Earlier this year, the World Health Organization (WHO) released a new guideline for the pharmacological treatment of hypertension in adults. The key recommendations are as below:

• Start antihypertensive treatment of individuals with a confirmed diagnosis of hypertension and systolic blood pressure of ≥140 mmHg or diastolic blood pressure of ≥90 mmHg.
• Persons with existing heart disease and systolic BP ranging between 130 and139 mmHg should be put on pharmacological antihypertensive treatment.
• Pharmacological antihypertensive treatment should be considered in patients with no heart disease but with high cardiovascular risk, diabetes mellitus, or chronic kidney disease and systolic BP of 130–139 mmHg.
• Screen patients for comorbidities and secondary hypertension before initiating antihypertensive treatment. However, screening should not delay or hinder starting treatment.
• Assess cardiovascular risk at the time of starting antihypertensive treatment, or after, but only where this is feasible and does not delay treatment.
• Drugs from any of the following three classes of antihypertensives as an initial treatment can be considered: thiazide and thiazide-like agents, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs) and long-acting dihydropyridine calcium channel blockers (CCBs).
• For adults with hypertension requiring pharmacological treatment, combination therapy, preferably with a single-pill combination (to improve adherence and persistence), is suggested as an initial treatment.
• In hypertensive patients without comorbidities, the recommended target BP goal is <140/90 mmHg.
• In patients with hypertension and known heart disease, the recommended target BP goal is <130mmHg.
• A target systolic BP treatment goal of <130 mmHg is recommended in high-risk patients with hypertension (those with high CVD risk, diabetes mellitus, chronic kidney disease.
• Patients should be followed up every month after starting medication or change in antihypertensive medications until patients reach their target BP. Patients in whom the BP is under control, should be followed up every 3-6 months.

 Source: Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization; 2021.