Cardiovascular Atlas
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Blood-pressure lowering to a target

Using medicines and lifestyle changes to bring blood pressure below a chosen number and keep it there.

  • Intervention
  • In this atlas

Overview

Technical summary

Generic treat-to-target antihypertensive management. The target belongs to the guideline context or study arm, not to this entity.

About this intervention

Type
Medicine
Mechanism
Not reported

Claims and evidence

Context Adults with elevated blood pressure or hypertension (2024 ESC guideline)

Recipient
Adult
Population
Adults with elevated blood pressure or hypertension. Age limits and pregnancy handling are not stated in the sources read.
Care setting
Not stated in the sources read
Geography
Not stated in the sources read (guideline of the European Society of Cardiology; applicability by country not verified)
Life stage
Adult
Follow-up
Not applicable (guideline context)
Eligibility: 1 inclusion criterion; exclusion criteria not stated
Included
  • Adults with elevated blood pressure or hypertension
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    The European Society of Cardiology's summary of its 2024 guideline gives 120 to 129 mmHg systolic and 70 to 79 mmHg diastolic as the pressure to aim for during treatment in all adults, if the treatment is well tolerated. It says the aim is the same whatever the pressure at which treatment is advised to start. It also says there are a number of important exceptions, and that decisions made for the individual patient always come first.

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

    Applies to Adult
    • Adults with elevated blood pressure or hypertension. Age limits and pregnancy handling are not stated in the sources read.
    • Not stated in the sources read
    • Not stated in the sources read (guideline of the European Society of Cardiology; applicability by country not verified)
    • Adult
    Follow-up Not applicable (guideline context)
    Certainty method
    Not assessed
    Limitations
    The source is the ESC's condensed Essential Messages, not the recommendation tables, so the class of recommendation, the level of evidence, the exceptions and the pressure at which to start treatment were not read. This is a claim only and has no recommendation decision. Two later corrections are listed in PubMed, their text was not read, and the Essential Messages was produced before both, so whether the corrections change the target given here is unknown. Any other guideline states its own target. A claim about another guideline is recorded separately and is not reconciled with this one, so this claim does not say which target is right. Pregnancy handling is not stated in the sources read.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    1. Supports 2024 ESC Guidelines for the management of elevated blood pressure and hypertension

      Guideline · Oxford University Press (OUP) · Edition Issued by the European Society of Cardiology and published in European Heart Journal 45(38):3912-4018. The publisher field is the journal publisher as Crossref names it. Publisher summary only. The version of record was not read: doi.org and academic.oup.com returned HTTP 403 (a Cloudflare challenge), PubMed holds no abstract for it, and Europe PMC lists it as subscription required. The facts come from the ESC Essential Messages PDF for this guideline, found through the ESC Essential messages page, and from the ESC guideline page. Two later corrections are listed in PubMed (Eur Heart J 2025 Apr 7;46(14):1300, doi 10.1093/eurheartj/ehaf031, and 2025 Dec 1;46(45):4949, doi 10.1093/eurheartj/ehaf659). Their text was not read, and the Essential Messages was produced before both. · Published 2024-08-30 · doi: 10.1093/eurheartj/ehae178

      Locator
      Section 1 Key messages, message 10
      How it applies
      ESC Essential Messages PDF for the 2024 guideline.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      1002525ded65298879e25304fbc88d4af91631b7dd4977df3ec2e67f504ffd98
      Reuse basis
      Hashes only and nothing committed. The ESC states that its guidelines are protected by copyright, are for personal and educational use with no commercial use, and that it reserves the right to license use of its guidelines for training generative AI (EU Directive 2019/790, Article 4 section 3). Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the ESC's recommendations in the atlas's own words, with a citation and a link, and use no ESC wording.

    2. Background 2024 ESC Guidelines for the management of elevated blood pressure and hypertension

      Guideline · Oxford University Press (OUP) · Edition Issued by the European Society of Cardiology and published in European Heart Journal 45(38):3912-4018. The publisher field is the journal publisher as Crossref names it. Publisher summary only. The version of record was not read: doi.org and academic.oup.com returned HTTP 403 (a Cloudflare challenge), PubMed holds no abstract for it, and Europe PMC lists it as subscription required. The facts come from the ESC Essential Messages PDF for this guideline, found through the ESC Essential messages page, and from the ESC guideline page. Two later corrections are listed in PubMed (Eur Heart J 2025 Apr 7;46(14):1300, doi 10.1093/eurheartj/ehaf031, and 2025 Dec 1;46(45):4949, doi 10.1093/eurheartj/ehaf659). Their text was not read, and the Essential Messages was produced before both. · Published 2024-08-30 · doi: 10.1093/eurheartj/ehae178

      Locator
      Back page, corrections notice
      How it applies
      The ESC says it posts corrections and updates made after publication on its guidelines page.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      1002525ded65298879e25304fbc88d4af91631b7dd4977df3ec2e67f504ffd98
      Reuse basis
      Hashes only and nothing committed. The ESC states that its guidelines are protected by copyright, are for personal and educational use with no commercial use, and that it reserves the right to license use of its guidelines for training generative AI (EU Directive 2019/790, Article 4 section 3). Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the ESC's recommendations in the atlas's own words, with a citation and a link, and use no ESC wording.

    3. Background 2024 ESC Guidelines for the management of elevated blood pressure and hypertension

      Guideline · Oxford University Press (OUP) · Edition Issued by the European Society of Cardiology and published in European Heart Journal 45(38):3912-4018. The publisher field is the journal publisher as Crossref names it. Publisher summary only. The version of record was not read: doi.org and academic.oup.com returned HTTP 403 (a Cloudflare challenge), PubMed holds no abstract for it, and Europe PMC lists it as subscription required. The facts come from the ESC Essential Messages PDF for this guideline, found through the ESC Essential messages page, and from the ESC guideline page. Two later corrections are listed in PubMed (Eur Heart J 2025 Apr 7;46(14):1300, doi 10.1093/eurheartj/ehaf031, and 2025 Dec 1;46(45):4949, doi 10.1093/eurheartj/ehaf659). Their text was not read, and the Essential Messages was produced before both. · Published 2024-08-30 · doi: 10.1093/eurheartj/ehae178

      Locator
      CommentsCorrectionsList, two ErratumIn entries
      How it applies
      Shows that two corrections exist. What they change is unknown.
      Retrieved
      Source effective date
      Not reported
      Source state
      Corrected
      Snapshot hash
      f9afb12c7dd4e0a09ed8cba2fbbc89cf98fe1655ea1bfe1bb04012b061740281
      Reuse basis
      Hashes only and nothing committed. The ESC states that its guidelines are protected by copyright, are for personal and educational use with no commercial use, and that it reserves the right to license use of its guidelines for training generative AI (EU Directive 2019/790, Article 4 section 3). Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the ESC's recommendations in the atlas's own words, with a citation and a link, and use no ESC wording.

Context Adults with hypertension aged under 80 (NICE NG136 recommendation 1.4.20)

Recipient
Adult
Population
Adults with hypertension aged under 80, with or without type 2 diabetes (NG136 Table 1)
Care setting
Not stated on the fetched page
Geography
Not stated on the fetched page (NICE guidance; jurisdiction not verified)
Life stage
Adult under 80
Follow-up
Not applicable (recommendation context)
Eligibility: 3 inclusion criteria; exclusion criteria not stated
Included
  • Adult with hypertension
  • Aged under 80
  • With or without type 2 diabetes (NG136 Table 1)
Excluded
None stated

  • Recommendation Guidance Certainty not assessed

    NICE guideline NG136 recommends lowering clinic blood pressure below 140/90 mmHg, and keeping it there, for adults with hypertension aged under 80.

    Applies to Adult
    • Adults with hypertension aged under 80, with or without type 2 diabetes (NG136 Table 1)
    • Not stated on the fetched page
    • Not stated on the fetched page (NICE guidance; jurisdiction not verified)
    • Adult under 80
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    Limitations
    NICE's population includes people with type 2 diabetes, whom SPRINT excluded. The fetched page gives no strength label for this imperative wording (a pair of directive verbs, one to lower the pressure and one to keep it there), and NICE's page on recommendation wording explains only the verbs offer and consider. The jurisdiction is not stated on the fetched page. The recommendation carries the tag 2019, amended 2022; the exact amendment date was not recorded. This claim records what NICE recommends. It does not say that NICE assessed or rejected SPRINT's target.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (3)

    1. Supports Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked. · Published 2019-08-28 · nice: NG136

      Locator
      Recommendation 1.4.20, the sentence on adults aged under 80
      How it applies
      NICE NG136 as shown on 2026-10-09, last updated 2026-02-26.
      Retrieved
      Source effective date
      2026-02-26
      Source state
      Current
      Snapshot hash
      68ce72f3487ffa4715f92ddfa8aaf6e093f5aecd3598cd59a0ab58f74ce86f28
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only. Outside the United Kingdom, apart from private use, study or one's own research, reuse needs NICE's prior written agreement, which may carry a licence and a fee, and use for artificial intelligence needs approval and a licensing arrangement. The terms also say NICE does not write its content as a basis for decisions outside the United Kingdom. The page bytes are not committed.

    2. Background Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked. · Published 2019-08-28 · nice: NG136

      Locator
      Recommendation 1.4.20, version tag
      How it applies
      Dates the wording of this recommendation.
      Retrieved
      Source effective date
      2026-02-26
      Source state
      Current
      Snapshot hash
      68ce72f3487ffa4715f92ddfa8aaf6e093f5aecd3598cd59a0ab58f74ce86f28
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only. Outside the United Kingdom, apart from private use, study or one's own research, reuse needs NICE's prior written agreement, which may carry a licence and a fee, and use for artificial intelligence needs approval and a licensing arrangement. The terms also say NICE does not write its content as a basis for decisions outside the United Kingdom. The page bytes are not committed.

    3. Background Making decisions using NICE guidelines

      Webpage · National Institute for Health and Care Excellence (NICE)

      Locator
      Section on recommendation wording, the sentence on the verb offer
      How it applies
      Explains how NICE uses the verb offer. It does not say what strength imperative verbs such as reduce carry.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      b7838d1bdb692f2b6dfc71480aa95803d68c64aa0dde406375953c9479aaae7c
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only; outside it, apart from private use, study or one's own research, NICE's prior written agreement is needed.

Context Adults with hypertension and known cardiovascular disease (WHO 2021 recommendation 6b)

Recipient
Adult
Population
Adults with hypertension and known cardiovascular disease. WHO says the guideline targets non-pregnant adults.
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
  • Hypertension
  • Known cardiovascular disease
Excluded
  • Pregnant patients: WHO says the recommendations target non-pregnant patients

  • Recommendation Guidance Moderate certainty

    WHO recommends a systolic blood pressure target of below 130 mmHg for adults with hypertension and known cardiovascular disease.

    Applies to Adult
    • Adults with hypertension and known cardiovascular disease. WHO says the guideline targets non-pregnant adults.
    • 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, moderate-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 (4)

    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 28, section 3.6, recommendation 6, second statement
      How it applies
      The target and the population.
      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 28, section 3.6, recommendation 6, second statement, strength label
      How it applies
      The strength label WHO prints under the statement: Strong 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.

    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.

Context Adults with hypertension at high risk (WHO 2021 recommendation 6c)

Recipient
Adult
Population
Adults with hypertension who are at high risk, which WHO lists as high cardiovascular risk, diabetes mellitus or chronic kidney disease. WHO says the guideline targets non-pregnant adults.
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
  • Hypertension
  • High cardiovascular risk, or diabetes mellitus, or chronic kidney disease
Excluded
  • Pregnant patients: WHO says the recommendations target non-pregnant patients

  • Recommendation Guidance Moderate certainty

    WHO suggests a systolic blood pressure target of below 130 mmHg for adults with hypertension who are at high risk because of high cardiovascular risk, diabetes or chronic kidney disease.

    Applies to Adult
    • Adults with hypertension who are at high risk, which WHO lists as high cardiovascular risk, diabetes mellitus or chronic kidney disease. WHO says the guideline targets non-pregnant adults.
    • 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". It is a suggestion, weaker than 6a and 6b. 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 (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 28, section 3.6, recommendation 6, third statement (part 1)
      How it applies
      The target and the population.
      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 28, section 3.6, recommendation 6, third statement (part 2)
      How it applies
      The remaining high-risk conditions.
      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 28, section 3.6, recommendation 6, third statement, 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.

    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.

Context Adults with hypertension without comorbidities (WHO 2021 recommendation 6a)

Recipient
Adult
Population
Adults with hypertension and no comorbidities. The recommendation statement does not define comorbidities. The rationale on the same page (PDF page 28) names them: "In patients with comorbidity (CAD, DM, CKD) there is consistent benefit with lower targets", where WHO's list of acronyms gives CAD as coronary artery disease, DM as diabetes mellitus and CKD as chronic kidney disease. WHO says the guideline targets non-pregnant adults.
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
  • Hypertension
  • No comorbidities
Excluded
  • Pregnant patients: WHO says the recommendations target non-pregnant patients

  • Recommendation Guidance Moderate certainty

    WHO recommends a blood pressure target of below 140/90 mmHg for adults with hypertension who have no comorbidities.

    Applies to Adult
    • Adults with hypertension and no comorbidities. The recommendation statement does not define comorbidities. The rationale on the same page (PDF page 28) names them: "In patients with comorbidity (CAD, DM, CKD) there is consistent benefit with lower targets", where WHO's list of acronyms gives CAD as coronary artery disease, DM as diabetes mellitus and CKD as chronic kidney disease. WHO says the guideline targets non-pregnant adults.
    • 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, moderate-certainty evidence". The certainty above is that label. The recommendation statement does not define comorbidities. The rationale on the same page (PDF page 28) names them: "In patients with comorbidity (CAD, DM, CKD) there is consistent benefit with lower targets", where WHO's list of acronyms gives CAD as coronary artery disease, DM as diabetes mellitus and CKD as chronic kidney disease. Statements 6b and 6c set a lower systolic target for two other groups. NICE sets its own target in a separate claim. 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 28, section 3.6, recommendation 6, first statement
      How it applies
      The target and the population.
      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 28, section 3.6, recommendation 6, first statement, strength label
      How it applies
      The strength label WHO prints under the statement: Strong 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.

    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 28, section 3.6, Evidence and rationale, sentence on comorbidity (CAD, DM, CKD)
      How it applies
      The comorbidities WHO names beside the statement.
      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.

Guidance

Recommended: Blood-pressure lowering to a target

Applies to Adult
  • Adults with hypertension aged under 80, with or without type 2 diabetes (NG136 Table 1)
  • Not stated on the fetched page
  • Not stated on the fetched page (NICE guidance; jurisdiction not verified)
  • Adult under 80
Follow-up Not applicable (recommendation context)
Issued by
National Institute for Health and Care Excellence
Guideline
Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter, edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked.
Strength
Not labeled on the fetched page. The recommendation uses imperative wording (directive verbs to lower the pressure and to keep it there). (NICE wording convention. The fetched NICE page explains only that NICE uses the verb offer where the evidence of benefit is strong and leaves little doubt, and the verb consider where the benefit is less certain. How NICE treats imperative verbs was not verified.)
Effective
2019-08-28 (The date NG136 was first published. Recommendation 1.4.20 carries the tag 2019, amended 2022, so it was amended in 2022. The page shows a last update of 26 February 2026.)
Jurisdiction
Not stated on the fetched page
Basis
NICE guideline NG136 recommends lowering clinic blood pressure below 140/90 mmHg, and keeping it there, for adults with hypertension aged under 80.

Limitations. NICE's population includes people with type 2 diabetes, whom SPRINT excluded. The fetched page gives no strength label for this imperative wording (a pair of directive verbs, one to lower the pressure and one to keep it there), and NICE's page on recommendation wording explains only the verbs offer and consider. The jurisdiction is not stated on the fetched page. The recommendation carries the tag 2019, amended 2022; the exact amendment date was not recorded. This claim records what NICE recommends. It does not say that NICE assessed or rejected SPRINT's target.

Recommended: Blood-pressure lowering to a target

Applies to Adult
  • Adults with hypertension and no comorbidities. The recommendation statement does not define comorbidities. The rationale on the same page (PDF page 28) names them: "In patients with comorbidity (CAD, DM, CKD) there is consistent benefit with lower targets", where WHO's list of acronyms gives CAD as coronary artery disease, DM as diabetes mellitus and CKD as chronic kidney disease. WHO says the guideline targets non-pregnant adults.
  • 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-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 a blood pressure target of below 140/90 mmHg for adults with hypertension who have no comorbidities.

Limitations. WHO labels this statement "Strong recommendation, moderate-certainty evidence". The certainty above is that label. The recommendation statement does not define comorbidities. The rationale on the same page (PDF page 28) names them: "In patients with comorbidity (CAD, DM, CKD) there is consistent benefit with lower targets", where WHO's list of acronyms gives CAD as coronary artery disease, DM as diabetes mellitus and CKD as chronic kidney disease. Statements 6b and 6c set a lower systolic target for two other groups. NICE sets its own target in a separate claim. 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 to a target

Applies to Adult
  • Adults with hypertension and known cardiovascular disease. WHO says the guideline targets non-pregnant adults.
  • 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-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 a systolic blood pressure target of below 130 mmHg for adults with hypertension and known cardiovascular disease.

Limitations. WHO labels this statement "Strong recommendation, moderate-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 to a target

Applies to Adult
  • Adults with hypertension who are at high risk, which WHO lists as high cardiovascular risk, diabetes mellitus or chronic kidney disease. WHO says the guideline targets non-pregnant adults.
  • 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 a systolic blood pressure target of below 130 mmHg for adults with hypertension who are at high risk because of high cardiovascular risk, diabetes or chronic kidney disease.

Limitations. WHO labels this statement "Conditional recommendation, moderate-certainty evidence". It is a suggestion, weaker than 6a and 6b. 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.

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 NICE NG136 1.4.20: below 140/90 mmHg for adults under 80: Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • Adults with hypertension aged under 80, with or without type 2 diabetes (NG136 Table 1)
    • Not stated on the fetched page
    • Not stated on the fetched page (NICE guidance; jurisdiction not verified)
    • Adult under 80
    Follow-up Not applicable (recommendation context)
    NICE guideline NG136 recommends lowering clinic blood pressure below 140/90 mmHg, and keeping it there, for adults with hypertension aged under 80.

    Limitations. NICE's population includes people with type 2 diabetes, whom SPRINT excluded. The fetched page gives no strength label for this imperative wording (a pair of directive verbs, one to lower the pressure and one to keep it there), and NICE's page on recommendation wording explains only the verbs offer and consider. The jurisdiction is not stated on the fetched page. The recommendation carries the tag 2019, amended 2022; the exact amendment date was not recorded. This claim records what NICE recommends. It does not say that NICE assessed or rejected SPRINT's target.

  • Claim, not a settled fact WHO 2021 6a: below 140/90 mmHg without comorbidities (strong): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • Adults with hypertension and no comorbidities. The recommendation statement does not define comorbidities. The rationale on the same page (PDF page 28) names them: "In patients with comorbidity (CAD, DM, CKD) there is consistent benefit with lower targets", where WHO's list of acronyms gives CAD as coronary artery disease, DM as diabetes mellitus and CKD as chronic kidney disease. WHO says the guideline targets non-pregnant adults.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    WHO recommends a blood pressure target of below 140/90 mmHg for adults with hypertension who have no comorbidities.

    Limitations. WHO labels this statement "Strong recommendation, moderate-certainty evidence". The certainty above is that label. The recommendation statement does not define comorbidities. The rationale on the same page (PDF page 28) names them: "In patients with comorbidity (CAD, DM, CKD) there is consistent benefit with lower targets", where WHO's list of acronyms gives CAD as coronary artery disease, DM as diabetes mellitus and CKD as chronic kidney disease. Statements 6b and 6c set a lower systolic target for two other groups. NICE sets its own target in a separate claim. 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 6b: systolic below 130 mmHg with cardiovascular disease (strong): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • Adults with hypertension and known cardiovascular disease. WHO says the guideline targets non-pregnant adults.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    WHO recommends a systolic blood pressure target of below 130 mmHg for adults with hypertension and known cardiovascular disease.

    Limitations. WHO labels this statement "Strong recommendation, moderate-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 6c: systolic below 130 mmHg at high risk (conditional): Hypertension (high blood pressure) (Recommended for)

    Applies to Adult
    • Adults with hypertension who are at high risk, which WHO lists as high cardiovascular risk, diabetes mellitus or chronic kidney disease. WHO says the guideline targets non-pregnant adults.
    • Not stated for this recommendation in the source
    • Global WHO guidance; national adoption not recorded
    • Adult
    Follow-up Not applicable (recommendation context)
    WHO suggests a systolic blood pressure target of below 130 mmHg for adults with hypertension who are at high risk because of high cardiovascular risk, diabetes or chronic kidney disease.

    Limitations. WHO labels this statement "Conditional recommendation, moderate-certainty evidence". It is a suggestion, weaker than 6a and 6b. 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.

Record details

Record id
cardio:bp-lowering-to-target
Content hash
d33c9d683bed068fb711c5cecbb97b48466f27aa03f2ed47581a139eda082709