Global survey of current practice in management of hypertension as reported by societies affiliated with the international society of hypertension

Abstract

The International Society of Hypertension (ISH) surveyed trends in the management of hypertension worldwide, as reported by its affiliated societies. A formal questionnaire was emailed in December 2011 to 90 national and regional societies affiliated with the ISH, from 77 countries. Responses received by June 2012 were analysed. Thirty-one societies responded (nine high-income, 17 upper-middle-income, five lower-middle/low-income countries). Twenty-one reported use of national guidelines, three used regional and 17 used 'international guidelines', two-thirds used mercury, aneroid and semi-automatic sphygmomanometers and half used ambulatory blood pressure monitoring. Exercise, salt restriction and weight reduction were recommended by 31, 27 and 26 nations, respectively, but less for other diets, smoking cessation and alcohol restriction. Almost all nations used angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers and diuretics. β Blockers were only recommended for patients with coronary disease. ACEI and ARB were preferred for patients with diabetes, renal disease and metabolic syndrome. Combination treatment was recommended by all, for initiation of treatment by most, and in fixed-dose formulation by half. Most used a threshold of 140/90 mmHg to initiate drug treatment in uncomplicated patients but only half retained the threshold of 130/80 mmHg for high-risk patients. Differences in treatment patterns across regions or across high, middle and low-income countries were minimal. There was surprising consistency across countries from different regions and with varying degrees of affluence. There was a trend towards more conservative thresholds and targets than those recommended by JNC7 or ESH/ESC 2007. Combination therapy was favoured by all, but β blockers were restricted to patients with coronary heart disease.