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In their discussion, Drs. Hyeok Hee Lee and Eric Secemsky expand on findings from the JACC study “Trends in Prevalence, Treatment, and Control of Cardiometabolic Risk Factors Among Adults With Hypertension in the US, 1999–2023” which shows a rising burden of diabetes, hyperlipidemia, obesity, smoking, and high risk alcohol use among patients with hypertension—and persistently poor joint control of blood pressure, glucose, and lipids, achieved in fewer than one in four affected individuals. They highlight how fragmented, single risk factor care models have failed to keep pace with an increasingly multimorbid population, contributing to polypharmacy, low adherence, and stagnant outcomes. Both physicians call for integrated cardiometabolic management, emphasizing emerging therapies such as GLP 1 agonists and renal denervation that can act across multiple risk pathways to reduce pill burden, improve adherence, and better address the intertwined continuum of cardio kidney metabolic disease.