From the Guidelines
The latest hypertension guidelines recommend a blood pressure target of less than 130/80 mmHg for most adults. This is based on the most recent evidence from the World Health Organization (WHO) guidelines for the pharmacological treatment of hypertension in adults, published in 2022 1. Treatment should begin with lifestyle modifications including the DASH diet, sodium restriction to less than 2,300 mg daily, regular physical activity, weight management, and limiting alcohol consumption. For pharmacological treatment, first-line medications include thiazide diuretics, calcium channel blockers, ACE inhibitors, or ARBs. Most patients will require two or more medications to achieve target blood pressure.
Key Recommendations
- For Black patients, initial therapy should include a thiazide diuretic or calcium channel blocker.
- For patients with specific comorbidities, medication choices should be tailored:
- ACE inhibitors or ARBs for those with diabetes or chronic kidney disease.
- Beta-blockers for those with coronary artery disease or heart failure.
- Blood pressure should be monitored regularly, with home monitoring encouraged to confirm diagnosis and assess treatment effectiveness.
Rationale
These lower targets are based on evidence showing reduced cardiovascular events and mortality with more intensive blood pressure control, particularly in high-risk individuals. The WHO guidelines aim to provide the most current and relevant evidence-based guidance for pharmacological treatment of hypertension in non-pregnant adults, with a particular focus on practice in middle- and low-income countries. The guidelines emphasize the importance of lifestyle modifications and management of other cardiovascular disease risk factors, such as cigarette smoking, diabetes, lipid abnormalities, and comorbid conditions.
Evidence Base
The WHO guidelines are based on a comprehensive review of the evidence, including systematic reviews and meta-analyses. The guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, which provides a framework for evaluating the quality of evidence and making recommendations. The guidelines are intended to be used in routine, primary care settings and do not address the treatment of hypertensive emergencies or urgencies, secondary forms of hypertension, or resistant hypertension.
From the Research
Latest Guideline for Hypertension
The latest guidelines for hypertension recommend lifestyle management as the first-line strategy to prevent and control hypertension in adulthood 2. This approach includes maintaining a healthy body weight, increasing physical activity, eating a healthy diet, avoiding smoking and alcohol, and managing stress and sleep levels.
Key Recommendations
- Maintain a healthy body weight to reduce the risk of hypertension 2, 3
- Engage in regular physical activity to lower blood pressure and reduce the risk of cardiovascular disease 2, 3
- Follow a healthy eating pattern, such as the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fruits, vegetables, whole grains, and low-fat dairy products 4, 5, 6
- Limit sodium intake and consume potassium-rich foods to help lower blood pressure 2, 5
- Avoid smoking and limit alcohol consumption to reduce the risk of hypertension and cardiovascular disease 2, 3
- Manage stress and get adequate sleep to help regulate blood pressure 2, 3
Blood Pressure Goals
- The recommended blood pressure goal is less than 140/90 mmHg for most adults, including those with chronic kidney disease and diabetes mellitus 4
- For adults over 60 years, a blood pressure goal of less than 150/90 mmHg is recommended 4
Lifestyle Interventions
- Lifestyle interventions, such as regular physical exercise, body weight management, and healthy dietary patterns, can help prevent and treat hypertension 3
- Digital lifestyle interventions, such as mobile apps and online programs, can also be effective in helping individuals manage their blood pressure and adopt healthy lifestyle habits 2, 5