# Blood pressure lowering medicine

Intervention · id `cardio:bp-lowering-medicine` · Cardiovascular Atlas · release `2b2017b84496b985` (public)

> General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here.

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Also called: Antihypertensive medicine; Antihypertensive drug treatment

Browse, organ or system: Blood vessels  
Browse, condition area: High blood pressure  

## In plain language

Medicines that lower blood pressure, started and adjusted for adults whose high blood pressure is confirmed.

## Technical summary

Pharmacological antihypertensive treatment as framed by the WHO 2021 guideline: when to start (recommendation 1, three statements with different populations and strength labels), the first-line drug classes (recommendation 4) and combination therapy as initial treatment (recommendation 5). The classes are thiazide and thiazide-like agents, ACE inhibitors or angiotensin-receptor blockers, and long-acting dihydropyridine calcium channel blockers. Targets sit on the linked target record. Treatment steps in NICE NG136 were not read by this cluster. Each recommendation claim states its own population and strength label. One effect claim comes from a pooled analysis of 48 trials of blood-pressure-lowering medicines (BPLTTC, Lancet 2021), whose participants are not described as adults.

## Claims, with the population each applies to

## Context: Participants in 48 randomised blood-pressure-lowering trials (BPLTTC 2021 meta-analysis)

Recipient: Recipient not specified; Population: People randomised in 48 trials of blood-pressure-lowering medicines, analysed in two groups: those with and those without previous cardiovascular disease, defined as stroke, myocardial infarction or ischaemic heart disease before randomisation. Mean age at baseline was 65 years in both groups. The age range is not reported in the text read, which does not describe the participants as adults, and it does not say how pregnancy was handled.; Care setting: Randomised clinical trials of blood-pressure-lowering medicines. The settings of the individual trials are listed in the paper's appendix, which was not read.; Geography: Not stated in the text read (the trial list is in the appendix, which was not read); Life stage: Not stated in the text read; mean age 65 years at baseline, age range not reported; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Median follow-up of 4.15 years across the trials (Q1 to Q3 2.97 to 4.96 years).

### In a pooled analysis of individual-participant data from 48 randomised trials of blood-pressure-lowering medicines (344,716 people, median follow-up 4.15 years), a 5 mm Hg lower systolic blood pressure from treatment was associated with a lower risk of a major cardiovascular event: a stroke, a heart attack or ischaemic heart disease, or heart failure that caused death or needed hospital admission. The hazard ratio was 0.91 (95% CI 0.89 to 0.94) in people without previous cardiovascular disease and 0.89 (95% CI 0.86 to 0.92) in people with it. The authors report no reliable evidence that this proportional effect differed between the two groups.

- Category: Effect
- Evidence stage: Evidence synthesis
- Certainty: Certainty not assessed
- Applies to: Recipient: Recipient not specified; Population: People randomised in 48 trials of blood-pressure-lowering medicines, analysed in two groups: those with and those without previous cardiovascular disease, defined as stroke, myocardial infarction or ischaemic heart disease before randomisation. Mean age at baseline was 65 years in both groups. The age range is not reported in the text read, which does not describe the participants as adults, and it does not say how pregnancy was handled.; Care setting: Randomised clinical trials of blood-pressure-lowering medicines. The settings of the individual trials are listed in the paper's appendix, which was not read.; Geography: Not stated in the text read (the trial list is in the appendix, which was not read); Life stage: Not stated in the text read; mean age 65 years at baseline, age range not reported; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Median follow-up of 4.15 years across the trials (Q1 to Q3 2.97 to 4.96 years).
- Limitations: The pooled trials differ in design: placebo-controlled trials, comparisons of drug classes, and more-versus-less-intensive treatment. The hazard ratios are standardised to a 5 mm Hg systolic reduction, while the trials' average reduction between their groups, excluding the first 12 months, was 6.3 mm Hg. Previous cardiovascular disease means stroke, myocardial infarction or ischaemic heart disease before randomisation. Trials only in heart failure or acute settings, and people with known heart failure at baseline, are left out. The trials tested blood-pressure-lowering medicines in general, so the result is not specific to the first-line classes named in the WHO recommendations. The estimate is an average across trials. It says nothing about one drug or about benefit for one person. Each component outcome, stroke alone included, is shown in Figure 3 of the paper, an image that could not be read, so no component result is recorded here. The paper's Discussion also states a percentage reduction for each component, which comes from the same component results as Figure 3; those percentages are left unrecorded too, so this claim stays about the combined outcome. A two-stage sensitivity analysis gave similar estimates (0.89 with and 0.92 without previous cardiovascular disease). One erratum only updates the collaboration group list. The numbers are the authors' reported results, taken from the open-access PMC version rather than the publisher's version of record, and nobody has re-analysed them.
- Last checked: Not recorded
- Source problem: a cited source is corrected. Check the sources before relying on this claim.
- Sources:
  1. Supports: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Summary (abstract), Findings: participants and trials. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: PMC open-access version of the paper; the total number of people and trials in the analysis.
  2. Supports: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Summary (abstract), Findings: hazard ratios per 5 mm Hg systolic reduction. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: The two hazard ratios, by previous cardiovascular disease status.
  3. Supports: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Results, para 2. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: Median follow-up and the number of people with a major cardiovascular event.
  4. Supports: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Summary (abstract), Findings: heterogeneity sentence. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: The authors' statement that treatment effects did not differ reliably by previous cardiovascular disease status.
  5. Background: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Methods, Definition of outcomes and comparison groups, para 1. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: Defines the primary outcome, a major cardiovascular event.
  6. Background: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Summary (abstract), Methods, sentences 1 and 2. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: Which trials were included and which were excluded.
  7. Background: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Methods, Study selection criteria, para 1. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: How previous cardiovascular disease was defined, and the exclusion of people with known heart failure at baseline.
  8. Background: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Methods, Statistical analysis, para 1. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: The average systolic reduction between randomised groups, against which the 5 mm Hg standardisation is set.
  9. Background: Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis (Publication, edition Authored by the Blood Pressure Lowering Treatment Trialists' Collaboration and published in The Lancet 397(10285):1625-1636. The publisher field is the journal publisher as Crossref names it. The open-access PMC version (PMC8102467), fetched through NCBI efetch. The publisher pages were not readable: the DOI redirect returned only a redirect page and sciencedirect.com returned HTTP 403, so the version of record was not read. PubMed lists one published erratum (a Department of Error notice), which only updates the collaboration group list; it is a separate source in this atlas. Figure 3, which shows each component outcome including stroke alone, is an image that was not read. The publication date is the issue date.) <https://doi.org/10.1016/S0140-6736(21)00590-0>
     Locator: Results, para 10, two-stage sensitivity analysis. Retrieved 2026-10-11T19:11:47Z. Source state: Corrected. Snapshot hash: 0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03.
     How it applies: A second method gave similar estimates.
  10. Background: Department of Error: erratum to the BPLTTC individual participant-level data meta-analysis (Lancet 2021) (Publication, edition PubMed publication type Published Erratum. The notice says the collaboration group list was updated and the change was made to the online version as of May 20, 2021. It states no change to any result.) <https://doi.org/10.1016/S0140-6736(21)01069-2>
     Locator: Erratum text (Department of Error). Retrieved 2026-10-11T19:11:47Z. Source state: Current. Snapshot hash: 2201a9c966a07582e5f1e3d4fc8146b45461c002250e9b1c46906d12a954ff67.
     How it applies: The only erratum updates the collaboration group list and changes no result.

## Context: Adults with confirmed hypertension (WHO 2021 recommendations 1a, 4, 5 and 8)

Recipient: Adult; Population: Adults with a confirmed diagnosis of hypertension. Recommendation 1a covers systolic 140 mmHg or higher or diastolic 90 mmHg or higher. Recommendations 4, 5 and 8 cover adults with hypertension who need medicine. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed and counselled about lifestyle changes.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)

### WHO recommends starting blood-pressure-lowering medicine in adults with confirmed hypertension whose systolic pressure is 140 mmHg or higher or whose diastolic pressure is 90 mmHg or higher.

- Category: Recommendation
- Evidence stage: Guidance
- Certainty: Certainty not assessed
- Applies to: Recipient: Adult; Population: Adults with a confirmed diagnosis of hypertension. Recommendation 1a covers systolic 140 mmHg or higher or diastolic 90 mmHg or higher. Recommendations 4, 5 and 8 cover adults with hypertension who need medicine. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed and counselled about lifestyle changes.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Limitations: WHO labels this statement "Strong recommendation, moderate- to high-certainty evidence". The label gives the certainty as a range, which the claim certainty scale cannot hold, so the certainty stays not assessed. An implementation remark says treatment should start no later than four weeks after diagnosis. Global WHO guidance written for adults who are not pregnant; national adoption is not recorded. No evidence review behind the recommendation was read by this cluster. The WHO publication page and the PDF disagree on the page count (48 versus 61); this was not resolved.
- Last checked: 2026-10-11
- Sources:
  1. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, first statement (part 1). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: Who and what WHO recommends treating.
  2. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, first statement (part 2). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The blood pressure thresholds.
  3. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, first statement, strength label. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The strength label WHO prints under the statement: Strong recommendation, moderate- to high-certainty evidence
  4. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 2, sentence 2. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
  5. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 4, sentence 4. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO says it built summary of findings tables with the GRADE approach.
  6. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, implementation remarks. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO implementation remark that applies to recommendation 1.

### WHO recommends that adults with hypertension who need medicine start with a drug from any of three classes: thiazide and thiazide-like agents, ACE inhibitors or angiotensin-receptor blockers, or long-acting dihydropyridine calcium channel blockers.

- Category: Recommendation
- Evidence stage: Guidance
- Certainty: High certainty (method: The certainty is the GRADE level WHO prints in the strength label of this recommendation. It is WHO's assessment of the evidence base, not an assessment by this atlas.)
- Applies to: Recipient: Adult; Population: Adults with a confirmed diagnosis of hypertension. Recommendation 1a covers systolic 140 mmHg or higher or diastolic 90 mmHg or higher. Recommendations 4, 5 and 8 cover adults with hypertension who need medicine. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed and counselled about lifestyle changes.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Limitations: WHO labels this statement "Strong recommendation, high-certainty evidence". The certainty above is that label. Global WHO guidance written for adults who are not pregnant; national adoption is not recorded. No evidence review behind the recommendation was read by this cluster. The WHO publication page and the PDF disagree on the page count (48 versus 61); this was not resolved.
- Last checked: 2026-10-11
- Sources:
  1. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 23, section 3.4, recommendation 4, statement (part 1). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: Who the recommendation covers.
  2. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 23, section 3.4, recommendation 4, statement (part 2). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The initial-treatment wording.
  3. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 23, section 3.4, recommendation 4, class 1. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: First class.
  4. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 23, section 3.4, recommendation 4, class 2. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: Second class.
  5. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 23, section 3.4, recommendation 4, class 3. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: Third class.
  6. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 23, section 3.4, recommendation 4, strength label. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The strength label WHO prints under the statement: Strong recommendation, high-certainty evidence
  7. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 2, sentence 2. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
  8. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 4, sentence 4. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO says it built summary of findings tables with the GRADE approach.

### WHO suggests that adults with hypertension who need medicine start with combination therapy, preferably as a single-pill combination, with the drugs chosen from diuretics (thiazide or thiazide-like), ACE inhibitors or angiotensin-receptor blockers, and long-acting dihydropyridine calcium channel blockers.

- Category: Recommendation
- Evidence stage: Guidance
- Certainty: Moderate certainty (method: The certainty is the GRADE level WHO prints in the strength label of this recommendation. It is WHO's assessment of the evidence base, not an assessment by this atlas.)
- Applies to: Recipient: Adult; Population: Adults with a confirmed diagnosis of hypertension. Recommendation 1a covers systolic 140 mmHg or higher or diastolic 90 mmHg or higher. Recommendations 4, 5 and 8 cover adults with hypertension who need medicine. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed and counselled about lifestyle changes.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Limitations: WHO labels this statement "Conditional recommendation, moderate-certainty evidence". The certainty above is that label. It sits beside recommendation 4, which allows a start with a single drug from any of the classes; the page shows both. Global WHO guidance written for adults who are not pregnant; national adoption is not recorded. No evidence review behind the recommendation was read by this cluster. The WHO publication page and the PDF disagree on the page count (48 versus 61); this was not resolved.
- Last checked: 2026-10-11
- Sources:
  1. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 25, section 3.5, recommendation 5, statement (part 1). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: Who and what WHO suggests.
  2. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 25, section 3.5, recommendation 5, statement (part 2). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The single-pill preference and its stated reason.
  3. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 25, section 3.5, recommendation 5, statement (part 3). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The three drug classes to choose from.
  4. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 25, section 3.5, recommendation 5, strength label. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The strength label WHO prints under the statement: Conditional recommendation, moderate-certainty evidence
  5. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 2, sentence 2. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
  6. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 4, sentence 4. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO says it built summary of findings tables with the GRADE approach.

## Context: Adults with existing cardiovascular disease and systolic 130 to 139 mmHg (WHO 2021 recommendation 1b)

Recipient: Adult; Population: Adults with existing cardiovascular disease and a systolic blood pressure of 130 to 139 mmHg. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed with hypertension.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)

### WHO recommends blood-pressure-lowering medicine in adults with existing cardiovascular disease whose systolic pressure is 130 to 139 mmHg.

- Category: Recommendation
- Evidence stage: Guidance
- Certainty: Certainty not assessed
- Applies to: Recipient: Adult; Population: Adults with existing cardiovascular disease and a systolic blood pressure of 130 to 139 mmHg. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed with hypertension.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Limitations: WHO labels this statement "Strong recommendation, moderate- to high-certainty evidence". The label gives the certainty as a range, which the claim certainty scale cannot hold, so the certainty stays not assessed. This statement sits beside 1a and 1c, which carry other populations and, for 1c, a different strength. Global WHO guidance written for adults who are not pregnant; national adoption is not recorded. No evidence review behind the recommendation was read by this cluster. The WHO publication page and the PDF disagree on the page count (48 versus 61); this was not resolved.
- Last checked: 2026-10-11
- Sources:
  1. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, second statement. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The population and threshold WHO recommends treating.
  2. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, second statement, strength label. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The strength label WHO prints under the statement: Strong recommendation, moderate- to high-certainty evidence
  3. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 2, sentence 2. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
  4. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 4, sentence 4. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO says it built summary of findings tables with the GRADE approach.
  5. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, implementation remarks. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO implementation remark that applies to recommendation 1.

## Context: Adults without cardiovascular disease but at high risk, with diabetes or with chronic kidney disease, systolic 130 to 139 mmHg (WHO 2021 recommendation 1c)

Recipient: Adult; Population: Adults without cardiovascular disease who have high cardiovascular risk, diabetes mellitus or chronic kidney disease, and a systolic blood pressure of 130 to 139 mmHg. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed with hypertension.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)

### WHO suggests blood-pressure-lowering medicine in adults without cardiovascular disease who have high cardiovascular risk, diabetes or chronic kidney disease and whose systolic pressure is 130 to 139 mmHg.

- Category: Recommendation
- Evidence stage: Guidance
- Certainty: Certainty not assessed
- Applies to: Recipient: Adult; Population: Adults without cardiovascular disease who have high cardiovascular risk, diabetes mellitus or chronic kidney disease, and a systolic blood pressure of 130 to 139 mmHg. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed with hypertension.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Limitations: WHO labels this statement "Conditional recommendation, moderate- to high-certainty evidence". It is a suggestion, weaker than 1a and 1b. The label gives the certainty as a range, which the claim certainty scale cannot hold, so the certainty stays not assessed. Global WHO guidance written for adults who are not pregnant; national adoption is not recorded. No evidence review behind the recommendation was read by this cluster. The WHO publication page and the PDF disagree on the page count (48 versus 61); this was not resolved.
- Last checked: 2026-10-11
- Sources:
  1. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, third statement (part 1). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The population WHO suggests treating.
  2. Supports: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, third statement (part 2). Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The systolic range.
  3. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, third statement, strength label. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: The strength label WHO prints under the statement: Conditional recommendation, moderate- to high-certainty evidence
  4. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 2, sentence 2. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
  5. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 9, Executive summary, paragraph 4, sentence 4. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO says it built summary of findings tables with the GRADE approach.
  6. Background: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021) (Guideline, edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.) <https://www.who.int/publications/i/item/9789240033986>
     Locator: PDF page 19, section 3.1, recommendation 1, implementation remarks. Retrieved 2026-10-11T19:11:40Z. Source state: Current. Snapshot hash: 57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb.
     How it applies: WHO implementation remark that applies to recommendation 1.

## Guidance, authorization and access

### Recommendation `cardio:rec-who-2021-r1a`

- Intervention: Blood pressure lowering medicine (`cardio:bp-lowering-medicine`)
- Direction: Recommended
- Issued by: World Health Organization (`cardio:who`)
- Guideline: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021), edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.; snapshot `cardio:who-9789240033986-eng-pdf-2026-10-11`
- Jurisdiction: Global WHO guidance; national adoption not recorded
- Strength: Strong recommendation, moderate- to high-certainty evidence (GRADE. Section 2.5 of the WHO guideline (PDF page 17) says the guideline development group rated the certainty of evidence and developed the recommendations with the GRADE approach, and it defines a strong recommendation and a weak or conditional one.)
- Effective: 2021-08-24 (The publication date on the WHO publication page.)
- Supersession: Not checked
- Applies to: Recipient: Adult; Population: Adults with a confirmed diagnosis of hypertension. Recommendation 1a covers systolic 140 mmHg or higher or diastolic 90 mmHg or higher. Recommendations 4, 5 and 8 cover adults with hypertension who need medicine. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed and counselled about lifestyle changes.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Basis: claim `cardio:claim-who-2021-r1a`

### Recommendation `cardio:rec-who-2021-r1b`

- Intervention: Blood pressure lowering medicine (`cardio:bp-lowering-medicine`)
- Direction: Recommended
- Issued by: World Health Organization (`cardio:who`)
- Guideline: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021), edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.; snapshot `cardio:who-9789240033986-eng-pdf-2026-10-11`
- Jurisdiction: Global WHO guidance; national adoption not recorded
- Strength: Strong recommendation, moderate- to high-certainty evidence (GRADE. Section 2.5 of the WHO guideline (PDF page 17) says the guideline development group rated the certainty of evidence and developed the recommendations with the GRADE approach, and it defines a strong recommendation and a weak or conditional one.)
- Effective: 2021-08-24 (The publication date on the WHO publication page.)
- Supersession: Not checked
- Applies to: Recipient: Adult; Population: Adults with existing cardiovascular disease and a systolic blood pressure of 130 to 139 mmHg. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed with hypertension.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Basis: claim `cardio:claim-who-2021-r1b`

### Recommendation `cardio:rec-who-2021-r1c`

- Intervention: Blood pressure lowering medicine (`cardio:bp-lowering-medicine`)
- Direction: Recommended
- Issued by: World Health Organization (`cardio:who`)
- Guideline: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021), edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.; snapshot `cardio:who-9789240033986-eng-pdf-2026-10-11`
- Jurisdiction: Global WHO guidance; national adoption not recorded
- Strength: Conditional recommendation, moderate- to high-certainty evidence (GRADE. Section 2.5 of the WHO guideline (PDF page 17) says the guideline development group rated the certainty of evidence and developed the recommendations with the GRADE approach, and it defines a strong recommendation and a weak or conditional one.)
- Effective: 2021-08-24 (The publication date on the WHO publication page.)
- Supersession: Not checked
- Applies to: Recipient: Adult; Population: Adults without cardiovascular disease who have high cardiovascular risk, diabetes mellitus or chronic kidney disease, and a systolic blood pressure of 130 to 139 mmHg. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed with hypertension.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Basis: claim `cardio:claim-who-2021-r1c`

### Recommendation `cardio:rec-who-2021-r4`

- Intervention: Blood pressure lowering medicine (`cardio:bp-lowering-medicine`)
- Direction: Recommended
- Issued by: World Health Organization (`cardio:who`)
- Guideline: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021), edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.; snapshot `cardio:who-9789240033986-eng-pdf-2026-10-11`
- Jurisdiction: Global WHO guidance; national adoption not recorded
- Strength: Strong recommendation, high-certainty evidence (GRADE. Section 2.5 of the WHO guideline (PDF page 17) says the guideline development group rated the certainty of evidence and developed the recommendations with the GRADE approach, and it defines a strong recommendation and a weak or conditional one.)
- Effective: 2021-08-24 (The publication date on the WHO publication page.)
- Supersession: Not checked
- Applies to: Recipient: Adult; Population: Adults with a confirmed diagnosis of hypertension. Recommendation 1a covers systolic 140 mmHg or higher or diastolic 90 mmHg or higher. Recommendations 4, 5 and 8 cover adults with hypertension who need medicine. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed and counselled about lifestyle changes.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Basis: claim `cardio:claim-who-2021-r4`

### Recommendation `cardio:rec-who-2021-r5`

- Intervention: Blood pressure lowering medicine (`cardio:bp-lowering-medicine`)
- Direction: Recommended
- Issued by: World Health Organization (`cardio:who`)
- Guideline: Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021), edition Two snapshots of one edition, fetched on 2026-10-11: the WHO publication page, and the English PDF through the IRIS REST bitstream (843539 bytes, 61 pages counted from the file). The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.; snapshot `cardio:who-9789240033986-eng-pdf-2026-10-11`
- Jurisdiction: Global WHO guidance; national adoption not recorded
- Strength: Conditional recommendation, moderate-certainty evidence (GRADE. Section 2.5 of the WHO guideline (PDF page 17) says the guideline development group rated the certainty of evidence and developed the recommendations with the GRADE approach, and it defines a strong recommendation and a weak or conditional one.)
- Effective: 2021-08-24 (The publication date on the WHO publication page.)
- Supersession: Not checked
- Applies to: Recipient: Adult; Population: Adults with a confirmed diagnosis of hypertension. Recommendation 1a covers systolic 140 mmHg or higher or diastolic 90 mmHg or higher. Recommendations 4, 5 and 8 cover adults with hypertension who need medicine. WHO says the guideline targets non-pregnant adults who were appropriately diagnosed and counselled about lifestyle changes.; Care setting: Not stated for this recommendation in the source; Geography: Global WHO guidance; national adoption not recorded; Life stage: Adult; Follow-up: Not applicable (recommendation context)
- Basis: claim `cardio:claim-who-2021-r5`

## Connected pages

- WHO 2021 1a: start at systolic 140 mmHg or higher, or diastolic 90 mmHg or higher (strong): Hypertension (high blood pressure) (`core:hypertension`) [a claim, not a settled fact; see claim `cardio:claim-who-2021-r1a` and its context]
- WHO 2021 1b: with cardiovascular disease, systolic 130 to 139 mmHg (strong): Hypertension (high blood pressure) (`core:hypertension`) [a claim, not a settled fact; see claim `cardio:claim-who-2021-r1b` and its context]
- WHO 2021 1c: high risk, diabetes or kidney disease, systolic 130 to 139 mmHg (conditional): Hypertension (high blood pressure) (`core:hypertension`) [a claim, not a settled fact; see claim `cardio:claim-who-2021-r1c` and its context]
- WHO 2021 4: first-line drug classes (strong): Hypertension (high blood pressure) (`core:hypertension`) [a claim, not a settled fact; see claim `cardio:claim-who-2021-r4` and its context]
- WHO 2021 5: combination therapy as initial treatment (conditional): Hypertension (high blood pressure) (`core:hypertension`) [a claim, not a settled fact; see claim `cardio:claim-who-2021-r5` and its context]
- BPLTTC 2021 pooled trials: major cardiovascular events per 5 mm Hg lower systolic pressure from treatment: Preventing heart attack, stroke and heart failure (`cardio:cardiovascular-prevention`) [a claim, not a settled fact; see claim `cardio:claim-bplttc-mace-per-5mmhg` and its context]
- Treatment and its target: Blood-pressure lowering to a target (`cardio:bp-lowering-to-target`)
- Required by: Hypertension treatment by nonphysician professionals, such as pharmacists and nurses (`cardio:nonphysician-hypertension-treatment`)

## Provenance

Content hash: f947bed0fc70bce7efbead43c16b901af6ba7ade1dd96988fc0ae9e1266efb8b
Last substantive edit: 2026-10-12
Evidence last checked: 2026-10-11