{ "release_id": "2b2017b84496b985", "id": "cardio:bp-lowering-medicine", "owner": "cardio", "kind": "intervention", "slug": "bp-lowering-medicine", "name": "Blood pressure lowering medicine", "aliases": [ "Antihypertensive medicine", "Antihypertensive drug treatment" ], "atlases": [ "cardio" ], "summary_plain": "Medicines that lower blood pressure, started and adjusted for adults whose high blood pressure is confirmed.", "summary_technical": "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.", "editorial_state": "draft", "last_substantive_edit": "2026-10-12", "last_evidence_check": "2026-10-11", "next_review_due": null, "external_ids": [], "navigation": { "cardio": { "system": [ "blood-vessels" ], "condition-area": [ "hypertension" ] } }, "payload": { "subtype": "medicine", "mechanism": null, "taxonomy_codes": [] }, "content_digest": "f947bed0fc70bce7efbead43c16b901af6ba7ade1dd96988fc0ae9e1266efb8b", "review": { "content_digest": "f947bed0fc70bce7efbead43c16b901af6ba7ade1dd96988fc0ae9e1266efb8b", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "2b2017b84496b985", "id": "cardio:claim-bplttc-mace-per-5mmhg", "owner": "cardio", "subject_entity_id": "cardio:bp-lowering-medicine", "category": "effect", "statement": "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.", "context": { "id": "cardio:ctx-bplttc-trial-participants", "label": "Participants in 48 randomised blood-pressure-lowering trials (BPLTTC 2021 meta-analysis)", "recipient": "unknown", "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_min_days": null, "gestational_age_max_days": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Median follow-up of 4.15 years across the trials (Q1 to Q3 2.97 to 4.96 years).", "eligibility": { "inclusion": [ "Trials that randomised people to blood-pressure-lowering medicines versus placebo or another class, or to more versus less intensive treatment", "Trials with at least 1000 person-years of follow-up in each randomised group", "Trials that shared baseline blood pressure, primary and secondary outcomes, and whether previous cardiovascular disease was present" ], "exclusion": [ "Trials done only in people with heart failure", "Short-term trials in acute myocardial infarction or other acute settings", "People with known heart failure at baseline, in trials that had included them" ] } }, "evidence_stage": "synthesis", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": null, "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Summary (abstract), Findings: participants and trials", "applicability_note": "PMC open-access version of the paper; the total number of people and trials in the analysis.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Summary (abstract), Findings: hazard ratios per 5 mm Hg systolic reduction", "applicability_note": "The two hazard ratios, by previous cardiovascular disease status.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Results, para 2", "applicability_note": "Median follow-up and the number of people with a major cardiovascular event.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "Summary (abstract), Findings: heterogeneity sentence", "applicability_note": "The authors' statement that treatment effects did not differ reliably by previous cardiovascular disease status.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Definition of outcomes and comparison groups, para 1", "applicability_note": "Defines the primary outcome, a major cardiovascular event.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Summary (abstract), Methods, sentences 1 and 2", "applicability_note": "Which trials were included and which were excluded.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Study selection criteria, para 1", "applicability_note": "How previous cardiovascular disease was defined, and the exclusion of people with known heart failure at baseline.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Methods, Statistical analysis, para 1", "applicability_note": "The average systolic reduction between randomised groups, against which the 5 mm Hg standardisation is set.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Results, para 10, two-stage sensitivity analysis", "applicability_note": "A second method gave similar estimates.", "snapshot": { "id": "cardio:pmc-pmc8102467-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:bplttc-lancet-2021", "source_type": "publication", "title": "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", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)00590-0", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)00590-0", "publication_date": "2021-05-01", "publisher": "Elsevier BV", "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.", "reuse_basis": "CC BY 4.0, stated in the PMC permissions element (an open access article under the CC BY 4.0 license, 2021 The Author(s), published by Elsevier). The PMC XML is committed at research/snapshots/cd-pmc-PMC8102467.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Lancet 2021;397:1625-1636, doi 10.1016/S0140-6736(21)00590-0, via PMC (PMC8102467). The XML carries one corresponding-author email address exactly as published; this atlas does not repeat it. The PubMed record is kept as a hash only.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "Erratum text (Department of Error)", "applicability_note": "The only erratum updates the collaboration group list and changes no result.", "snapshot": { "id": "cardio:pmc-pmc8165755-2026-10-11", "retrieved_at": "2026-10-11T19:11:47Z", "content_hash": "2201a9c966a07582e5f1e3d4fc8146b45461c002250e9b1c46906d12a954ff67", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:bplttc-lancet-2021-erratum", "source_type": "publication", "title": "Department of Error: erratum to the BPLTTC individual participant-level data meta-analysis (Lancet 2021)", "canonical_url": "https://doi.org/10.1016/S0140-6736(21)01069-2", "identifier_namespace": "doi", "identifier_value": "10.1016/S0140-6736(21)01069-2", "publication_date": "2021-05-22", "publisher": "Elsevier (The Lancet 397(10288):1884)", "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.", "reuse_basis": "CC BY, stated in the PMC permissions element (an open access article under the CC BY license). The PMC XML is committed at research/snapshots/cd-pmc-PMC8165755-erratum.xml. Attribution: The Blood Pressure Lowering Treatment Trialists' Collaboration, Department of Error, Lancet 2021;397:1884, doi 10.1016/S0140-6736(21)01069-2, via PMC (PMC8165755). 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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. 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The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. 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The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. 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The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "PDF page 9, Executive summary, paragraph 2, sentence 2", "applicability_note": "WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "PDF page 9, Executive summary, paragraph 4, sentence 4", "applicability_note": "WHO says it built summary of findings tables with the GRADE approach.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. 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The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } } ], "review": { "content_digest": "a1463b6f89abf34324183b812fd331d9d412ac83f89c6774fe2bab9553647435", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/cardio--claim-who-2021-r1c.json" }, { "release_id": "2b2017b84496b985", "id": "cardio:claim-who-2021-r4", "owner": "cardio", "subject_entity_id": "cardio:bp-lowering-medicine", "category": "recommendation", "statement": "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.", "context": { "id": "cardio:ctx-who-2021-adults-confirmed-hypertension", "label": "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", "gestational_age_min_days": null, "gestational_age_max_days": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Adult", "Confirmed diagnosis of hypertension", "Counselled about lifestyle modifications (WHO scope statement)" ], "exclusion": [ "Pregnant patients: WHO says the recommendations target non-pregnant patients" ] } }, "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.", "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.", "editorial_state": "draft", "checked_at": "2026-10-11", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "PDF page 23, section 3.4, recommendation 4, statement (part 1)", "applicability_note": "Who the recommendation covers.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. 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The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. 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The publication page states 48 pages. This cluster did not resolve the difference. A separate WHO summary edition exists and was not fetched.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "PDF page 23, section 3.4, recommendation 4, class 2", "applicability_note": "Second class.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } }, { "evidence_role": "supports", "locator": "PDF page 23, section 3.4, recommendation 4, class 3", "applicability_note": "Third class.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "PDF page 23, section 3.4, recommendation 4, strength label", "applicability_note": "The strength label WHO prints under the statement: Strong recommendation, high-certainty evidence", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "PDF page 9, Executive summary, paragraph 2, sentence 2", "applicability_note": "WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } }, { "evidence_role": "context", "locator": "PDF page 9, Executive summary, paragraph 4, sentence 4", "applicability_note": "WHO says it built summary of findings tables with the GRADE approach.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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.", "reuse_basis": "CC BY-NC-SA 3.0 IGO, as the PDF states. Short quotations with attribution only. The non-commercial and share-alike terms need a decision on the atlas public data licence before any reuse beyond short quotation. Neither snapshot is committed.", "public_text": "quote" } } ], "review": { "content_digest": "655433f727b8febe4071f283a90a05db6227ddc18a8f10835e287f664d1f5de4", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/cardio--claim-who-2021-r4.json" }, { "release_id": "2b2017b84496b985", "id": "cardio:claim-who-2021-r5", "owner": "cardio", "subject_entity_id": "cardio:bp-lowering-medicine", "category": "recommendation", "statement": "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.", "context": { "id": "cardio:ctx-who-2021-adults-confirmed-hypertension", "label": "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", "gestational_age_min_days": null, "gestational_age_max_days": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (recommendation context)", "eligibility": { "inclusion": [ "Adult", "Confirmed diagnosis of hypertension", "Counselled about lifestyle modifications (WHO scope statement)" ], "exclusion": [ "Pregnant patients: WHO says the recommendations target non-pregnant patients" ] } }, "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.", "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.", "editorial_state": "draft", "checked_at": "2026-10-11", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "PDF page 25, section 3.5, recommendation 5, statement (part 1)", "applicability_note": "Who and what WHO suggests.", "snapshot": { "id": "cardio:who-9789240033986-eng-pdf-2026-10-11", "retrieved_at": "2026-10-11T19:11:40Z", "content_hash": "57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb", "source_effective_date": "2021-08-24", "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:who-2021-hypertension-pharmacological", "source_type": "guideline", "title": "Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)", "canonical_url": "https://www.who.int/publications/i/item/9789240033986", "identifier_namespace": "isbn", "identifier_value": "978-92-4-003398-6", "publication_date": "2021-08-24", "publisher": "World Health Organization", "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). 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