Preamble

Jiang Bin, Researcher and Chief Physician, Deputy Director of the Department of Neuroepidemiology, Beijing Neurosurgical Institute. Council Member of the China Hypertension League, Executive Committee Member and Secretary-General of the Hypertension Prevention and Management Branch of the Chinese Stroke Association, Committee Member of the Cerebrovascular High-Risk Population Management Branch of the Chinese Stroke Association, and Committee Member of the Stroke Prevention and Control Professional Committee of the Chinese Preventive Medicine Association. His primary research focuses on neuroepidemiology and community-based stroke prevention and control. In recent years, he has participated in and led over ten national or provincial-level research projects, published numerous academic papers (including SCI-indexed articles), contributed to multiple guideline expert consensuses and monograph chapters, and co-authored popular science books. He has served as an editorial board member and reviewer for domestic and international journals including Stroke, Frontiers in Neurology, Chinese General Practice, Chinese Journal of Stroke, Chinese Journal of Cerebrovascular Diseases, International Journal of Cerebrovascular Diseases, and Chinese Journal of Prevention and Control of Chronic Diseases.

Sun Haixin^{1,2,3}, Jiang Bin^{1,2,3*}

1. Department of Neuroepidemiology, Beijing Neurosurgical Institute, Beijing 100070, China
2. Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
3. Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100070, China

*Corresponding author: JIANG Bin, Researcher; E-mail: bjyjiang@163.com

Abstract

Hypertension is the primary cause of both death from stroke and the increased DALY burden of stroke. As the most important modifiable risk factor, the effective prevention and control of hypertension has become the core task of primary and secondary prevention of stroke. In February 2025, the World Stroke Organization and the World Hypertension League released the "2025 WSO/WHL Position Statement: Application of Hypertension Control Strategies in Stroke Prevention and Management". Based on the strategies and recommendations of the statement, this paper analyzes and interprets the practical evidence in the prevention and control of hypertension in China, and gives thoughts on constructing a hypertension prevention and control path with Chinese characteristics, aiming to provide reference for future applications and research of stroke prevention and management in China.

Keywords: Stroke; Hypertension prevention and control; Policy-driven; Digital intelligence technology; National health literacy

1. The Current Situation of Stroke and Hypertension Burden in China

1.1 The "Three Highs" Characteristic of China's Stroke Burden

Stroke is an acute neurological deficit syndrome caused by cerebrovascular disease and represents one of the leading causes of disability and mortality among adults worldwide [1]. In recent years, although the incidence and mortality of stroke have declined in some economically developed countries, the incidence continues to rise in many low- and middle-income countries, imposing a heavy burden on society and families [2-3]. In China, stroke has become one of the top three causes of disability and death among adults, with its incidence ranking among the highest globally [4]. Among cerebrovascular disease risk factors, hypertension is the leading cause of stroke death and the primary contributor to the increased disability-adjusted life years (DALY) burden, as well as the most important modifiable risk factor [5], with its prevention and control significance supported by extensive global evidence. Blood pressure level demonstrates a continuous, independent, and direct positive correlation with cardiovascular risk including stroke [6-8]. A meta-analysis of individual data from one million adults across 61 prospective cohort studies showed that higher systolic or diastolic blood pressure was associated with higher stroke mortality across all age groups [8]. Effective prevention and control of hypertension has thus become the core task of both primary and secondary stroke prevention.

To effectively prevent and control hypertension and reduce the stroke burden, the World Stroke Organization (WSO) and the World Hypertension League (WHL) released the "2025 WSO/WHL Position Statement: Application of Hypertension Control Strategies in Stroke Prevention and Management" in February 2025 [9]. This statement provides comprehensive recommendations for hypertension control strategies in stroke prevention and management, including various blood pressure measurement techniques, blood pressure classification, the relationship between blood pressure and stroke risk, antihypertensive drug therapy in primary and secondary stroke prevention, drug selection, optimal blood pressure targets, non-pharmacological approaches to stroke prevention through blood pressure reduction, blood pressure management in acute ischemic stroke and spontaneous intracerebral hemorrhage, and community-based implementation of hypertension prevention, treatment, and control. From the perspective of health service equity and accessibility, the statement re-emphasizes the importance of healthy lifestyles closely related to hypertension and community-based control of hypertension and stroke. Based on the strategies and recommendations in the "2025 WSO/WHL Position Statement," this paper reviews current progress in hypertension prevention and control and China's implementation status, identifies gaps between practical application and statement recommendations, and provides evidence and reflections for further strengthening the role of hypertension management in stroke prevention and control in China.

China's current stroke burden exhibits typical "three highs" characteristics: high incidence, high disability rate, and high mortality. Data from the 2013 China National Stroke Epidemiology Survey (NESS-China) showed that compared with survey data from 30 years prior, stroke incidence and prevalence in rural China increased by 31.6% and 155%, respectively, while mortality decreased by 11.4%. In urban areas, incidence and mortality decreased by 18.1% and 31%, respectively, while prevalence increased by 18.2% [10]. Stroke surveillance results from rural Tianjin over 22 years confirmed that stroke incidence in rural China is rising rapidly, with an average annual increase of 6.3% [11]. Further follow-up and in-depth analysis from the NESS-China study showed that both first-ever stroke and stroke event incidence rates are increasing, while mortality is decreasing, which will inevitably lead to further increases in stroke prevalence and consequently increase the socioeconomic burden of stroke [12-13]. According to the Global Burden of Disease (GBD) 2019 study, in 2019 China had 3.94 million new stroke cases, 28.76 million stroke survivors, and 2.19 million stroke deaths. Between 1990 and 2019, the age-standardized DALY rate for stroke in China increased by 36.7%, reaching 45.9 million DALYs in 2019 [14].

1.2 The "One High, Three Lows" Dilemma of Hypertension Prevention and Control in China

The current status of hypertension prevention and control in China can be summarized as the "one high, three lows" dilemma: high prevalence, low awareness, low treatment rate, and low control rate. Data from the China Chronic Disease and Risk Factor Surveillance showed that in 2018, the weighted prevalence of hypertension among Chinese adults aged 18 and above was 27.5%, with higher rates in men (30.8%) than in women (24.2%), and higher in rural areas (29.4%) than in urban areas (25.7%). Age-specific prevalence increased with age in both men and women [15]. Among adults with hypertension, 41.0% were aware of their condition, 34.9% were taking antihypertensive medication, and only 11.0% had their blood pressure under control. Among residents without diagnosed hypertension, 50.9% had prehypertension [15]. Awareness, treatment, and control rates were relatively higher in women and urban residents compared to men and rural residents [15].

The 2019 Global Hypertension Control Rate report from the Non-Communicable Disease Risk Factor Collaboration (NCD-RisC) showed that between 1990 and 2019, the number of hypertensive patients aged 30-79 worldwide doubled, increasing from 331 million to 626 million in women and from 317 million to 652 million in men. In 2019, over one billion hypertensive patients (82% of all hypertensive patients globally) lived in low- and middle-income regions. Hypertension control rates were highest in South Korea, Canada, and the United States (control rate >50%), while China's hypertension control rate (13.9% in men/17.8% in women) was far below that of developed countries and the global average [16]. The situation of hypertension prevention and control among stroke patients is similarly concerning. In the China National Adult Chronic Disease and Nutrition Surveillance (2015-2017) of 6,580 stroke patients, awareness, treatment, and control rates were 73.6%, 70.2%, and 17.8%, respectively [17]. The NESS-China survey showed that awareness of hypertension among stroke patients was 76.3% [10], while the control rate was only 8% [4].

The "one high, three lows" status of hypertension control among the general population increases the risk of stroke incidence, while the same pattern among stroke patients increases the risk of stroke recurrence, thereby increasing stroke disability and mortality rates. Currently, China faces a heavy stroke burden, particularly in underdeveloped rural areas, where the task of hypertension prevention and control remains arduous. There is an urgent need to promote and implement evidence-based, locally-adapted hypertension prevention and control strategies.

2. Practical Evidence of Hypertension Control Strategies in Stroke Prevention and Management

2.1 Evidence from the "Shandong Salt Reduction" Initiative and Salt Substitution Trials

The "Shandong Ministry of Health Salt and Hypertension Action Plan (SMASH)," launched in 2011, is a government-led initiative aimed at reducing adult hypertension prevalence by controlling salt intake. The program employed multiple strategies including media campaigns, distribution of calibrated salt spoons, and public education activities, with remarkable results: a significant 24.8% reduction in sodium intake was observed over five years. Measured by 24-hour urinary sodium excretion, daily sodium intake decreased from 5,338 mg/day (13.6 g of salt) to 4,013 mg/day (10 g of salt). Potassium excretion increased by 15.1%, and the sodium-to-potassium ratio decreased by 37.7%, indicating positive dietary changes. In addition to reduced sodium intake, the SMASH program demonstrated improved blood pressure levels, with adjusted mean systolic blood pressure decreasing by 1.8 mmHg (1 mmHg = 0.133 kPa) and mean diastolic pressure decreasing by 3.1 mmHg, likely attributable to reduced sodium intake. Beyond these physiological changes, systematic evaluation showed the program had positive impacts on participants' knowledge, attitudes, and behaviors regarding sodium reduction and hypertension. Participants showed improved awareness of recommended salt intake, paid more attention to processed food labels, and took action to reduce dietary sodium [18].

Another open-label, cluster-randomized trial examined cardiovascular and safety outcomes of salt substitutes versus regular salt in high-risk adults. The trial assigned 600 villages in rural China to use salt substitutes (75% sodium chloride, 25% potassium chloride) or continue regular salt (100% sodium chloride) for all household cooking and food preservation. The trial enrolled 20,995 adults with a history of stroke or aged ≥60 years with poorly controlled blood pressure. The primary outcome was stroke events (including first-ever and recurrent stroke), while secondary outcomes were major cardiovascular events and all-cause death. Results showed that during an average follow-up of 4.74 years, compared with the regular salt group, the salt substitute group had a 14% reduction in stroke events (RR = 0.86, 95% CI = 0.77–0.96), a 13% reduction in major cardiovascular events (RR = 0.87, 95% CI = 0.80–0.94), and a 12% reduction in all-cause death (RR = 0.88, 95% CI = 0.82–0.95). There was no difference in the incidence of clinical hyperkalemia between the two groups. These findings support the use of salt substitutes [19]. In terms of safety, the incidence of clinical hyperkalemia did not differ between groups [19].

2.2 Evidence from Urban Community Practice

Between 1991 and 2000, the Beijing Neurosurgical Institute established intervention and control communities in Beijing, Shanghai, and Changsha, each including approximately 50,000 people. The intervention communities implemented comprehensive multifactorial interventions focusing on hypertension among high-risk populations (including stroke survivors returning to the community) and conducted universal health education and promotion. After three years of observation, the study evaluated key indicators including first-ever stroke incidence, stroke mortality outcomes, and stroke recurrence outcomes. Results showed that the risk of first-ever stroke decreased by 11.4% (RR = 0.8959, 95% CI = 0.8483–0.9460, P < 0.001), with ischemic stroke risk decreasing by 13.2% (OR = 0.868, 95% CI = 0.805–0.934, P < 0.001) and hemorrhagic stroke risk decreasing by 7.2% (OR = 0.928, 95% CI = 0.852–1.012, P = 0.0899), though the latter difference was not statistically significant [20-21]. In the Beijing area, population monitoring showed that the 3-year mortality risk after first-ever stroke decreased by 26% (RR = 0.74, 95% CI = 0.61–0.89, P = 0.002). The 3-year cumulative recurrence rates of first-ever stroke in intervention and control communities were 11.7% and 20.8%, respectively (P = 0.029). In the intervention community, the 3-year recurrence risk of first-ever stroke decreased by 42% (RR = 0.58; 95% CI = 0.34–1.00, P = 0.048), with the mortality risk of first-ever hemorrhagic stroke decreasing by 39% (RR = 0.61, 95% CI = 0.46–0.81, P = 0.001) [21]. Another urban community-based comprehensive intervention study targeting hypertension, diabetes, and smoking control showed that after four years of follow-up, risk factor levels decreased in the intervention community population, with stroke incidence decreasing by 41.4% in men and 46.3% in women. Stroke mortality decreased by 31.8% in men and 19.0% in women when comparing pre- and post-intervention periods. The differences in average incidence and mortality rates between intervention and control communities over five years were statistically significant (P < 0.01) [22].

2.3 Evidence from Rural Community Practice

In 2022, the Phase I results of the China Rural Hypertension Control Project (CRHCP study) were published in The Lancet, confirming that after 18 months of treatment, the intervention group achieved significantly greater reductions in mean systolic and diastolic blood pressure compared with the control group (14.5 mmHg and 7.1 mmHg, respectively) [23]. In 2023, The Lancet published the Phase II results of the CRHCP study: 36-month follow-up data first confirmed that implementing a comprehensive protocol including intensive blood pressure control in the entire population reduced systolic blood pressure by >21 mmHg, decreased cardiovascular disease risk by 30%, stroke risk by 23%, and all-cause mortality risk by 15% [24]. In 2024, it was first confirmed that trained village doctors, through multifaceted interventions, could safely and effectively control blood pressure below 130/80 mmHg in hypertensive patients aged 60 years and older, reducing cardiovascular disease risk by 25%, stroke risk by 26%, and total mortality risk by 10% [25].

2.4 Evidence from Polypill Strategy

2.4.1 The SECURE Trial

The SECURE trial was a four-year Phase III randomized controlled clinical trial enrolling post-myocardial infarction patients within six months. The polypill group included 1,237 patients, while the control group included 1,229 patients. The polypill treatment included aspirin (100 mg), ramipril (2.5, 5.0, or 10.0 mg), and atorvastatin (20.0 or 40.0 mg). The primary composite endpoint was cardiovascular death, non-fatal type 1 myocardial infarction, non-fatal ischemic stroke, or urgent revascularization. Results showed that 118 patients (9.5%) in the polypill group versus 156 patients (12.7%) in the usual care group experienced the primary outcome event (RR = 0.76, 95% CI = 0.60–0.96, P = 0.02). For the secondary endpoint (cardiovascular death, non-fatal type 1 myocardial infarction, or non-fatal ischemic stroke), 101 patients (8.2%) in the polypill group versus 144 patients (11.7%) in the usual care group experienced events (RR = 0.70, 95% CI = 0.54–0.90, P = 0.005). Medication adherence was higher in the polypill group, with similar adverse events between groups. This study demonstrated that polypill therapy containing aspirin, ramipril, and atorvastatin within six months after myocardial infarction significantly reduced the risk of major adverse cardiovascular events [26].

2.4.2 The PolyIran Trial

The PolyIran trial was a five-year pragmatic cluster-randomized trial in Iran evaluating polypill effectiveness for primary and secondary prevention of cardiovascular diseases. The polypill group included 3,421 participants, while the control group included 3,417 participants. The polypill contained hydrochlorothiazide (12.5 mg), aspirin (81 mg), atorvastatin (20 mg), and enalapril (5 mg), with 5 mg enalapril replaced by 40 mg valsartan if cough occurred during follow-up. Results showed that in a real-world setting, polypill use significantly reduced the risk of major adverse cardiovascular events (including hospitalization for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary revascularization procedures, and non-fatal and fatal stroke) in individuals aged 50–75 years. The trial confirmed that polypill effectively prevented major adverse cardiovascular events, with high patient adherence, few adverse reactions, and cost-effectiveness [27]. Therefore, the polypill strategy is particularly suitable for promotion as a prevention program to reduce cardiovascular disease burden in low- and middle-income countries.

2.6 WHO HEARTS Program in China Practice

The WHO-developed HEARTS technical package provides tools for governments and professional organizations to support primary care services (PCS) in applying evidence-based strategies to control and prevent cardiovascular diseases [31]. The HEARTS modules include healthy lifestyle counseling, evidence-based treatment protocols, access to essential medicines and technologies, cardiovascular disease risk management, team-based care, monitoring systems, and implementation guidelines. The HEARTS China Hypertension Control Project was launched in Henan Province in 2017. By December 2021, 894 PCS had participated in the project, screening over 620,000 people, registering 268,000 patients, and treating 190,000 hypertensive patients. At the last visit, 86,523 patients had achieved blood pressure control targets, and all-cause cardiovascular disease hospitalizations decreased by 13%. However, data recorded in the monitoring system indicated serious clinical inertia in implementing the HEARTS protocol, suggesting that more training courses and incentive mechanisms might help PCS improve care quality [32].

In summary, the successful practical experiences described above can provide reference for optimizing hypertension control strategies in future stroke prevention and management in China and inspire the construction of a hypertension prevention and control pathway with Chinese characteristics. Based on existing evidence, population-based hypertension prevention and control practice must be adapted to local conditions and integrate multiple strategies, including advocating for sodium-reduced diets and other healthy lifestyles closely related to hypertension, implementing comprehensive multifactorial interventions focusing on blood pressure control, and leveraging digital intelligence technologies that promote health equity and accessibility while reducing adverse drug reactions and increasing medication adherence through cost-effective polypills.

3. Constructing a "Chinese Pathway" for Hypertension and Stroke Prevention and Control

The "2025 WSO/WHL Position Statement: Application of Hypertension Control Strategies in Stroke Prevention and Management" [9] emphasizes the importance of community-based stroke control from the perspective of health service equity and accessibility, identifying six key strategies: opportunistic screening/lifestyle modification, public awareness improvement/salt reduction, task shifting/task sharing, polypills/digital technology, national hypertension control programs, and the WHO HEARTS program. These strategies provide important inspiration for innovation in China's prevention and control system. Constructing a pathway with Chinese characteristics requires adapting these international experiences to China's unique healthcare system, cultural traditions, and technological development level.

3.1 Policy-Driven Systemic Reform

The "Healthy China Action (2019-2030)" has established specific targets for hypertension and cardiovascular disease prevention and control, including expected reductions in cardiovascular disease mortality by 2030, and targets for hypertension awareness, standardized management, treatment, and control rates [33]. It is hoped that the formulation of these related policies will further promote the implementation of effective evidence-based strategies. In recent years, with improvements in living standards and vigorous salt reduction advocacy, public awareness of salt reduction has gradually increased. The "Xinhua·China Salt Reduction Health Index Report (2024)" showed that in 2024, China's resident salt reduction health index was 76.98 points, an increase of 1.23 points year-on-year, remaining in the good range of 60–80 points, indicating continuous improvement in residents' salt reduction health levels, though there remains considerable room for improvement [34]. In 2024, Xinhua News Agency and China Salt Group jointly launched the 2024 "Healthy China Salt Reduction Action" series of activities in central state-owned enterprises, effectively promoting salt reduction knowledge dissemination, enhancing public health awareness, and contributing to Healthy China construction. Based on the effectiveness of polypills in hypertension prevention and control [26-27], corresponding policies are needed to promote their adoption, including accelerating polypill review and approval processes and addressing medical insurance directory access issues. On March 1, 2023, the new edition of the "National Basic Medical Insurance, Work Injury Insurance, and Maternity Insurance Drug Directory (2022)" was officially implemented, with the clopidogrel-aspirin polypill included in the newly added drug directory. It is believed that more polypills will be included in the medical insurance directory in the future, allowing patients to benefit from innovative drugs.

Since 2009, hypertension management has been a core component of the National Basic Public Health Service Project. The continuously updated "National Guidelines for Primary Hypertension Prevention and Management" [35-36] provide more comprehensive guidance for primary healthcare workers in hypertension management. The National Basic Public Health Service Project aims to gradually achieve homogenization of hypertension management levels between primary healthcare institutions and hospitals, and to gradually improve the first-visit rate and control rate of hypertension in primary healthcare institutions. Currently, the primary hypertension management project has gradually formed a systematic and standardized prevention and control system with continuously expanding service coverage and significant management effects. By 2019, approximately 109 million hypertensive patients were registered nationwide, with the standardized management rate increasing by 29.28% over ten years and the blood pressure control rate among managed populations increasing by 16.84% over ten years, representing average annual growth rates of 3.28%. The gaps in various indicators among eastern, central, and western regions are gradually narrowing [37-38]. Given that there are currently 245 million hypertensive patients nationwide, hypertension control in China's population remains a formidable task.

3.2 Digital Intelligence Technology-Enabled Precision Prevention and Control

We are currently in an era of rapid technological development. In recent years, digital intelligence technologies such as wearable devices and machine learning hold promise for providing effective technological support for screening, monitoring, and precision prevention and control of hypertension and stroke high-risk populations. First, the vigorous development of non-invasive, portable, and cuffless sensor technologies enables long-term continuous blood pressure monitoring and facilitates home blood pressure monitoring. Studies have shown that home-measured blood pressure values correlate more significantly with cerebrovascular events than office blood pressure measurements [39]. Additionally, wearable devices can effectively identify nocturnal or sleep-time hypertension, which is more valuable than daytime blood pressure in predicting stroke risk [40]. Based on the promotion and application of wearable devices, real-time monitoring of blood pressure fluctuations can be achieved, with data synchronized to the cloud. Artificial intelligence (AI) algorithms can identify morning surge hypertension or abnormal fluctuations and automatically push alerts to doctors and patients to prompt attention and timely intervention. Beyond blood pressure, wearable devices have made significant advances in electrocardiogram monitoring, diabetes, sleep apnea, lifestyle, hemodynamics, plaque monitoring, and gait and exercise monitoring, providing new solutions for stroke risk assessment and prevention and control [41]. Second, high-risk population prediction based on multi-source data and AI algorithms, as well as intelligent management platforms for risk factors based on large models, can already be used for accurate dynamic prediction of stroke risk, enabling early identification of high-risk populations and intensive intervention to reduce stroke risk [42]. Third, health lifestyle interventions, emotional regulation, and medication adjustments delivered through internet-plus-medical care, smartphone apps, and mobile health education can improve patient medication adherence, enhance patient confidence in treatment and blood pressure self-management capabilities, and enable remote medical collaboration to guide grassroots adjustment of personalized intervention and prevention plans for better blood pressure control [43-45].

These digital intelligence technologies are no longer just prospects; many places domestically and internationally have already taken the lead in exploration and practice, achieving good results [43,45-49]. Studies have shown that village doctor-led mobile health interventions can significantly reduce residents' cardiovascular disease risk and improve risk factors and behaviors. During the 12-month follow-up period, the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) in the intervention group decreased from 18% to 11.7%, while the control group decreased from 17.8% to 13.6%, with an absolute difference of -1.88%. The intervention group's mean systolic blood pressure decreased by 23.2 mmHg (-23.9 to -22.5 mmHg), while the control group decreased by 15.2 mmHg (-15.9 to -14.4 mmHg) (P < 0.001). The intervention group's mean diastolic blood pressure decreased by 10.9 mmHg (-11.3 to -10.4 mmHg), while the control group decreased by 6.9 mmHg (-7.3 to -6.4 mmHg) (P < 0.001) [49]. Additionally, the study observed that medication adherence among intervention group participants gradually improved, and they showed stronger awareness of daily health behaviors, which is more gratifying than numerical reductions alone. It is hoped that digital intelligence technology will become more mature and be promoted and popularized soon to benefit the public.

3.3 Improvement of National Health Literacy

The 55th "Statistical Report on China's Internet Development" shows that as of December 2024, China had 1.108 billion internet users, with an internet penetration rate of 78.6% and mobile phone usage for internet access reaching 99.7% [50]. Currently, platforms such as Weibo and WeChat have gradually become the fastest-growing and most active internet applications. With their integrated audio-visual-text content, strong timeliness, wide coverage, and strong interactivity, they offer tremendous advantages in medical science education. It is necessary to utilize this new media model for innovative health education to better disseminate knowledge about hypertension hazards and prevention and control, thereby improving awareness rates. Simultaneously, attention should be paid to establishing authoritative health education platforms, strengthening crackdowns on pseudoscience, providing guidance on scientific medication use, reducing misconceptions about "health supplements replacing medications," and improving public information discrimination capabilities. Training in home blood pressure monitoring skills and promotion of smart device applications with data synchronized to family doctors can enable early screening and early intervention. Improving national health literacy can help form a "knowledge-attitude-practice" closed loop, facilitating the shift of hypertension prevention and control from passive treatment to active prevention, and helping non-professionals better connect with medical personnel for hypertension and stroke prevention and control management.

4. Conclusion: Optimizing Hypertension Control Strategies in Stroke Prevention and Control

Although age-standardized stroke mortality in China's population has begun to decline [13], stroke-related risk factors, particularly the continuously rising prevalence of hypertension, remain concerning, and awareness, treatment, and control rates of hypertension are still not optimistic [17]. Therefore, as the primary controllable factor, how to optimize hypertension control strategies in stroke prevention and control according to local conditions and improve population blood pressure control is particularly urgent. China's breakthrough in hypertension prevention and control requires multi-dimensional collaborative efforts to build a hypertension prevention and control system with Chinese characteristics, focusing on three key dimensions: integrating traditional medical wisdom with modern technology in the technical pathway, combining top-level design with grassroots innovation in implementation strategies, and adhering to both health equity and efficiency improvement in value orientation. Establishing a government-led, multi-party participatory, and technology-supported collaborative governance mechanism will contribute Chinese solutions and strength to global hypertension and stroke prevention and control, transforming the "Healthy China 2030" goals from vision into tangible benefits for hundreds of millions of people.

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Author Contributions: Sun Haixin was responsible for data collection and drafting the manuscript; Jiang Bin proposed the main ideas and was responsible for revision and review; Sun Haixin and Jiang Bin take overall responsibility for the manuscript.

Conflict of Interest: The authors declare no conflict of interest.