Table 1.
WHO guideline recommendations for the pharmacological treatment of hypertension in adults.
| Recommendation | Strength of recommendation/certainty of evidence |
|---|---|
| Recommendation on Blood Pressure Threshold for Initiation of Pharmacological Treatment | |
| Initiate pharmacological antihypertensive treatment of individuals with a confirmed diagnosis of hypertension and systolic blood pressure of ≥ 140 mmHg or diastolic blood pressure of ≥ 90 mmHg. | Strong / moderate to high |
| Initiate pharmacological antihypertensive treatment of individuals with existing cardiovascular disease (CVD) and systolic blood pressure of ≥ 130 mmHg. | Strong / moderate to high |
| Suggests pharmacological antihypertensive treatment of individuals without CVD but with high CVD risk, diabetes mellitus, or chronic kidney disease, and systolic blood pressure of 130–139 mmHg. | Conditional / low |
| Recommendation on Laboratory Testing | |
| Suggests obtaining tests to screen for comorbidities and secondary hypertension when starting pharmacological therapy for hypertension, but only when testing does not delay or impede starting treatment. | Conditional / low |
| Recommendation on CVD Risk Assessment | |
| Suggests CVD risk assessment at or after the initiation of pharmacological treatment for hypertension, but only where this is feasible and does not delay treatment. | Conditional / low |
| Recommendation on Drug Classes to be Used as First-Line Agents | |
Use of drugs from any of the following three classes of pharmacological antihypertensive medications as an initial treatment in those requiring pharmacological treatment:
|
Strong / high |
| Recommendation on Combination Therapy | |
| Suggests combination therapy, preferably with a single-pill combination (to improve adherence and persistence), as an initial treatment for adults with hypertension requiring pharmacological treatment. Antihypertensive medications used in combination therapy should be chosen from the following three drug classes: diuretics (thiazide or thiazide-like), ACEIs/ARBs, and long-acting dihydropyridine calcium channel blockers (CCBs). | Conditional / moderate |
| Recommendations on Target Blood Pressure | |
| Recommends a target blood pressure treatment goal of < 140/90 mmHg in all patients with hypertension without comorbidities. | Strong / moderate |
| Recommends a target systolic blood pressure treatment goal of <130 mmHg in patients with hypertension and known CVD. | Strong / moderate |
| Suggests a target systolic blood pressure treatment goal of <130 mmHg in high-risk patients with hypertension (those with high CVD risk, diabetes mellitus, chronic kidney disease). | Conditional / moderate |
| Recommendations on Frequency of Assessment | |
| Suggests a monthly follow up after initiation or a change in antihypertensive medications until patients reach target. | Conditional / low |
| Suggests a follow up every 3–6 months for patients whose blood pressure is under control. | Conditional / low |
| Recommendation on Treatment by Non-physician Professionals | |
| Suggests that pharmacological treatment of hypertension can be provided by nonphysician professionals such as pharmacists and nurses, if the following conditions are met: proper training, prescribing authority, specific management protocols and physician oversight. | Conditional / low |