Table 3.

Summary of potential impact and solutions for application of the ACC/AHA guidelines in LMICs

Recommendation	Impact	Solutions
Diagnose hypertension at a BP ≥130/80 mm Hg	Increased hypertension prevalence/larger population requiring diagnostic workup and close initial follow‐up, leading to health system congestion	Allocate additional resources to meet increased demand
Increase detection and evaluation of individuals with BP ≥ 130/80 mm Hg, particularly persons at high risk or unaware of the condition		Consider utilizing nonphysician, team‐based approach and protocols for BP management in patients with low risk or stage 1 hypertension
Treat BP to a target < 130/80 mm Hg	More individuals who require BP‐lowering medications	Improve medication procurement and distribution
		Prescribe low‐cost, high‐quality, effective generic BP‐lowering medicines
	More medications needed per patient to meet BP targets	Consider fixed, single‐pill combinations to decrease pill burden, reduce side effects, and increase adherence
	Higher risk of side effects including syncope and falls	Stratify patients at increased risk of complications and utilize a more gradual approach to medication titration and addition
Treat stage 1 hypertension based on ASCVD risk	Need for additional laboratory testing	Negotiate affordable point‐of‐care lipid and glucose testing
		Utilize the PAHO/WHO risk calculator
Encourage out‐of‐office BP measurement	Increased cost of acquiring validated machines	Encourage BP check visits in clinic
		Facilitate BP measurement in pharmacies, supermarkets, barbershops, and other public spaces to help offset cost

ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; JNC 7, Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; LMICs, low‐ and middle‐income countries; PAHO, Pan American Health Organization; WHO, World Health Organization.