resistant Hypertension. N Engl J Med 2023;388:395-405. 22. Laffin LJ, Rodman D, Luther JM, et al. Target-HTN Investigators. Aldosterone Synthase Inhibition With Lorundrostat for Uncontrolled Hypertension: The Target-HTN Randomized Clinical Trial. JAMA 2023;330:1140-50. 23. Desai AS, Webb DJ, Taubel J, et al. Zilebesiran, an RNA Interference Therapeutic Agent for Hypertension. N Engl J Med 2023;389:228-38. 24. Azizi M, Saxena M, Wang Y, et al. Endovascular Ultrasound Renal Denervation to Treat Hypertension: The RADIANCE II Randomized Clinical Trial. JAMA 2023;329:651-61. 25. Fan J, Zheng W, Liu W, et al. Cost-Effectiveness of Intensive Versus Standard Blood Pressure Treatment in Older Patients With Hypertension in China. Hypertension 2022;79:2631-41. 26. Derington CG, King JB, Bryant KB, et al. Cost-Effectiveness and Challenges of Implementing Intensive Blood Pressure Goals and Team-Based Care. Curr Hypertens Rep 2019;21:91. 27. Zhang Y, Yin L, Mills K, et al. Cost-effectiveness of a Multicomponent Intervention for Hypertension Control in Low-Income Settings in Argentina. JAMA Netw Open 2021;4:e2122559. 28. Finkelstein EA, Krishnan A, Naheed A, et al. COBRA-BPS study group. Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka. Lancet Glob Health 2021;9:e660-7. 29. Augustovski F, Chaparro M, Palacios A, et al. Cost-Effectiveness of a Comprehensive Approach for Hypertension Control in Low-Income Settings in Argentina: Trial-Based Analysis of the Hypertension Control Program in Argentina. Value Health 2018;21:1357-64. 30. Jafar TH, Tan NC, Allen JC, et al. Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial. Trials 2018;19:180. 31. Marra C, Johnston K, Santschi V, Tsuyuki RT. Cost-effectiveness of pharmacist care for managing hypertension in Canada. Can Pharm J (Ott) 2017;150:184-97. 32. Penaloza-Ramos MC, Jowett S, Mant J, et al. Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with suboptimal control and established cardiovascular disease or additional cardiovascular risk diseases (TASMIN-SR). Eur J Prev Cardiol 2016;23:902-12. 33. Li T, Ding W, Li X, Lin A. Mobile health technology (WeChat) for the hierarchical management of community hypertension: protocol for a cluster randomized controlled trial. Patient Prefer Adherence 2019;13:1339-52. 34. Anchala R, Kaptoge S, Pant H, Di Angelantonio E, Franco OH, Prabhakaran D. Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial. J Am Heart Assoc 2015;4:e001213. 35. Smith SM, Campbell JD. Cost-effectiveness of renin-guided treatment of hypertension. Am J Hypertens 2013;26:1303-1310. 36. Penaloza-Ramos MC, Jowett S, Barton P, et al. Cost-effectiveness analysis of different systolic blood pressure targets for people with a history of stroke or transient ischaemic attack: Economic analysis of the PAST-BP study. Eur J Prev Cardiol 2016;23:1590-8. 37. Gu D, He J, Coxson PG, et al. The Cost-Effectiveness of Low-Cost Essential Antihypertensive Medicines for Hypertension Control in China: A Modelling Study. PLoS Med 2015;12:e1001860. 38. Ma W, Sun N, Duan C, et al. for LEADER Study Group. Effectiveness of Levoamlodipine Maleate for Hypertension Compared with Amlodipine Besylate: a Pragmatic Comparative Effectiveness Study. Cardiovasc Drugs Ther 2021;35:41-50. 39. Li C, Chen K, Cornelius V, et al. Applicability and cost-effectiveness of the Systolic Blood Pressure Intervention Trial (SPRINT) in the Chinese population: A cost-effectiveness modeling study. PLoS Med 2021;18:e1003515. 40. Ghazi L, Oparil S. Impact of the SPRINT Trial on Hypertension Management. Annu Rev Med 2018;69:81-95. 41. Oseran AS, Sun T, Wadhera RK. Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status. JAMA Cardiol 2022;7:708-14. 42. Berman AN, Biery DW, Ginder C, et al. Association of Socioeconomic Disadvantage With Long-term Mortality After Myocardial Infarction: The Mass General Brigham YOUNG-MI Registry. JAMA Cardiol 2021;6:880-8. 43. Richman IB, Fairley M, Jørgensen ME, Schuler A, Owens DK, Goldhaber-Fiebert JD. Cost-effectiveness of Intensive Blood Pressure Management. JAMA Cardiol 2016;1:872-9. 44. Lewey J, Murphy S, Zhang D, et al. Effectiveness of a Text-Based Gamification Intervention to Improve Physical Activity Among Postpartum Individuals With Hypertensive Disorders of Pregnancy: A Randomized Clinical Trial. JAMA Cardiol 2022;7:591-9. 45. Cao DY, Giani JF, Veiras LC, et al. An ACE inhibitor reduces bactericidal activity of human neutrophils in vitro and impairs mouse neutrophil activity in vivo. Sci Transl Med 2021;13:eabj2138. 46. Xu X, Kawakami J, Millagaha Gedara NI, et al. Data mining methodology for response to hypertension symptomology-application to COVID-19-related pharmacovigilance. Elife 2021;10:e70734. 47. Shen Q, Zhang H, Huang Y, et al. Sensitive detection of single-nucleotide polymorphisms by conjugated polymers for personalized treatment of hypertension. Sci Transl Med 2023;15:eabq5753. 48. Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet 2020;395:1802-12. 49. Hu C, Wu Q. Health: a dream from reality to the future. Front Med 2016;10:233-5. 50. Hu CS. Intervention of RT-ABCDEF for cancer. Croat Med J 2019;60:55-7. 51. Hu C, Tkebuchava T. Health in All Laws: A better strategy for global health. J Evid Based Med 2022;15:10-4. Information & Authors Information Version history V1 Version 1 27 February 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords cardiology clinical pharmacology health economics health services research hypertension internal medicine pharmacotherapy prescribing Authors Affiliations Chunsong Hu 0000-0002-0590-3909 [email protected] Nanchang University View all articles by this author Metrics & Citations Metrics Article Usage 437 views 135 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Chunsong Hu. Is it about time to establish economics of hypertension?. Authorea . 27 February 2025. DOI: https://doi.org/10.22541/au.174064702.28694036/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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