Source 丨21 Healthnews21 original work
Author 丨Ji Yuanyuan
Editor 丨Xu Xu
Image source 丨 Figureworm
With the rapid development of China's economic level and the improvement of medical and health conditions, the composition of the major disease burden in China has undergone an essential shift, and the cardiovascular disease dominated by stroke and ischemic heart disease ranks first in China's lethal diseases, and affected by the deepening degree of aging of China's population, cardiovascular disease is bound to form a huge burden and impact on China in the future.
According to the "China Cardiovascular Health and Disease Report 2020", the number of hypertensive patients in China has reached 245 million in 2018, that is to say, there may be one hypertension patient in every 5-6 people, and this number continues to rise. The huge disease base makes it the main risk factor for cardiovascular disease in China, and under such a situation, it is particularly critical to strengthen the prevention and treatment of hypertension.
Recently, the market rumors that the hypertension vaccine will be available in 2022, which is undoubtedly a great news for hypertensive patients. After all, compared with traditional oral antihypertensive drugs, the advantages of hypertension vaccines are significant, on the one hand, high compliance. There is no need to take the drug daily, only a few injections per year, the compliance advantage is significantly higher than oral drugs; on the other hand, the half-life is long. Hypertension vaccine acts on blood vessels for long time and stabilizes the control of blood pressure peaks; in addition, it has a high safety profile. Avoid irregular medication, missed medication, misuse of medication, and adverse drug reactions as a result.
However, is the hypertension vaccine really coming to market so quickly? With the introduction of hypertension vaccines, are antihypertensive drugs still competitive in the market?
Is the hypertension vaccine really such a god?
According to public information, as early as the 1860s, a company in the United States proposed the idea of research and development of hypertension vaccines, and previously, relevant American magazines had also reported that there was a certain possibility for medical companies to study hypertension vaccines. In this way, with the continuous development of the times, more and more people are gradually concerned about the symptoms of hypertension, and there is a certain desire for hypertension vaccines.
After many years, reports of a vaccine for hypertension have reappeared. The news stemmed from the 6th Central Cardiology Conference held in 2016. At this meeting, Liao Yuhua, director of the Department of Cardiovascular Medicine of Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology, announced that the hypertension vaccine that his team has studied for more than ten years has entered the preclinical stage and is expected to be applied to the clinic as soon as 6 years, that is, in 2022.
In 2012, Liao Yuhua's team published an article saying that the antihypertensive vaccine they developed (ATRQβ-001) showed in animal trials that the vaccine had a significant antihypertensive effect and had a certain protective effect on target organs. If approved, it will be the first hypertension vaccine independently developed in China.
However, Liao Yuhua responded in an interview with China News Weekly a few days ago, "At present, we are in the process of pilot sample development, waiting for the clinical trial stage, and then introduce this project." It is expected that the vaccine will not be available until 2026. ”
In this regard, a cardiologist introduced that vaccines refer to biological products made of various pathogenic microorganisms for vaccination. Simply put, the raw materials for making vaccines are derived from pathogenic microorganisms and metabolites, and then made by artificial attenuation and inactivation or the use of genetically modified biological products to prevent diseases. It should be noted that the hypertension vaccine is not the same as the ordinary vaccine, not to prevent hypertension, but to treat hypertension, it can replace some antihypertensive drugs, so as to achieve the effect of controlling blood pressure.
Most vaccines target infectious diseases, and hypertension vaccines target non-infectious diseases. There is a renin-angiotensin-aldosterone system (RASS) in our bodies. When it is abnormally activated, it triggers high blood pressure. The mechanism by which hypertension vaccines exert a hypotensive effect is to inhibit the activity of the renin-angiotensin-aldosterone system, thereby lowering blood pressure. Of course, after the injection of hypertension vaccine, it will stimulate the immune system to produce antibodies against angiotensin, so that angiotensin will be suppressed, thus achieving a hypotensive effect.
Previously, according to the news disclosed by Hypertension, the research of Liao Yuhua's research team confirmed that the hypertension vaccine was effective in rat models. Once put into clinical practice, this is of great significance to reduce the prevalence and mortality rate of coronary heart disease and stroke.
Do I no longer have to take antidotes after having a vaccine?
The public's attention to hypertension vaccines also shows the severity of hypertension diagnosis and treatment. Patients with hypertension are looking forward to a vaccine, their blood pressure will be effectively reduced, and they do not need to be treated by taking drugs in the later stage, which makes people with many years of hypertension history moved, but only know that the hypertension vaccine is still not on the market, which people have some doubts.
After the hypertension vaccine is on the market, can patients say goodbye to antihypertensive drugs?
In this regard, the vascular doctor of a third-class hospital in Shanghai said in an interview with the 21st Century Business Herald reporter that the hypertension vaccine can not prevent hypertension, it is an efficient treatment drug, an injection can stabilize blood pressure for 1-3 months, but it can not cure hypertension, nor can it play the purpose of preventing hypertension. At present, adhering to antihypertensive drugs and adhering to healthy living and eating habits are still the first choice for patients to stabilize blood pressure.
Professor Li Yuming, vice president of TEDA International Cardiovascular Hospital, introduced that there should be a target value for blood pressure reduction, in China, for the vast majority of adults, it is recommended to reduce blood pressure to less than 140/90mmHg. If the patient does not have symptoms such as insufficient cerebral blood supply, fatigue, and poor organ blood supply, it is necessary to reduce the blood pressure to less than 130/80mmHg, and even clinically advocate that in some younger patients, the blood pressure will be lowered to systolic blood pressure below 120mmHg, which we believe is the ideal blood pressure. Diastolic pressure is acceptable as long as it is not less than 70. "At present, in terms of blood pressure reduction, mainly through the use of drugs and some methods, including non-drugs, is a healthy lifestyle. As for the time to reach the antihypertensive target, we advocate that it is best to lower the blood pressure in 2-4 weeks, that is, half a month to a month, and the sooner the target is reached, the sooner the patient benefits. Professor Li Yuming said.
At present, in the treatment of antihypertensive, drug therapy is the main modality. At present, there are five categories of commonly used antihypertensive drugs, one is calcium channel antagonists (i.e., CCB); the other is angiotensin-converting enzyme inhibitors (ie, ACEI); the third is angiotensin receptor antagonists (i.e., ARB); the fourth is β receptor blockers; and the fifth is diuretics. Also due to the large number of domestic hypertension, China's antihypertensive drug market sales scale showed a steady growth trend, according to the data of Zhiyan Consulting, in 2020, China's antihypertensive drug market size is about 95.6 billion yuan, an increase of 8% year-on-year, the future market size will continue to expand.
The "Guidelines for the Prevention and Treatment of Hypertension in China (2018 Revised Edition)" points out that in addition to further clarifying the clinical benefits of intensive antihypertensive reduction, the blood pressure level of 130~139/85~89mm Hg (1mm Hg = 0.133kPa) is taken as a new standard for cardiovascular disease risk stratification, in order to improve the high detection of cardiovascular and cerebrovascular diseases in China through better blood pressure control and lipid management. Studies have shown that in patients with hypertension, such as risk factors such as dyslipidemia, smoking, obesity, and abnormal glucose metabolism, the risk of cardiovascular disease occurrence and death is doubled, and simple antihypertensive therapy has limitations for the risk management of cardiovascular and cerebrovascular diseases in hypertensive patients. Another large meta-analysis of 68 randomized controlled trials showed that the remaining risk after antihypertensive therapy increased with increased cardiovascular risk stratification.
Therefore, based on blood pressure reduction, comprehensive intervention of multiple risk factors has become an important part of China's cardiovascular disease prevention and control system. According to the model calculation, if China can actively reduce blood pressure and cholesterol in the next 15 years and achieve the standard, 1 million to 1.65 million cases of acute myocardial infarction, 1.4 million to 2.5 million cases of stroke and 450,000 to 850,000 cases of cardiovascular disease deaths can be avoided.
Standardized bucking is key
However, this is also based on standardized antihypertensive therapy.
Wang Jiguang, director of the Department of Hypertension at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, once said in an interview with the 21st Century Business Herald that for most patients with hypertension, blood pressure will reach the highest peak of the day in the first few hours (usually between 6:00 and 10:00) after waking up in the morning and starting daily activities. The cause of improper management of blood pressure in the early morning of patients, in addition to their own pathophysiology and other factors, there are also problems with drug use.
"Many patients use antihypertensive drugs that cannot control blood pressure for 24 hours. If the patient is taking a short-acting antihypertensive drug or a so-called 'long-acting drug', the effect cannot last for 24 hours. Before taking the drug in the morning, it is also a high incidence of cardiovascular and cerebrovascular diseases, and cardiovascular and cerebrovascular diseases such as myocardial infarction, sudden cardiac death and stroke are more common in this period. From a therapeutic point of view, choosing a truly molecular long-acting antihypertensive drug is the focus of controlling early morning blood pressure. Wang Jiguang said.
In addition, patients with hypertension take the drug initially, starting with the minimum dose. If the effect is not good after taking the drug for a week, a combination of the two drugs can be considered. For most patients, taking two antihypertensive drugs at the same time is completely possible to lower blood pressure to the desired level. If blood pressure is maintained normally for 1 to 2 months, the second drug can be gradually reduced and the effect can be maintained directly with the smallest dose of antihypertensive drugs. Patients should not start with the results and take a lot of antihypertensive drugs. This does not have any benefit for later treatment.
"Hypertension is a disease that requires long-term management and regular monitoring of blood pressure, and at present, many patients with hypertension in China do not take medication without dizziness, refuse to monitor blood pressure regularly, and stop the drug at will." This not only brings hidden dangers to the health of patients, but also becomes a difficult problem in The management of hypertension in the Chinese style, resulting in blood pressure not being well controlled, and eventually causing serious cardiovascular and cerebrovascular diseases. Wang Jiguang stressed that hypertension emphasizes individualized treatment plans, which is very important. The determination of the treatment plan requires an assessment of each patient's specific circumstances, including the time of administration, the dosage taken, and the type of medication taken.
Therefore, for the medication for hypertension, let the doctor understand the condition as much as possible in detail, and prescribe the most suitable drug to reduce the chance of frequent dressing changes. Take the medicine as regularly as possible, and keep in touch with the pharmacist, understand the "temperament" of various drugs, and solve any problems encountered during the medication, including side effects.
In addition to standardizing the use of antihypertensive drugs, a healthy lifestyle cannot be ignored. In August 2021, a study by the Third Hospital of Peking University published in the Journal of Clinical Hypertension found that after three months of fast walking, most people's blood pressure dropped by about 2-3 mmHg. According to the researchers, for patients with hypertension, brisk walking 4000 to 8000 steps a day can achieve the desired effect on reducing hypertension. All in all, in the face of high blood pressure, if you want to complete the goal of lowering blood pressure, medication and a healthy lifestyle are the first choice.