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REFLECTIONS
Hypertension
Hypertension Global Newsletter #6 2024

WHO guideline recommendations on the pharmacological treatment of hypertension in adults Hypertension

1. Recommendation on blood pressure threshold of initiation of pharmacological treatment

WHO recommends initiation of pharmacological antihypertensive treatment of individuals with a confirmed diagnosis of
hypertension and SBP of ≥140 mmHg or DBP of ≥90 mmHg.
WHO recommends pharmacological antihypertensive treatment of individuals with existing cardiovascular disease (CVD) and
SBP of 130–139 mmHg.

WHO suggests pharmacological antihypertensive treatment of individuals without CVD but with high CV risk, diabetes mellitus,
or CKD, and SBP of 130–139 mmHg.

2. Recommendation on laboratory testing
When starting pharmacological therapy for hypertension, WHO suggests obtaining tests to screen for comorbidities and
secondary hypertension, but only when testing does not delay or impede starting treatment.

3. Recommendation on cardiovascular disease risk assessment
WHO 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.
4. Recommendation on drug classes to be used as first-line agents

For adults with hypertension requiring pharmacological treatment, WHO recommends the use of drugs from any of the following
three classes of pharmacological antihypertensive medications as an initial treatment:
1. Thiazide and thiazide-like agents
2. Angiotensin converting-enzyme inhibitors (ACEis)/angiotensin receptor blockers (ARBs)
3. Long-acting dihydropyridine calcium channel blockers (CCBs)

5. Recommendation on combination therapy
For adults with hypertension requiring pharmacological treatment, WHO suggests combination therapy, preferably with a
single-pill combination (to improve adherence and persistence), as an initial 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 CCBs.

6. Recommendations on target blood pressure

WHO recommends a target BP treatment goal of <140/90 mmHg in all patients with hypertension without comorbidities.
WHO recommends a target SBP treatment goal of <130 mmHg in patients with hypertension and known CVD.
WHO suggests a target SBP treatment goal of <130 mmHg in high-risk patients with hypertension (those with high CVD risk,
diabetes mellitus, CKD).
7. Recommendations on frequency of assessment

WHO suggests a monthly follow-up after initiation or a change in antihypertensive medications until patients reach target.
WHO suggests a follow-up every three to six months for patients whose BP is under control.

8. Recommendation on treatment by non-physician professionals
WHO suggests that pharmacological treatment of hypertension can be provided by non-physician professionals such as
pharmacists and nurses, if the following conditions are met: proper training, prescribing authority, specific management
protocols, and physician oversight.

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