World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension-Do These Differ From the U.S. Recommendations? Which Guidelines Should the Practicing Physician Follow?
The recent World Health Organization-International Society of Hypertension (WHO-ISH) recommendations for the treatment of hypertension are consistent with the guidelines established by the Sixth Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) in the U.S. with several exceptions. Both reports define hypertension as a persistent elevation of blood pressure greater than 140/90 mm Hg and advocate the lowering of blood pressure for all patients with cardiovascular (CV) risk factors in addition to hypertension. The WHO-ISH report, however, suggests continuing monitoring without medication for subjects without other risk factors if pressures are not greater than 150/95 mm Hg. The JNC VI recommends drug therapy even in these subjects if blood pressures remain greater than 140/90 mm Hg after a 6-12 month period of nonpharmacologic interventions. Based on available data this would appear to be a more reasonable recommendation. The WHO-ISH indicates that all classes of medication are suitable initial therapy, despite the lack of morbidity and mortality data with several of them. The JNC VI continues to use outcome data to recommend diuretics or Ã -blockers as initial treatment. The WHO-ISH recommendations may prove to be appropriate-i.e., the lowering of blood pressure makes the difference and not which medication is used-There are some data to support this position but at present the strongest outcome data support the JNC VI recommendations. Both reports stress the importance of lowering blood pressure to levels of 130/85 mm Hg or even lower in patients with diabetes, renal, or heart failure. The addition of the WHO-ISH report should help to focus more clearly the need for better blood pressure control. (c)1999 by Le Jacq Communications, Inc.
Moser
Marvin
M
Clinical Professor of Medicine, Yale University School of Medicine, Senior Medical Consultant, National High Blood Pressure Education Program, NHLBI.