Abstract
Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.
Highlights
Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries
Cardiovascular disease (CVD) is the leading cause of death worldwide, with most deaths attributed to hypertension resulting from coronary heart disease or stroke and more than three quarters of these deaths occurring in low- and middle-income countries.[1]
Clinical trials have repeatedly demonstrated that lowering blood pressure (BP) in adults with high baseline BP level provides an effective means for preventing CVD
Summary
Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. In 1978, the World Health Organization (WHO) published one of the earliest clinical practice guidelines for the diagnosis and management of arterial hypertension, which were later updated in 1999 and 2003.6,7 In 2007, the WHO published some recommendations for the management of hypertension in guidelines for the assessment and management of total CVD risk These are outdated considering new evidence and practices.[8] Guidance is needed on some controversial issues, such as the threshold level of BP at which to start pharmacological treatment and whether laboratory testing and CVD risk assessment are needed before initiating antihypertensive pharmacological therapy. The 2021 WHO hypertension guidelines aim to provide the most current and relevant evidence-based guidance for pharmacological treatment of hypertension in nonpregnant adults, with a particular focus on practice in middle- and low-income countries
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