In early spring, March 9-10, 2024, the "Pilot Program - Hypertension Elite Scientific Research Workshop" was held in Changsha. Professor Zou Yunzeng from Zhongshan Hospital Affiliated to Fudan University, Professor Jiang Chao from Beijing Anzhen Hospital Affiliated to Capital Medical University, Professor Cui Zhaoqiang from Zhongshan Hospital Affiliated to Fudan University, and Professor Wang Yang from Fuwai Hospital of the Chinese Academy of Medical Sciences were specially invited to share new scientific research ideas in the field of hypertension and cardiovascular diseases in combination with the current situation, latest and classic research on hypertension diagnosis and treatment, so as to promote the development of clinical and scientific research in the field of hypertension and related diseases, and enhance the independent innovation and clinical application capabilities of clinical medical institutions. At the meeting, the participating experts had a heated discussion on hot scientific research topics such as innovative scientific research thinking and clinical practice. The key content of the conference is now sorted out and shared with readers.
Academic topic sharing
Prof. Zou Yunzeng: The birth of "new ideas" in scientific research
The continuous progress in the field of scientific research is inseparable from the emergence of new ideas, and the birth of these new ideas often contains a wealth of experience and wisdom. Combined with his rich scientific research experience, Professor Zou Yunzeng shared his wonderful views on the application and evaluation of fund projects, the selection and design of projects, and the generation of new scientific research ideas with the theme of "The Birth of New Scientific Research Ideas".
Professor Zou Yunzeng shared at the scene
First of all, Professor Zou shared his experience in the application and evaluation process of the fund project, emphasizing the importance of formal examination to avoid the formal examination being rejected due to the applicant's excess, inconsistent personal information, missing items in the application, etc.; in the first instance stage, it is very important to choose the keywords, which is directly related to the selection of reviewers; at the same time, the innovation of the topic, the feasibility of the research plan and other issues are also the focus of the first-instance experts. In terms of topic selection and design, Professor Zou pointed out that a good topic selection needs to conform to the principles of scientificity, innovation, practicability and feasibility, and suggested that the topic can be selected from the perspectives of practical work and blank spots in the literature. In addition, Professor Zou also shared his experience in the generation of topic selection and his experience in the process of innovation and practice based on his personal experience of applying for funds for key projects in the past 20 years and more than 10 times, which provided valuable experience and inspiration to scientific researchers, and helped them move forward more smoothly on the road of scientific research and achieve more breakthroughs and achievements.
Professor Jiang Chao: Strong antihypertensive and 3D heart protection: the new connotation of antihypertensive treatment from the latest research
According to the 2023 World Health Organization (WHO) Global Hypertension Report, only 21% of patients worldwide have effectively controlled hypertension, and improving the control status of hypertension is still a difficult problem to be overcome in the field of hypertension treatment [1]. Professor Jiang Chao shared the latest views on the treatment of hypertension around the latest research progress and guideline recommendations in the field of hypertension, in order to provide reference for the clinical and scientific research of hypertension.
Professor Jiang Chao shared at the scene
The latest ESH hypertension guidelines released in 2023 point out [2] that for patients aged 18~64 years, the blood pressure reduction target is less than 130/80 mmHg, and for patients aged 65~79 years, the treatment target is less than 140/90 mmHg, and the guidelines also point out that if the patient tolerates the treatment well, the blood pressure can be considered to be reduced to less than 130/80 mmHg. Several studies, including ESPRIT [3], have demonstrated the role of intensive antihypertensive therapy in reducing the risk of cardiovascular events, and the lower the blood pressure target, the greater the variety of medications required [4].
Professor Jiang Chao pointed out that from the latest research and authoritative guidelines at home and abroad, the treatment of hypertension should not only pay attention to the blood pressure target in the office, but also pay attention to the 24-hour and long-lasting target, and the long-term blood pressure lowering and long-lasting target will help to comprehensively manage the blood pressure of patients. In terms of drug selection, Professor Jiang Chao said that the single-tablet compound preparation of A+C/A+D can meet the multi-dimensional antihypertensive needs of hypertensive patients, and can stabilize blood pressure while strongly lowering blood pressure, and achieve long-term blood pressure standards, which is the preferred recommendation of the 2023 WHO Global Hypertension Report [1]. Among the many SPCs, perindopril/amlodipine SPC is a potent, stable, and long-term control of blood pressure, and has demonstrated a clear cardiovascular benefit in large randomized controlled studies [5].
Prof. Yang Wang: Statistical considerations in clinical study design and evaluation
Statistics plays a key role in clinical study design, not just as a tool, but as a fully integrated approach to clinical practice. Professor Wang Yang shared how to make better use of statistics to maximize its role in clinical research based on classic research in the cardiovascular field, such as ASCOT study, DETAIL study, and SAVOR study. Taking the ASCOT study design idea as an example, the study enrolled nearly 20,000 hypertensive patients, carried out two different antihypertensive strategies in a randomized manner, and introduced a 2×2 factorial study to analyze the intervention effect of different treatment methods from the two dimensions of antihypertensive and lipid lowering, and the ASCOT study confirmed that amlodipine was ± compared with the atenolol ±thiazide groupPerindopril is more effective in lowering blood pressure, significantly reducing the risk of major cardiovascular endpoint events and all-cause mortality, providing important new evidence for new combinations and strategies of amlodipine and perindopril [5]. The design ideas of this study are very valuable. Professor Wang Yang pointed out that the ASCOT study used the classic "PROBE" study design model - prospective, randomized, open-ended, and blinded endpoint trial design (Prospective, Randomized Open-label, Blinded Endpoint), which is more acceptable to clinical practice The bias of the endpoint assessment was greatly reduced, and this design also required the investigator to set the scientific endpoint in advance to avoid bias in the study results.
Professor Wang Yang said that returning to real scientific research practice, statistics can provide support for clinical research in terms of sample size calculation, data analysis, result interpretation, experimental type design and risk assessment, which can not only help researchers design and implement research, but also help them interpret and infer research results, thereby promoting the development and progress of clinical practice. It is hoped that you will be able to make better use of statistical tools in future scientific research work, and better design and interpret research results with the help of statistics, so as to provide more effective guidance for clinical practice.
Professor Wang Yang shared at the scene
Interactive discussion workshops
Topic 1: Feasibility and management of real-world studies in clinical research on hypertension from a doctor's perspective
Moderator: Prof. Chui Zhaoqiang
Professor Cui Zhaoqiang shared the importance of clinical research exploration for the development of disease cognition and diagnosis and treatment based on the cognitive process of hypertension, from the initial quantification, the formation of treatment concepts, the change of diagnostic standards, and the iteration of measurement methods, as well as significant research findings (such as the SPRINT study [4] and the ASCOT-Legacy study [6-7]. Professor Cui Zhaoqiang emphasized the value of conducting real-world research (RWS) and analysing real-world data (RWD).
Professor Cui Zhaoqiang shared at the scene
In addition, the participating experts and scholars also shared their own scientific research experience, combined with the difficulties encountered in scientific research practice, such as the optimization of follow-up paths in RWS, data maintenance and storage, expense management, etc. Issues such as the balance of time and energy were hotly discussed, and many common problems encountered in scientific research practice were discovered.
Topic 2: Clinical Research Paper Reporting Standards
Moderator: Prof. Yang Wang
Standardized clinical research paper reports are not only the premise of ensuring the quality of research and the authenticity of data, but also an important guarantee for improving the transparency and reproducibility of research. Prof. Yang Wang moderated an interactive discussion on clinical research paper reporting guidelines, and shared the general requirements in clinical research paper reporting guidelines using the ASCOT-Legacy study (a long-term follow-up study of the ASCOT study) as an example.
The ASCOT-Legacy study [6-7] included 8580 patients with hypertension in long-term follow-up observation, of which 4305 and 4275 patients were treated with diuretics ± amlodipine perindopril, atenolol and ± diuretics, respectively, for a follow-up period of 16 years, exploring the long-term effects of early amlodipine ± perindopril treatment on cardiovascular and cerebrovascular events and outcomes, and confirmed that amlodipine significantly reduced ± perindopril by 21% and 24% cardiovascular mortality and coronary heart disease mortality risk, with significant benefit from long-term follow-up.
The latest results from the study in 2024 also found that amlodipine reduced systolic blood pressure variability (BPV) ± perindopril groups compared to atenolol ± thiazide groups, and that changes in BPV were significantly associated with endpoint events, where BPV was calculated based on mean systolic blood pressure versus standard deviation of systolic blood pressure [7].
In the writing of clinical research reports, the processing of missing data, especially in the case of a large proportion of missing data, how to ensure the accuracy of the report is the focus of attention and common problems of the participating experts, and it is also the focus of discussion. Multiple subgroup comparisons and a variety of statistical methods, in various situations, how to better present clinical reports, were also highlighted by the participating experts, and Professor Wang Yang also gave detailed answers based on his rich scientific research experience.
Summary of the conference
The two-day "Pilot Program - Hypertension Elite Scientific Research Workshop" affirmed the role of classic clinical studies such as ASCOT in promoting the cognitive progress of hypertension, explored new ideas in the field of hypertension, and discussed the best way to combine scientific research innovation and clinical practice. During the conference, experts and scholars actively shared their views, exchanged and interacted, from fund application to clinical practice, from research design to data interpretation, from research development to disease progress, condensing the experience and wisdom of scientific research pioneers, and opening a door to scientific progress for us. In the future scientific research journey, it is still necessary to continue to explore and innovate, transform academic theories into practical results, and better promote the prevention and development of hypertension and related diseases.
On-site pictures (swipe left and right to see more)
Bibliography:
1. Global report on hypertension: the race against a silent killer.2023,WHO.https://www.who.int/publications/i/item/9789240081062
2. 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens. 2023 Jun 21.
3 . ESPRIT AHA News Release. Nov 13, 2023
4. SPRINT Research Group; et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015 Nov 26; 373(22):2103-16.
5. Dahlof B, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005 Sep 10-16; 366(9489):895-906.
6. Gupta A, et al. Long-term mortality after blood pressure-lowering and lipid-lowering treatment in patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study: 16-year follow-up results of a randomised factorial trial. Lancet. 2018 Sep 29; 392(10153):1127-1137.
7. Gupta A, et al. ASCOT-10 Investigators. Legacy benefits of blood pressure treatment on cardiovascular events are primarily mediated by improved blood pressure variability: the ASCOT trial. Eur Heart J. 2024 Jan 31:ehad814.
审批号:M-CORAM-CN-202403-00002