From the Guidelines
The latest hypertension guidelines, as per the 2022 World Health Organization (WHO) guideline executive summary 1, recommend initiating pharmacological treatment in adults with a blood pressure threshold of 140/90 mmHg, with a treatment target of less than 140/90 mmHg for most adults. The guidelines emphasize the importance of a comprehensive treatment plan that includes lifestyle modifications, such as a healthy diet, regular physical activity, and limited alcohol consumption, in addition to pharmacological treatment. For pharmacological treatment, the WHO Essential Medicines List includes ACE inhibitors, calcium channel blockers, angiotensin receptor blockers, and thiazide diuretics as first-line medications 1. Some key points to consider when managing hypertension include:
- Initiating treatment with a single agent in stage 1 hypertension (130-139/80-89 mmHg) and two agents for stage 2 hypertension (≥140/90 mmHg)
- Monitoring blood pressure regularly, with home monitoring encouraged to guide treatment adjustments
- Considering comorbidities, such as diabetes or chronic kidney disease, when selecting pharmacological agents
- Using single-pill combination antihypertensive medications, which were added to the WHO Essential Medicines List in 2019, to improve adherence and simplify treatment regimens 1. The ultimate goal of these guidelines is to reduce the risk of cardiovascular events, stroke, and kidney disease, which are leading causes of morbidity and mortality worldwide, by providing evidence-based guidance for the pharmacological treatment of hypertension in non-pregnant adults, particularly in middle- and low-income countries 1.
From the Research
Latest Hypertension Guidelines
The latest guidelines for hypertension management recommend a multifaceted approach, including lifestyle modifications and pharmacologic therapy.
- First-line therapy for hypertension is lifestyle modification, consisting of:
- Weight loss
- Healthy dietary pattern with low sodium and high potassium intake
- Physical activity
- Moderation or elimination of alcohol consumption 2
- The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk.
- First-line drug therapy for hypertension consists of:
- Blood pressure targets are:
- Less than 130/80 mm Hg for adults under 65 years
- Less than 130 mm Hg for adults 65 years and older 2
- Lifestyle modifications have been shown to decrease resting blood pressure and reduce the risk of cardiovascular disease morbidity and mortality 5, 6
Special Considerations
- In black patients, thiazide diuretics or calcium channel blockers are preferred 3, 4
- In patients with chronic kidney disease, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker plus a thiazide diuretic or calcium channel blocker is recommended 3, 4
- In patients with diabetes mellitus, treatment should include an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, unless proteinuria is present, in which case combination therapy should include an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker 4