World Health Organization issues new guidelines to control hypertension

The World Health Organization on Wednesday came out with a new guideline on blood pressure control suggesting that a systolic pressure of 130 should be the threshold to start medication in people with a history of heart complications or other risk factors whereas for others such a threshold would be 140/90.

In its new guideline, the WHO recommended initiating anti-hypertensive treatment with medicine for people with a past history of heart diseases, or diabetes or chronic kidney diseases if their systolic blood pressure is between 130-139. For others, the treatment can start at 140/90.

The global health agency came out with the new guidelines after 21 years and following detailed analysis of the latest scientific research on elevated blood pressure that has emerged as a key risk factor behind a large number of deaths.

Read | One-third of Indians suffer from hypertension: Study

High blood pressure is directly linked to more than 8.5 million deaths worldwide each year and is the leading risk factor for stroke, ischaemic heart disease, other vascular diseases, and renal disease.

Lowering blood pressure can cut the number of strokes by 35%-40%, heart attacks by 20%-25%, and heart failure by around 50%, says a study published in the Lancet on Tuesday.

The comprehensive analysis in the Lancet charting hypertension prevalence, diagnosis, treatment and control in 200 countries over the past 30 years reveals that 720 million people with hypertension worldwide were untreated in 2019.

Despite being straightforward to diagnose and relatively easy to treat with low-cost drugs, nearly half of people (41% of women and 51% of men) with hypertension worldwide in 2019 were unaware of their condition, and more than half of women (53%) and men (62%) with the condition weren’t treated.

The new WHO guidelines differ in two specific ways from the standard treatment protocol for hypertension released by India’s health ministry in February 2016.

The Indian protocol requires people with blood pressure readings 130-39/80-89 to be advised a recheck after a year and sooner if they have other cardiovascular risk factors, whereas the WHO recommends treatment with medicine at any level above the threshold of 130 for people who have existing cardiovascular disease, or are at high risk through diabetes or chronic kidney disease.

Also, the Indian protocol recommends treatment initiation with a single drug for patients with blood pressure readings lower than 180/110 but the WHO recommends a two-drug combination therapy for adults.

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