WHO releases new blood pressure guidelines as number untreated reaches 720million

10 October 2021

This August, the World Health Organisation (WHO) published their Guideline for the pharmacological treatment of hypertension in adults, providing new recommendations to help countries improve the management of hypertension (high blood pressure). The guidelines include the most current and relevant evidence-based guidelines for starting treatment.

The recommendations include:

1. The threshold of blood pressure for starting medication: systolic blood pressure (the top number) of ≥140 mmHg or diastolic blood pressure (the bottom number) of ≥90 mmHg. The threshold is lower for people with existing disease of the heart and blood vessels at 130–139 mmHg.
2. Laboratory testing for other diseases (where it doesn’t cause a delay).
3. Risk assessment for diseases of the heart and blood vessels.
4. Which drugs to use first, including thiazide and thiazide-like agents, ACE inhibitors, ARBs, and calcium channel blockers (CCBs).
5. Deciding whether to use one or two medicines or a combination pill: the guidelines recommend a combination pill to improve adherence and persistence (using medicines as prescribed in the long term).
6. The target blood pressure level: <140/90mmHg for people without other disease, and <130mmHg for those with.
7. How often to have follow-up checks: monthly after starting or changing medicines, then every 3-6 months.
8. Which health professionals can prescribe medicines, including nurses, with proper training and management.

The guidelines also provide a basis for how health professionals can help improve the detection of high blood pressure – as it is commonly undiagnosed. High blood pressure is a major cause of heart attacks, strokes and other disease, at huge cost to individuals and health care services around the world, but once diagnosed the treatments are simple and inexpensive.

720 million are not receiving treatment for high blood pressure

The WHO published their guidelines on the same day that they released the latest figures for those living with high blood pressure in collaboration with Imperial College London. Data shared by researchers around the world, collected from 1990 to 2019, showed:

• 1.28 billion adults aged 30-79 have high blood pressure, doubling from 650 million 30 years ago.
  
  
• 720 million people are not receiving the treatment they need – that’s more than half of those with high blood pressure (53% of women and 62% of men).
  
  
• About 580 million people with high blood pressure don’t know it because it has not been diagnosed.
  
  
• Less than a quarter of women and a fifth of men with high blood pressure have it brought under control with medicines.

The percentage of the population with high blood pressure has not changed much since 1990 but the total number has risen due to a growing and aging population. Importantly, there has been a shift in prevalence from richer countries to poorer. Now, 80% of those with high blood pressure are in poorer countries.

The World Heart Federation (WHF) has since published their WHF Roadmap on Hypertension, which complements the new guidelines and provides practical suggestions for health professionals.

CEO of Blood Pressure UK Phil Pyatt says: “In the UK and around the world, we need better detection of high blood pressure and more effective ways of managing it. We welcome the new guidelines and their potential to improve both, including recognising the roles of different health professionals for prescribing medicines, identifying other health problems and disease risk, and reaching those who are undiagnosed.

“It’s interesting to see the recommendation for use of a combination pill combining more than one blood pressure drug, aiming to make it easier for people to take their medicines – as this is an important barrier to getting blood pressure under control. Combination pills are currently recommended in Europe and the evidence and expert opinion is heading more and more in this direction.”