Cardiovascular Atlas
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Blood pressure lowering medicine

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

Also called Antihypertensive medicine · Antihypertensive drug treatment

  • Intervention
  • In this atlas

Overview

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.

About this intervention

Type
Medicine
Mechanism
Not reported

Claims and evidence

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)
Eligibility: 3 inclusion criteria; 1 exclusion criterion
Included
  • Adult
  • Confirmed diagnosis of hypertension
  • Counselled about lifestyle modifications (WHO scope statement)
Excluded
  • Pregnant patients: WHO says the recommendations target non-pregnant patients

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (6)

    1. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, first statement (part 1)
      How it applies
      Who and what WHO recommends treating.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    2. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, first statement (part 2)
      How it applies
      The blood pressure thresholds.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    3. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, first statement, strength label
      How it applies
      The strength label WHO prints under the statement: Strong recommendation, moderate- to high-certainty evidence
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    4. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 2, sentence 2
      How it applies
      WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    5. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 4, sentence 4
      How it applies
      WHO says it built summary of findings tables with the GRADE approach.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    6. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, implementation remarks
      How it applies
      WHO implementation remark that applies to recommendation 1.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

  • Recommendation Guidance High certainty

    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.

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    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.
    Last checked
    2026-10-11
    Next evidence check due
    Not scheduled
    Sources and citations (8)

    1. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 23, section 3.4, recommendation 4, statement (part 1)
      How it applies
      Who the recommendation covers.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    2. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 23, section 3.4, recommendation 4, statement (part 2)
      How it applies
      The initial-treatment wording.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    3. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 23, section 3.4, recommendation 4, class 1
      How it applies
      First class.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    4. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 23, section 3.4, recommendation 4, class 2
      How it applies
      Second class.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    5. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 23, section 3.4, recommendation 4, class 3
      How it applies
      Third class.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    6. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 23, section 3.4, recommendation 4, strength label
      How it applies
      The strength label WHO prints under the statement: Strong recommendation, high-certainty evidence
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    7. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 2, sentence 2
      How it applies
      WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    8. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 4, sentence 4
      How it applies
      WHO says it built summary of findings tables with the GRADE approach.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

  • Recommendation Guidance Moderate certainty

    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.

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    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.
    Last checked
    2026-10-11
    Next evidence check due
    Not scheduled
    Sources and citations (6)

    1. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 25, section 3.5, recommendation 5, statement (part 1)
      How it applies
      Who and what WHO suggests.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    2. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 25, section 3.5, recommendation 5, statement (part 2)
      How it applies
      The single-pill preference and its stated reason.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    3. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 25, section 3.5, recommendation 5, statement (part 3)
      How it applies
      The three drug classes to choose from.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    4. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 25, section 3.5, recommendation 5, strength label
      How it applies
      The strength label WHO prints under the statement: Conditional recommendation, moderate-certainty evidence
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    5. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 2, sentence 2
      How it applies
      WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    6. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 4, sentence 4
      How it applies
      WHO says it built summary of findings tables with the GRADE approach.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

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)
Eligibility: 3 inclusion criteria; 1 exclusion criterion
Included
  • Adult
  • Existing cardiovascular disease
  • Systolic blood pressure of 130 to 139 mmHg
Excluded
  • Pregnant patients: WHO says the recommendations target non-pregnant patients

  • Recommendation Guidance Certainty not assessed

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

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, second statement
      How it applies
      The population and threshold WHO recommends treating.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    2. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, second statement, strength label
      How it applies
      The strength label WHO prints under the statement: Strong recommendation, moderate- to high-certainty evidence
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    3. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 2, sentence 2
      How it applies
      WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    4. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 4, sentence 4
      How it applies
      WHO says it built summary of findings tables with the GRADE approach.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    5. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, implementation remarks
      How it applies
      WHO implementation remark that applies to recommendation 1.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

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)
Eligibility: 4 inclusion criteria; 1 exclusion criterion
Included
  • Adult
  • No cardiovascular disease
  • High cardiovascular risk, or diabetes mellitus, or chronic kidney disease
  • Systolic blood pressure of 130 to 139 mmHg
Excluded
  • Pregnant patients: WHO says the recommendations target non-pregnant patients

  • Recommendation Guidance Certainty not assessed

    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.

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (6)

    1. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, third statement (part 1)
      How it applies
      The population WHO suggests treating.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    2. Supports Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, third statement (part 2)
      How it applies
      The systolic range.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    3. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, third statement, strength label
      How it applies
      The strength label WHO prints under the statement: Conditional recommendation, moderate- to high-certainty evidence
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    4. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 2, sentence 2
      How it applies
      WHO scope: adult, non-pregnant patients appropriately diagnosed with hypertension and counselled about lifestyle.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    5. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 9, Executive summary, paragraph 4, sentence 4
      How it applies
      WHO says it built summary of findings tables with the GRADE approach.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

    6. Background Guideline for the pharmacological treatment of hypertension in adults (World Health Organization, 2021)

      Guideline · 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. · Published 2021-08-24 · isbn: 978-92-4-003398-6

      Locator
      PDF page 19, section 3.1, recommendation 1, implementation remarks
      How it applies
      WHO implementation remark that applies to recommendation 1.
      Retrieved
      Source effective date
      2021-08-24
      Source state
      Current
      Snapshot hash
      57f6376d5c9bc4ea6c44873625547c8a5443d5a6ad8c8c422733681563db05fb
      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.

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).
Eligibility: 3 inclusion criteria; 3 exclusion criteria
Included
  • 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
Excluded
  • 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

  • Effect Evidence synthesis Certainty not assessed

    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.

    Source problem. A cited source is corrected. Check the sources before relying on this claim.

    Applies to Recipient not specified
    • 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.
    • 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.
    • Not stated in the text read (the trial list is in the appendix, which was not read)
    • 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).
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (10)

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Summary (abstract), Findings: participants and trials
      How it applies
      PMC open-access version of the paper; the total number of people and trials in the analysis.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Summary (abstract), Findings: hazard ratios per 5 mm Hg systolic reduction
      How it applies
      The two hazard ratios, by previous cardiovascular disease status.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Results, para 2
      How it applies
      Median follow-up and the number of people with a major cardiovascular event.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Summary (abstract), Findings: heterogeneity sentence
      How it applies
      The authors' statement that treatment effects did not differ reliably by previous cardiovascular disease status.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Methods, Definition of outcomes and comparison groups, para 1
      How it applies
      Defines the primary outcome, a major cardiovascular event.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Summary (abstract), Methods, sentences 1 and 2
      How it applies
      Which trials were included and which were excluded.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Methods, Study selection criteria, para 1
      How it applies
      How previous cardiovascular disease was defined, and the exclusion of people with known heart failure at baseline.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Methods, Statistical analysis, para 1
      How it applies
      The average systolic reduction between randomised groups, against which the 5 mm Hg standardisation is set.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    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 · 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. · Published 2021-05-01 · doi: 10.1016/S0140-6736(21)00590-0

      Locator
      Results, para 10, two-stage sensitivity analysis
      How it applies
      A second method gave similar estimates.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      0531fab89a3769c062eb6e5a2a9b11a8c670c67811bcef1c6959884f3522cf03
      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.

    10. Background Department of Error: erratum to the BPLTTC individual participant-level data meta-analysis (Lancet 2021)

      Publication · 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. · Published 2021-05-22 · doi: 10.1016/S0140-6736(21)01069-2

      Locator
      Erratum text (Department of Error)
      How it applies
      The only erratum updates the collaboration group list and changes no result.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      2201a9c966a07582e5f1e3d4fc8146b45461c002250e9b1c46906d12a954ff67
      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). The PubMed record is kept as a hash only.

Guidance

Recommended: Blood pressure lowering medicine

Applies to Adult
  • 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.
  • Not stated for this recommendation in the source
  • Global WHO guidance; national adoption not recorded
  • Adult
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global WHO guidance; national adoption not recorded
Supersession
Not checked
Basis
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.

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.

Recommended: Blood pressure lowering medicine

Applies to Adult
  • 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.
  • Not stated for this recommendation in the source
  • Global WHO guidance; national adoption not recorded
  • Adult
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global WHO guidance; national adoption not recorded
Supersession
Not checked
Basis
WHO recommends blood-pressure-lowering medicine in adults with existing cardiovascular disease whose systolic pressure is 130 to 139 mmHg.

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.

Recommended: Blood pressure lowering medicine

Applies to Adult
  • 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.
  • Not stated for this recommendation in the source
  • Global WHO guidance; national adoption not recorded
  • Adult
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global WHO guidance; national adoption not recorded
Supersession
Not checked
Basis
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.

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.

Recommended: Blood pressure lowering medicine

Applies to Adult
  • 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.
  • Not stated for this recommendation in the source
  • Global WHO guidance; national adoption not recorded
  • Adult
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global WHO guidance; national adoption not recorded
Supersession
Not checked
Basis
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.

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.

Recommended: Blood pressure lowering medicine

Applies to Adult
  • 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.
  • Not stated for this recommendation in the source
  • Global WHO guidance; national adoption not recorded
  • Adult
Follow-up Not applicable (recommendation context)
Issued by
World Health Organization
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.
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.)
Jurisdiction
Global WHO guidance; national adoption not recorded
Supersession
Not checked
Basis
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.

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.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

  • Claim, not a settled fact WHO 2021 1a: start at systolic 140 mmHg or higher, or diastolic 90 mmHg or higher (strong): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • 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.

    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.

  • Claim, not a settled fact WHO 2021 1b: with cardiovascular disease, systolic 130 to 139 mmHg (strong): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • 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.

    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.

  • Claim, not a settled fact WHO 2021 1c: high risk, diabetes or kidney disease, systolic 130 to 139 mmHg (conditional): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • 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.

    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.

  • Claim, not a settled fact WHO 2021 4: first-line drug classes (strong): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    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.

    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.

  • Claim, not a settled fact WHO 2021 5: combination therapy as initial treatment (conditional): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • 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.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    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.

    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.

  • Claim, not a settled fact BPLTTC 2021 pooled trials: major cardiovascular events per 5 mm Hg lower systolic pressure from treatment: Preventing heart attack, stroke and heart failure (Evaluated for)

    Applies to Recipient not specified
    • 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.
    • 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.
    • Not stated in the text read (the trial list is in the appendix, which was not read)
    • 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.

    Source problem. A cited source is corrected. Check the sources before relying on this claim.

    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.

Record details

Record id
cardio:bp-lowering-medicine
Content hash
f947bed0fc70bce7efbead43c16b901af6ba7ade1dd96988fc0ae9e1266efb8b