Is high blood pressure reversible?

Can High Blood Pressure Be Cured? For Some, the Answer Is Yes

Some high blood pressure could have surprising causes – and for one such cause, there’s a surgical cure.

According to the U.S. Centers for Disease Control and Prevention, high blood pressure affects nearly 30% of the adult population or about 90 million Americans. High blood pressure disproportionately affects non-Hispanic blacks, where its prevalence is more than 40%; however, more than 25% of Hispanics and non-Hispanic whites have high blood pressure too. The importance of high blood pressure is its consequences, which include such serious life-threatening disorders as heart attack, heart failure, atrial fibrillation, stroke, and kidney failure. Early and adequate treatment of high blood pressure can prevent these complications.

High blood pressure is defined as a blood pressure greater than 140/90 millimeters of mercury (mmHg). Most cases of high blood pressure (about 85% to 90%) are referred to as essential or primary hypertension. By definition, essential hypertension has no identifiable cause. Risk factors for essential hypertension include advanced age, black race, family history of high blood pressure, being overweight or obese, being physically inactive, smoking or chewing tobacco, and excessive alcohol consumption. Other disorders, like diabetes, high cholesterol, and sleep apnea, are also associated with essential hypertension.

About 10% to 15% of people have secondary hypertension – high blood pressure caused by an underlying condition or medication. Secondary hypertension is presumably curable, if the underlying condition is treated or the offending drug is stopped. Some causes of secondary hypertension are:

  • Tumors or other disorders of the adrenal gland
  • Kidney problems
  • Thyroid disease
  • Hyperparathyroidism
  • Prescription medications including decongestants, non-steroidal anti-inflammatory drugs (NSAIDs, like ibuprofen), steroids, antidepressants, and birth control pills
  • Herbal supplements such as Ma Huang (ephedra), St. John’s Wort, ginseng, and black licorice
  • Illicit drugs like cocaine and methamphetamine

A recent study from Elena Azizan and colleagues indicates that one of the more common causes of secondary hypertension is a particular non-cancerous tumor of the adrenal gland that produces too much of the hormone aldosterone. These tumors are called adrenal adenomas or, more properly, aldosterone-producing adrenal adenomas and they may account for at least 5% to 10% of all cases of high blood pressure. Aldosterone is involved in blood pressure regulation through complex effects on the heart, the blood vessels, and particularly the kidneys. Removal of these tumors through minimally-invasive surgery may cure the high blood pressure, especially if done early after the diagnosis of hypertension is made.

Screening for these tumors can be accomplished with a simple blood test, called the aldosterone to plasma renin activity ratio. While this test is highly sensitive, meaning that it will identify most cases, it is not very specific, meaning that it will also be positive in situations other than aldosterone-producing adrenal adenomas. The study from Azizan identified a number of genetic mutations underlying these tumors that could potentially help in the diagnosis aldosterone-producing adrenal adenomas.

Bottom line: If you have recently been diagnosed with high blood pressure, consult with your physician on the possibility of screening for an aldosterone-producing adrenal adenoma. If you have one, your high blood pressure may be cured with surgery, eliminating the need for lifelong treatment with blood pressure lowering medications.

Can Prehypertension Be Reversed?

Has your doctor warned you that you’re prehypertensive? Or have your own blood pressure readings revealed you’re near the danger zone? In either case, prehypertension is a serious condition you shouldn’t take lightly. High blood pressure is linked to a variety of severe conditions, including heart attack, stroke, coronary artery disease and even kidney failure.

Fortunately, prehypertension can be reversed. A warning sign of higher pressures and dangerous downstream effects, prehypertension should prompt you to make a few important lifestyle changes.

To learn how you can get your blood pressure back down to safe levels, read on to find out more about the condition’s symptoms, causes and cures.

Signs and Symptoms

How will you know whether you’re prehypertensive? According to the World Health Organization, prehypertensive or “at risk” patients have systolic blood pressures between 120 and 139, diastolic between 80 and 89. If you’re looking at the numbers on a medical report, they’ll probably appear as 120 / 80 to 139 / 89.

For most patients, however, even dangerously high blood pressures won’t produce symptoms. In fact, blood pressure is often called the “silent killer,” and few people ever experience headaches, facial flushing or dizziness. Ultimately, it’s crucial that you keep an eye on your readings, both at your doctor’s office and with an at-home monitor.

Understanding the Causes

Hypertension and prehypertension are complex conditions, and any factor that increases the pressure against artery walls can elevate blood pressure. Common causes include:

  • Atherosclerosis (plaque buildup in the arteries)
  • Kidney, adrenal and thyroid diseases
  • Sleep apnea

Just as importantly, there are a variety of risk factors that increase your chances of developing high blood pressure. According to the Mayo Clinic, these risk factors include:

  • Being overweight and obese
  • Family history of high blood pressure
  • Age, sex and race
  • Sedentary lifestyle
  • High-sodium and low-potassium diets
  • Tobacco use
  • Excessive alcohol consumption

While there are a few factors you can’t change, most are within your control. Here are a few of the best ways to address these risk factors and get your blood pressure back into a healthy range.

A Well-Balanced Diet

Improving your diet is one of the simplest, cheapest and most effective methods of reducing your blood pressure. By cutting back on saturated fats, cholesterol-rich foods and sugar, you’ll reduce your calorie consumption and improve your ratio of LDL (bad cholesterol) to HDL (good cholesterol). By reducing sodium and increasing potassium, you can also reduce the amount of water your body retains, which will in turn lower your blood pressure. Likewise, eating fiber-rich fruits and vegetables will help your kidneys excrete excess sodium.

Regular Exercise

Regular exercise has long been linked to healthy blood pressures. After all, a strong heart can pump more blood with less effort, reducing the pressure against your arterial walls. Exercise is particularly effective in reducing your systolic blood pressure–the top number of your reading, and the one with which people struggle the most.

Losing Weight

Aside from their direct effects on blood pressure, a better diet and regular exercise will also cause you to lose weight. Body mass index (BMI), body fat percentage and blood pressure are closely linked, and, in general, the slimmer you are, the less you’re at risk for hypertension. Prehypertensive patients typically see great results with a 20-pound loss–often a drop of 5 to 20 points from their systolic blood pressure!

Reducing Stress

While short-term stressors are nothing to worry about, chronic stress is closely correlated with high blood pressure. This may be because stress leads people to smoke, drink or eat poorly, or because it produces hormones which damage the heart and arteries. In either case, you can address undue levels of stress by simplifying your schedule and taking time to relax. It may seem like there aren’t enough hours in the day, but taking control of your health will ultimately make you more productive, not less.

Addressing Sleep Deficiencies

Poor sleep is also strongly correlated with high blood pressure. If you’re struggling to get a good night’s sleep, you may be able to address the problem with diet, exercise and weight reduction. If you’re still having problems, however, you should consider getting a sleep study to determine whether you have obstructive apnea. If you do, a continuous positive airway pressure (CPAP) machine could be your ticket to restful sleep and lower blood pressure.

An Opportunity for Change

Hypertension is a serious condition, but by making healthier lifestyle choices, you can lower your blood pressure and take control of your health. In doing so, you’ll ultimately feel better and reduce your risk for a variety of chronic diseases. If you’ve recently received a diagnosis of prehypertension, look at it as an opportunity for positive change. Concerned you might be at risk? Find a physician today and schedule an appointment.

High blood pressure should be treated

Hypertension (high blood pressure) is a key cause of preventable illness. It contributes to many strokes, heart attacks and cases of kidney disease.

High blood pressure is very common, but unfortunately most people with hypertension feel perfectly well and may have no idea of the potential consequences of this condition if it is left untreated.

What is high blood pressure?

Blood circulates through our bodies in a network of blood vessels known as the vascular system. The heart acts as a pump, continually pushing blood around the system. When blood pressure is measured, 2 figures are recorded, for example: 120/80 mmHg.

The higher number is called the systolic blood pressure. This is a measure of the highest pressure in the vascular system, which happens with each contraction of the heart. The lower figure, the diastolic pressure, is the pressure in the vascular system between heartbeats.

If either, or both, of these levels are too high, high blood pressure is present.

In general terms, there is cause for concern when the systolic pressure is above 140 mmHg and the diastolic pressure is above 90 mmHg. Readings above 140/90 mmHg are considered to be high blood pressure and are further classified as mild, moderate and severe hypertension.

Sometimes high blood pressure occurs as a result of other diseases, particularly kidney disease. But in many cases there is no obvious cause.

How is high blood pressure (hypertension) treated?

Mild hypertension can often be treated by changes to lifestyle. Weight loss and increased exercise can make a big difference for some people. Other lifestyle measures include quitting smoking, reducing the amount of alcohol you drink and eating a healthy, low-salt diet. These changes can lower blood pressure and your risk of heart disease.

For most cases of moderate and severe hypertension, treatment with medicine is necessary in addition to lifestyle changes. Hypertension is not a disease that can be cured, but it can be controlled.

A wide variety of medicines (known as anti-hypertensive medicines) is now available and treatment is tailored to suit the particular person. For some people, blood pressure may be controlled with a single tablet taken once a day. Others may need more than this and may need a combination of several different medicines to control their blood pressure.

Newer treatments generally have far fewer side effects than the medicines originally used to treat hypertension, and most people continue to live normal lives with the small inconvenience of having to take one or more tablets every day.

Blood pressure checks and staying healthy

It is sensible for all adults to have their blood pressure checked occasionally. If the level is high, your doctor will want to re-check it a few times on separate occasions. If the level remains high, tests (investigations) and treatment may be necessary.

By controlling blood pressure and addressing other risk factors such as smoking, obesity, lack of exercise and a high cholesterol level in the blood, many lives could be prolonged and devastating heart attacks and strokes prevented.

Hypertension – the Preventable and Treatable Silent Killer

2013-03-01

What is blood pressure?

  • Blood pressure is the pressure exerted on the walls of blood vessels as the heart pumps. We need normal blood pressure to push blood through the body so that oxygen and nutrients can reach the tissues.
  • Blood pressure is measured by blood pressure monitors, and is usually measured in millimeters of mercury (mmHg). A blood pressure reading consists of two numbers: The first number (systolic pressure) represents the pressure in the blood vessels when the heart contracts to pump blood, whereas the second number (diastolic pressure) represents the pressure when the heart relaxes between beats.
  • Blood pressure is not static. It fluctuates throughout the day and varies with emotions and different levels of physical activities. For example, blood pressure goes up with anger and anxiety, and drops during rest or sleep.

What is hypertension (high blood pressure)?

  • Hypertension, or high blood pressure, is a chronic disease. It occurs when the pressure exerted on the walls of arteries is persistently elevated.
  • The criteria of diagnosing hypertension are different between adults and children.
    • An adult is said to have hypertension if systolic blood pressure (SBP) is persistently ≥ 140 millimetres of mercury (mmHg) or diastolic blood pressure (DBP) is persistently ≥ 90 mmHg. Typically, an adult should keep his or her SBP and DBP below 120 mmHg and 80 mmHg respectively. SBP between 120 mmHg and 139 mmHg or DBP between 80 mmHg and 89 mmHg is considered pre-hypertension and should be of concern.
    • A child or adolescent is said to have hypertension if the SBP or DBP is ≥ 95th percentile for age, height and gender on repeated measurements.
  • Occasional elevation of blood pressure above the normal range may not be hypertension, since this can be a normal response of the body to stress. But if you are in doubt, seek medical advice.

How common is hypertension in Hong Kong?

  • Hypertension is actually very common among adults in Hong Kong, but the problem is many do not realise they have the disease. A study by the School of Public Health of the University of Hong Kong in 2012 revealed that about 1 in 3 adults in Hong Kong has hypertension, and among them, half did not know about it. In other words, about 1 in 6 persons in Hong Kong has hypertension without knowing it. Among those ever diagnosed with hypertension, 70% were prescribed blood pressure lowering medication, but only about 40% of this treated group attained good control of blood pressure.
  • The study confirmed the well-known “rule of halves” in hypertension –
    • roughly only half of all hypertensive cases are diagnosed,
    • half of those diagnosed are treated, and
    • half of those treated are well-controlled.

What are the causes of hypertension?

  • About 90% of all patients with hypertension are of unknown causes. This type of hypertension is called “primary hypertension” (or “essential hypertension”) and is probably related to hereditary factors. It usually presents after middle age.
  • The remaining 10% patients have the disease because of other diseases, such as kidney diseases or endocrine disorders. This type of hypertension is called “secondary hypertension”.

How do I know if I have hypertension?

  • While very few patients may suffer from headache, dizziness and fatigue, many people with hypertension for years are not aware of it because hypertension typically does not give rise to symptoms. If hypertension goes untreated or is not well controlled, it will damage the arteries and vital organs, in turn leading to coronary heart disease, stroke, retinal disease, kidney failure etc. which are serious consequences. As the first presenting symptom can be stroke or heart attack, this is why hypertension is often called the “silent killer”.
  • Getting regular, accurate blood pressure readings is thus essential for early detection of the problem. Adults aged 18 years or above should have their blood pressure checked at least once every two years. More frequent blood pressure monitoring may be required according to the blood pressure level, age, overall cardiovascular risk profile, and doctor’s advice.
Categories of blood pressure levels in adults and recommended follow-up actions
Category Systolic pressure Diastolic pressure Recommended follow-up actions
Normal < 120 < 80 Re-check within two years
Pre-hypertension 120 – 139 80 – 89 Re-check within a year
Hypertension ≥ 140 ≥ 90 Consult your family doctor for advice

Why is detecting and controlling hypertension so important?

  • Uncontrolled or untreated hypertension can lead to serious, even fatal consequences, including:
    • coronary heart disease and heart attack
    • heart failure
    • stroke
    • retinal disease
    • kidney failure
  • The higher the blood pressure and the longer it goes uncontrolled, the higher the chance and seriousness of complications.

What are common myths about hypertension?

Myth Fact
1. Hypertension cannot be prevented. The risk of hypertension can be reduced by having a healthy lifestyle, in particular reduced salt intake.
2. Patients with hypertension experience headache and fatigue. Most patients with hypertension have no symptom at all. Therefore, it is not reliable to only look out for symptoms. Regular check of the blood pressure is needed.
3. Only overweight or anxious people get hypertension. The risk of having hypertension increases with age. Therefore, everybody should watch their blood pressure, and seek medical advice if in doubt.
4. I have hypertension. My doctor told me that if I start taking medication, I need to take it for life. So I’d better not start taking it. Avoiding drug use will not change the fact that you have hypertension. But if you don’t take medication as directed, you run a much higher chance of having complications and a shorter life.
5. There is no need to continue taking medicine after the blood pressure returns to normal. Hypertension is a chronic disease. It can be controlled with medication, but it cannot be cured. Therefore, patients need to continue with the treatment and lifestyle modifications as advised by their doctor, and attend regular medical follow up, usually for life.

How to prevent and control hypertension?

  • Adopting a healthy lifestyle is essential for preventing and controlling hypertension, including:
    • Cut back on salt (sodium). Healthy adults should consume less than 2 grams of sodium (approximately one level teaspoon of salt) per day. Check the nutrition labels of prepackaged foods for their sodium content.
    • Eat a balanced diet. Consume a diet that is rich in fruit and vegetables with appropriate amounts of whole grain products, fish, nuts, lean meat, and low-fat or fat-free dairy products. Avoid frequent consumption of foods that are high in salt, sugar or oil.
    • Be active and avoid prolonged sitting. Adults should do at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity throughout the week. Inactive persons should start to build up a regular exercise regimen gradually.
    • Maintain an optimal body weight and waistline. For Asian adults, aim to maintain a body mass index (BMI) between 18.5 and 22.9. Irrespective of their BMI, Asian men should keep their waist circumference below 90 cm (~ 36 in) and Asian women should keep theirs below 80 cm (~ 32in).
    • Do not smoke. Quitting smoking markedly reduces overall cardiovascular risk. Those who want to quit smoking can call the Integrated Smoking Cessation Hotline of the Department of Health at 1833 183 for free advice and help. They can also visit the website of the Tobacco and Alcohol Control Office to download the free Quit Smoking iPhone or Android App.
    • Limit alcohol. Avoid alcoholic drinks. If you must drink alcohol, limit its intake to minimise alcohol-related harm.
    • Manage stress with healthy coping strategies, such as practising yoga, Tai Chi or deep breathing. Seek help from family and friends or health professionals if necessary.
    • Ensure enough sleep and rest.
  • If you have hypertension, you need to take your medication as directed by the doctor. Understand what the medication is for, how and when to take it. Attend regular medical follow up.

How to monitor blood pressure at home?

  • Checking your blood pressure at home is an important part of monitoring blood pressure and managing hypertension. There are many easy-to-use digital automatic blood pressure monitors in the market for home blood pressure monitoring.
  • Blood pressure measurements taken casually, without following standard procedures, produce unreliable results. Imprecise measurements, even those that are off by just a few points, can lead to inappropriate treatment. So it is important to get accurate blood pressure readings.
  • Here are a few tips on how to choose blood pressure monitors and how to get accurate readings:

How to choose blood pressure monitors

Arm monitor or wrist monitor:

  • The common digital monitors can be fitted on the upper arm or the wrist. Upper arm devices should preferably be used as they are more accurate. Wrist monitors may be used by people for whom a large upper arm cuff is too small or cannot be used because of shape or pain from the pressure of the cuff when it inflates. Speak with a doctor or qualified health care provider about which blood pressure monitor is right for you. Devices that measure blood pressure at the finger are not recommended.

Cuff size:

  • Blood pressure cuffs of upper arm devices come in different sizes. The wrong cuff size will give incorrect readings: using a cuff that is too small for the arm may overestimate blood pressure and one that is too big may underestimate it. So make sure the cuff size fits your arm. The cuff should be wide enough to cover two thirds of the upper arm and its length should be long enough to encircle the whole arm. Most monitors will come with medium-sized cuffs which suit most adults. People with large arm or overweight people may need bigger cuff. You may seek advice from your doctor or the supplier of the blood pressure monitor.

Validation of monitor:

  • Make sure the monitor you choose has been clinically validated for accuracy. Read the manual carefully and operate the device according to the manufacturer’s instructions. It is not uncommon for blood pressure readings taken at home to be different from those taken at your doctor’s office. If the blood pressure monitor is not too bulky, it is a good idea that you bring it along to your doctor’s appointment. Your doctor can help validate your monitor’s accuracy.

How to get accurate readings

When to measure:

  • Measure blood pressure at around the same time each day.
  • Do not measure blood pressure when you feel unwell, cold, anxious, stressed, in pain, or have a full bladder.

Before recording:

  • Do not exercise, smoke or consume foods or drinks containing caffeine (such as tea or coffee) at least 30 minutes before measurement.
  • Remember to wear loose-fitting clothes.
  • Rest and relax for 5 minutes without distractions (e.g. watching television).

Arm position:

  • Be seated comfortably with the back supported.
  • Push up the sleeve to bare your upper arm and wrap the cuff around your upper arm.
  • Make sure your arm is supported and your upper arm is at the same level as your heart.
  • Keep feet on the floor and do not cross legs.

Recording:

  • Relax and do not talk while taking the reading.
  • After the first measurement, release cuff pressure completely and repeat the same steps to obtain another reading of blood pressure. The two measurements should be taken at least 1 minute apart.
  • Take the average value of at least two readings. If the first two readings differ by more than 5 mmHg, additional readings should be obtained before taking the average.
  • Record down the readings to obtain a continuous monitoring.
  • Consult a doctor or a nurse if you have any concerns.

Further Information

Can You Be Cured of High Blood Pressure?

Doctor’s Response

Lifelong control of hypertension will minimize the risk of developing heart attack, stroke, kidney failure, blindness, and a variety of other illnesses. Unlike other illnesses in which medications are taken for only a short period of time, high blood pressure medication is usually expected to be taken for the rest of the individual’s life.

That said, it is uncommon, but not rare, that significant lifestyle changes can lower blood pressure readings to normal. Here are some tips that might help you minimize your medication, under the supervision of your doctor, of course:

  • Eat a nutritious, low-fat diet. The National Heart, Lung and Blood Institute of the NIH outlines the DASH diet, that is describes as a “flexible and balanced eating plan that helps create a heart-healthy eating style for life.”
  • Get regular exercise.
    • Physical activity reduces total cholesterol and bad cholesterol (low density lipoprotein or LDL) and raises the good cholesterol (high density lipoprotein or HDL).
    • Both the American Heart Association (AHA) and the U.S. Surgeon General recommend 30 minutes of physical activity on most days of the week.
    • Physical activity includes many daily activities such as cleaning the house, raking the lawn, and walking. Other possible sources of activity can include using the stairs instead of an elevator or escalator, walking for errands instead of driving a car, and participating in a sport or social activity such dancing.
  • Decrease salt (sodium) intake, read food labels so you know the salt content before you buy a product in the grocery store or eating a meal at a fast food restaurant, and avoid adding salt to foods.
  • Maintain a healthy weight, and if you are overweight or obese, try to lose weight.
    • Aim for a healthy weight range for your height and body type. Your health care practitioner can help you calculate a healthy target weight.
    • Even a small amount of weight loss can make a major difference in lowering or preventing high blood pressure.
    • You must burn more calories than you take in to lose weight.
    • Crash or fad diets are not helpful and may be dangerous.
    • Some weight loss medications also carry major risks and may even elevate blood pressure, and great caution is advised in using these drugs. Please ask your health care practitioner or pharmacist for help in deciding if a weight loss medication is appropriate for your situation.
  • Drink alcohol in moderation.
  • Stop smoking.
  • Get routine health assessments and blood pressure screening.
  • Take your blood pressure medications as directed, even if you’re feeling fine.
  • Reduce stress and practice relaxation techniques, for example, meditation, Yoga, Tai Chi, and other types of physical activity.

Alternative therapies may be helpful to people trying to control their blood pressure.

  • Acupuncture and biofeedback are well-accepted alternative techniques that may help some people with high blood pressure.
  • Techniques that induce relaxation and reduce stress are recommended. These include meditation, yoga, and relaxation training.
  • These techniques alone may not control high blood pressure for many people. They should not be used as a substitute for medical therapy without first consulting with your health care practitioner.

Dietary supplements and alternative medications and therapies are sometimes recommended for high blood pressure.

  • Examples include vitamins, garlic, fish oil, L-arginine, soy, coenzyme Q10, herbs, phytosterols, and chelation therapy.
  • While these substances may be beneficial, the exact nature of their benefits is not known.
  • Scientific studies have produced no evidence that these therapies lower blood pressure or prevent the complications of high blood pressure.
  • Most of these substances are harmless if taken in moderate doses. Most people can take them without problems.
  • Talk to your health care practitioner if you are considering any of these treatments. Substituting these therapies for medical therapies that have been shown to lower blood pressure and the risk of complications may have a harmful effect on your health.

Remember, even though it may be distasteful, stick to your medication if your doctor directs you to. Untreated or poorly controlled high blood pressure is a major risk factor for heart attack, stroke, and kidney failure. That is why high blood pressure is called “the silent killer.”

What happens when you hit a high blood pressure plateau?

You’ve made lifestyle changes. You’re taking a diuretic and at least two other blood pressure medicines. But your blood pressure still isn’t budging. This is called resistant hypertension. Simply put, it means that your high blood pressure (HBP or hypertension) is hard to treat and may also have an underlying (secondary) cause.

Possible causes of resistant hypertension

Resistant hypertension may have one or more other underlying medical conditions. In addition to treating resistant hypertension with medications, doctors typically investigate secondary causes (contributing factors), such as:

  • Abnormalities in the hormones that control blood pressure.
  • The accumulation of artery-clogging plaque in blood vessels that nourish the kidneys, a condition called renal artery stenosis.
  • Sleep problems, such as the breath-holding type of snoring known as obstructive sleep apnea.
  • Obesity or heavy intake of alcohol or other substances that can interfere with blood pressure.

Monitoring and treatment of resistant hypertension

Reining in blood pressure levels begins with the basics, such as understanding your pressure patterns. Sometimes that means wearing a pager-sized automatic blood pressure recorder for 24 hours or checking pressure with an at-home monitor several times a day. Treatment also usually involves a change or addition of medications and investigation of secondary causes – along with key lifestyle changes, including:

  • Eating a well-balanced, low-salt diet
  • Limiting alcohol
  • Enjoying regular physical activity
  • Maintaining a healthy weight
  • Managing stress
  • Taking your medications properly. People with resistant hypertension should take the right medications, in the right doses, at the right time. DO NOT take medications or supplements that can boost blood pressure, such as diet pills and stimulants, cyclosporine, natural licorice, ephedra and painkillers and non-steroidal anti-inflammatory agents (NSAIDs), such as ibuprofen and celecoxib.

Related links:

  • Find out more about lifestyle changes you can make to manage your blood pressure
  • Learn what high blood pressure can do to your body

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