Interpretation of the World Health Organization global report on hypertension 2023_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SUN Qin ¹ , TIAN Weifan ¹ , LUO Tingting ¹ , YU Jing ¹ , LI Dongze ¹ , ZHANG Haihong ¹ , ZENG Rui ² ,  WAN Zhi ¹

1. Department of Emergency/Research Laboratory of Emergency Medicine, West China Hospital, Disaster Medicine Center, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

WAN Zhi, Email: wanzhi4115@wchscu.cn

Keywords：

Hypertention; cardiovascular disease; World Health Organization; interpretation

DOI：

10.7507/1007-4848.202311032

Video：

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The World Health Organization (WHO) released the “Global report on hypertension” on September 19, 2023. This report systematically summarizes the prevalence, mortality, diagnosis and treatment of hypertension in various countries, and elucidates the current situation of hypertension management, and gives a series of suggestions on how to manage hypertension, providing new thinking and inspiration for countries to optimize hypertension management. Through the summary of relevant studies and reports, this paper further reviews the present situation, early identification and management of hypertension.

Citation： SUN Qin, TIAN Weifan, LUO Tingting, YU Jing, LI Dongze, ZHANG Haihong, ZENG Rui, WAN Zhi. Interpretation of the World Health Organization global report on hypertension 2023. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 203-208. doi: 10.7507/1007-4848.202311032 Copy

1.	Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA, 2017, 317(2): 165-182.
2.	Zhou B, Perel P, Mensah GA, et al. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol, 2021, 18(11): 785-802.
3.	NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: A pooled analysis of 1201 population-representative studies with 104 million participants. Lancet, 2021, 398(10304): 957-980.
4.	Beaney T, Schutte AE, Stergiou GS, et al. May measurement month 2019: The global blood pressure screening campaign of the International Society of Hypertension. Hypertension, 2020, 76(2): 333-341.
5.	Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA, 2013, 310(9): 959-968.
6.	Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: A pooled analysis. PLoS One, 2013, 8(7): e65174.
7.	Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002, 360(9349): 1903-1913.
8.	Lawes CM, Rodgers A, Bennett DA, et al. Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens, 2003, 21(4): 707-716.
9.	Dehmer SP, Maciosek MV, LaFrance AB, et al. Health benefits and cost-effectiveness of asymptomatic screening for hypertension and high cholesterol and aspirin counseling for primary prevention. Ann Fam Med, 2017, 15(1): 23-36.
10.	Eriksen CU, Rotar O, Toft U, et al. What is the effectiveness of systematic population-level screening programmes for reducing the burden of cardiovascular diseases? Copenhagen: WHO Regional Office for Europe, 2021. https://iris.who.int/handle/10665/337646. Accessed on 2023-10-30.
11.	Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens, 2020, 38(6): 982-1004.
12.	World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. https://iris.who.int/handle/10665/344424. Accessed on 2023-10-30.
13.	US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, et al. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. JAMA, 2017, 318(2): 167-174.
14.	US Preventive Services Task Force, Mangione CM, Barry MJ, et al. Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular disease risk factors: US Preventive Services Task Force Recommendation Statement. JAMA, 2022, 328(4): 367-374.
15.	Neal B, Tian M, Li N, et al. Rationale, design, and baseline characteristics of the Salt Substitute and Stroke Study (SSaSS): A large-scale cluster randomized controlled trial. Am Heart J, 2017, 188: 109-117.
16.	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(20): 1534-1541.
17.	Neal B, Wu Y, Feng X, et al. Effect of salt substitution on cardiovascular events and death. n engl j med, 2021, 385(12): 1067-1077.
18.	Fuchs FD, Fuchs SC. The effect of alcohol on blood pressure and hypertension. Curr Hypertens Rep, 2021, 23(10): 42.
19.	Virdis A, Giannarelli C, Neves MF, et al. Cigarette smoking and hypertension. Curr Pharm Des, 2010, 16(23): 2518-2525.
20.	Cao L, Li X, Yan P, et al. The effectiveness of aerobic exercise for hypertensive population: A systematic review and meta-analysis. J Clin Hypertens (Greenwich), 2019, 21(7): 868-876.
21.	Olsen MH, Angell SY, Asma S, et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: The Lancet Commission on Hypertension. Lancet, 2016, 388(10060): 2665-2712.
22.	Jaffe MG, Frieden TR, Campbell NRC, et al. Recommended treatment protocols to improve management of hypertension globally: A statement by resolve to save lives and the World Hypertension League (WHL). J Clin Hypertens (Greenwich), 2018, 20(5): 829-836.
23.	Cohn J, Bygrave H, Roberts T, et al. Addressing failures in achieving hypertension control in low- and middle-income settings through simplified treatment algorithms. Glob Heart, 2022, 17(1): 28.
24.	Kostova D, Spencer G, Moran AE, et al. The cost-effectiveness of hypertension management in low-income and middle-income countries: A review. BMJ Glob Health, 2020, 5(9): e002213.
25.	Rea F, Corrao G, Merlino L, et al. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension, 2018, 72(4): 846-853.
26.	Wang N, Salam A, Webster R, et al. Association of low-dose triple combination therapy with therapeutic inertia and prescribing patterns in patients with hypertension: A secondary analysis of the TRIUMPH trial. JAMA Cardiol, 2020, 5(11): 1219-1226.
27.	Williams B, Mancia G, Spiering W, et al. 2018 practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens, 2018, 36(12): 2284-2309.
28.	Attaei MW, Khatib R, McKee M, et al. Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: An analysis of the PURE study data. Lancet Public Health, 2017, 2(9): e411-e419.
29.	Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: Lifetime risks, healthy life-years lost, and age-specific associations in 1. 25 million people. Lancet, 2014, 383(9932): 1899-1911.
30.	Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour Health, 2017, 15(1): 29.
31.	Vedanthan R, Bernabe-Ortiz A, Herasme OI, et al. Innovative approaches to hypertension control in low- and middle-income countries. Cardiol Clin, 2017, 35(1): 99-115.
32.	Abegunde DO, Shengelia B, Luyten A, et al. Can non-physician health-care workers assess and manage cardiovascular risk in primary care? Bull World Health Organ, 2007, 85(6): 432-440.
33.	Kaur P, Kunwar A, Sharma M, et al. India Hypertension Control Initiative: Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics. J Clin Hypertens (Greenwich), 2021, 23(4): 720-729.
34.	Flint AC, Conell C, Ren X, et al. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. N Engl J Med, 2019, 381(3): 243-251.
35.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
36.	Blood Pressure Lowering Treatment Trialists' Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: A meta-analysis of individual patient data. Lancet, 2014, 384(9943): 591-598.
37.	Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: Update from the GBD 2019 Study. J Am Coll Cardiol, 2020, 76(25): 2982-3021.
38.	Lauder L, Mahfoud F, Azizi M, et al. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J, 2023, 44(23): 2066-2077.
39.	Basu S, Flood D, Geldsetzer P, et al. Estimated effect of increased diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among low-income and middle-income countries: A microsimulation model. Lancet Glob Health, 2021, 9(11): e1539-e1552.
40.	Flood D, Seiglie JA, Dunn M, et al. The state of diabetes treatment coverage in 55 low-income and middle-income countries: A cross-sectional study of nationally representative, individual-level data in 680 102 adults. Lancet Healthy Longev, 2021, 2(6): e340-e351.
41.	Anjana RM, Mohan V, Rangarajan S, et al. Contrasting associations between diabetes and cardiovascular mortality rates in low-, middle-, and high-income countries: Cohort study data from 143, 567 individuals in 21 countries in the PURE study. Diabetes Care, 2020, 43(12): 3094-3101.
42.	Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med, 2003, 348(5): 383-393.
43.	Rawshani A, Rawshani A, Franzén S, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med, 2018, 379(7): 633-644.
44.	Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment. Lancet Diabetes Endocrinol, 2014, 2(8): 634-647.
45.	Xie Y, Bowe B, Mokdad AH, et al. Analysis of the Global Burden of Disease Study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int, 2018, 94(3): 567-581.
46.	GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2020, 395(10225): 709-733.
47.	Hirschhorn LR, Kaaya SF, Garrity PS, et al. Cancer and the 'other' noncommunicable chronic diseases in older people living with HIV/AIDS in resource-limited settings: A challenge to success. AIDS, 2012, 26 Suppl 1: S65-S75.
48.	Shah ASV, Stelzle D, Lee KK, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: Systematic review and meta-analysis. Circulation, 2018, 138(11): 1100-1112.
49.	Bigna JJ, Ndoadoumgue AL, Nansseu JR, et al. Global burden of hypertension among people living with HIV in the era of increased life expectancy: A systematic review and meta-analysis. J Hypertens, 2020, 38(9): 1659-1668.
50.	Haregu TN, Setswe G, Elliott J, et al. National responses to HIV/AIDS and non-communicable diseases in developing countries: Analysis of strategic parallels and differences. J Public Health Res, 2014, 3(1): 99.
51.	Njuguna B, Vorkoper S, Patel P, et al. Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: Lessons learned and evidence gaps. AIDS, 2018, 32(Suppl 1): S33-S42.

1. Forouzanfar MH, Liu P, Roth GA, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA, 2017, 317(2): 165-182.
2. Zhou B, Perel P, Mensah GA, et al. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol, 2021, 18(11): 785-802.
3. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: A pooled analysis of 1201 population-representative studies with 104 million participants. Lancet, 2021, 398(10304): 957-980.
4. Beaney T, Schutte AE, Stergiou GS, et al. May measurement month 2019: The global blood pressure screening campaign of the International Society of Hypertension. Hypertension, 2020, 76(2): 333-341.
5. Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA, 2013, 310(9): 959-968.
6. Singh GM, Danaei G, Farzadfar F, et al. The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: A pooled analysis. PLoS One, 2013, 8(7): e65174.
7. Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002, 360(9349): 1903-1913.
8. Lawes CM, Rodgers A, Bennett DA, et al. Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens, 2003, 21(4): 707-716.
9. Dehmer SP, Maciosek MV, LaFrance AB, et al. Health benefits and cost-effectiveness of asymptomatic screening for hypertension and high cholesterol and aspirin counseling for primary prevention. Ann Fam Med, 2017, 15(1): 23-36.
10. Eriksen CU, Rotar O, Toft U, et al. What is the effectiveness of systematic population-level screening programmes for reducing the burden of cardiovascular diseases? Copenhagen: WHO Regional Office for Europe, 2021. https://iris.who.int/handle/10665/337646. Accessed on 2023-10-30.
11. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens, 2020, 38(6): 982-1004.
12. World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. https://iris.who.int/handle/10665/344424. Accessed on 2023-10-30.
13. US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, et al. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force Recommendation Statement. JAMA, 2017, 318(2): 167-174.
14. US Preventive Services Task Force, Mangione CM, Barry MJ, et al. Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular disease risk factors: US Preventive Services Task Force Recommendation Statement. JAMA, 2022, 328(4): 367-374.
15. Neal B, Tian M, Li N, et al. Rationale, design, and baseline characteristics of the Salt Substitute and Stroke Study (SSaSS): A large-scale cluster randomized controlled trial. Am Heart J, 2017, 188: 109-117.
16. 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(20): 1534-1541.
17. Neal B, Wu Y, Feng X, et al. Effect of salt substitution on cardiovascular events and death. n engl j med, 2021, 385(12): 1067-1077.
18. Fuchs FD, Fuchs SC. The effect of alcohol on blood pressure and hypertension. Curr Hypertens Rep, 2021, 23(10): 42.
19. Virdis A, Giannarelli C, Neves MF, et al. Cigarette smoking and hypertension. Curr Pharm Des, 2010, 16(23): 2518-2525.
20. Cao L, Li X, Yan P, et al. The effectiveness of aerobic exercise for hypertensive population: A systematic review and meta-analysis. J Clin Hypertens (Greenwich), 2019, 21(7): 868-876.
21. Olsen MH, Angell SY, Asma S, et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: The Lancet Commission on Hypertension. Lancet, 2016, 388(10060): 2665-2712.
22. Jaffe MG, Frieden TR, Campbell NRC, et al. Recommended treatment protocols to improve management of hypertension globally: A statement by resolve to save lives and the World Hypertension League (WHL). J Clin Hypertens (Greenwich), 2018, 20(5): 829-836.
23. Cohn J, Bygrave H, Roberts T, et al. Addressing failures in achieving hypertension control in low- and middle-income settings through simplified treatment algorithms. Glob Heart, 2022, 17(1): 28.
24. Kostova D, Spencer G, Moran AE, et al. The cost-effectiveness of hypertension management in low-income and middle-income countries: A review. BMJ Glob Health, 2020, 5(9): e002213.
25. Rea F, Corrao G, Merlino L, et al. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension, 2018, 72(4): 846-853.
26. Wang N, Salam A, Webster R, et al. Association of low-dose triple combination therapy with therapeutic inertia and prescribing patterns in patients with hypertension: A secondary analysis of the TRIUMPH trial. JAMA Cardiol, 2020, 5(11): 1219-1226.
27. Williams B, Mancia G, Spiering W, et al. 2018 practice guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens, 2018, 36(12): 2284-2309.
28. Attaei MW, Khatib R, McKee M, et al. Availability and affordability of blood pressure-lowering medicines and the effect on blood pressure control in high-income, middle-income, and low-income countries: An analysis of the PURE study data. Lancet Public Health, 2017, 2(9): e411-e419.
29. Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: Lifetime risks, healthy life-years lost, and age-specific associations in 1. 25 million people. Lancet, 2014, 383(9932): 1899-1911.
30. Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour Health, 2017, 15(1): 29.
31. Vedanthan R, Bernabe-Ortiz A, Herasme OI, et al. Innovative approaches to hypertension control in low- and middle-income countries. Cardiol Clin, 2017, 35(1): 99-115.
32. Abegunde DO, Shengelia B, Luyten A, et al. Can non-physician health-care workers assess and manage cardiovascular risk in primary care? Bull World Health Organ, 2007, 85(6): 432-440.
33. Kaur P, Kunwar A, Sharma M, et al. India Hypertension Control Initiative: Hypertension treatment and blood pressure control in a cohort in 24 sentinel site clinics. J Clin Hypertens (Greenwich), 2021, 23(4): 720-729.
34. Flint AC, Conell C, Ren X, et al. Effect of systolic and diastolic blood pressure on cardiovascular outcomes. N Engl J Med, 2019, 381(3): 243-251.
35. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 2020, 396(10258): 1223-1249.
36. Blood Pressure Lowering Treatment Trialists' Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: A meta-analysis of individual patient data. Lancet, 2014, 384(9943): 591-598.
37. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: Update from the GBD 2019 Study. J Am Coll Cardiol, 2020, 76(25): 2982-3021.
38. Lauder L, Mahfoud F, Azizi M, et al. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J, 2023, 44(23): 2066-2077.
39. Basu S, Flood D, Geldsetzer P, et al. Estimated effect of increased diagnosis, treatment, and control of diabetes and its associated cardiovascular risk factors among low-income and middle-income countries: A microsimulation model. Lancet Glob Health, 2021, 9(11): e1539-e1552.
40. Flood D, Seiglie JA, Dunn M, et al. The state of diabetes treatment coverage in 55 low-income and middle-income countries: A cross-sectional study of nationally representative, individual-level data in 680 102 adults. Lancet Healthy Longev, 2021, 2(6): e340-e351.
41. Anjana RM, Mohan V, Rangarajan S, et al. Contrasting associations between diabetes and cardiovascular mortality rates in low-, middle-, and high-income countries: Cohort study data from 143, 567 individuals in 21 countries in the PURE study. Diabetes Care, 2020, 43(12): 3094-3101.
42. Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med, 2003, 348(5): 383-393.
43. Rawshani A, Rawshani A, Franzén S, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med, 2018, 379(7): 633-644.
44. Global Burden of Metabolic Risk Factors for Chronic Diseases Collaboration. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment. Lancet Diabetes Endocrinol, 2014, 2(8): 634-647.
45. Xie Y, Bowe B, Mokdad AH, et al. Analysis of the Global Burden of Disease Study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int, 2018, 94(3): 567-581.
46. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2020, 395(10225): 709-733.
47. Hirschhorn LR, Kaaya SF, Garrity PS, et al. Cancer and the 'other' noncommunicable chronic diseases in older people living with HIV/AIDS in resource-limited settings: A challenge to success. AIDS, 2012, 26 Suppl 1: S65-S75.
48. Shah ASV, Stelzle D, Lee KK, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: Systematic review and meta-analysis. Circulation, 2018, 138(11): 1100-1112.
49. Bigna JJ, Ndoadoumgue AL, Nansseu JR, et al. Global burden of hypertension among people living with HIV in the era of increased life expectancy: A systematic review and meta-analysis. J Hypertens, 2020, 38(9): 1659-1668.
50. Haregu TN, Setswe G, Elliott J, et al. National responses to HIV/AIDS and non-communicable diseases in developing countries: Analysis of strategic parallels and differences. J Public Health Res, 2014, 3(1): 99.
51. Njuguna B, Vorkoper S, Patel P, et al. Models of integration of HIV and noncommunicable disease care in sub-Saharan Africa: Lessons learned and evidence gaps. AIDS, 2018, 32(Suppl 1): S33-S42.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of the World Health Organization global report on hypertension 2023

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