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

Cover of Guideline for the pharmacological treatment of hypertension in adults

Guideline for the pharmacological treatment of hypertension in adults [Internet].

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WEB ANNEX BEvidence-to-decision frameworks

Acronyms and abbreviations

ACE1

angiotensin-converting enzyme 1

ACE2

angiotensin-converting enzyme 2

ACEi

angiotensin-converting enzyme inhibitor

AE

adverse events

ARB

angiotensin-II-receptor blocker

BB

beta-blocker

BP

blood pressure

CAD

coronary artery disease

CCB

calcium channel blocker

CKD

chronic kidney disease

CV

cardiovascular

CVD

cardiovascular disease

DBP

diastolic blood pressure

DM

diabetes mellitus

ECG

electrocardiogram

GDG

Guideline Development Group

eGFR

estimated glomerular filtration rate

GRADE

Grading of Recommendations Assessment, Development and Evaluation

HCW

health care worker (nonphysician)

HF

heart failure

HIC

high-income country

HTN

hypertension

ICER

incremental cost-effectiveness ratio

LIC

low-income country

LVH

left ventricular hypertrophy

MACE

major adverse cardiovascular event

MI

myocardial infarction

MIC

middle-income country

NCD

noncommunicable disease

PICO

population intervention comparator outcome

QALY

quality-adjusted life year

RAAS

renin-angiotensin-aldosterone system

RCT

randomized-controlled trial

RR

relative risk

SBP

systolic blood pressure

SES

socioeconomic status

PICO question 1: At what level of blood pressure should pharmacological therapy be started to prevent cardiovascular events?

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PICO question 2: Is any laboratory testing necessary prior to initiation or during titration of pharmacological treatments?

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PICO question 3: Should cardiovascular risk assessment be used to guide initiation of antihypertensive medications?

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PICO questions 4–5: In adults with hypertension requiring pharmacological treatment, which drugs should be used as first-line agents? In adults with hypertension requiring pharmacological treatment, which drugs (BB, CCB, diuretics, ACE, or ARB vs BB, CCB, diuretics, ACE, or ARB in head-to-head studies) should be used as first-line agents?

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PICO question 6: In adults with hypertension requiring pharmacological treatment, which drugs (monotherapy using BB, CCB, diuretics, ACE or ARB vs combination therapy using BB, CCB, diuretics, ACE or ARB) should be used as first-line agents?

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PICO question 7: In adults with hypertension requiring pharmacological treatment, which drugs combination therapy of two or more drugs (BB, CCB, diuretics, ACE, or ARB) vs different combination therapy of two or more drugs (BB, CCB, diuretics, ACE, or ARB) should be used as first-line agents?

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PICO question 8: In adults with hypertension requiring pharmacological intervention, is use of a single-pill combination of antihypertensives drugs associated with improved outcomes?

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PICO question 9: What target BP should pharmacologic treatment aim to achieve?

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PICO question 10: In adults with hypertension given pharmacological treatment, when should BP be reassessed?

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PICO question 11: Can pharmacological management of hypertension be provided by nonphysician care providers?

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