title: Global survey of current practice in management of hypertension as reported by societies affiliated with the International Society of Hypertension.
abstract: OBJECTIVE
  The International Society of Hypertension (ISH) surveyed trends in the management of hypertension worldwide, as reported by its affiliated societies.
  
  
  METHODS
  A formal questionnaire was emailed in December 2011 to 90 national and regional societies affiliated with the ISH, from 77 countries. Responses received by June 2012 were analysed.
  
  
  RESULTS
  Thirty-one societies responded (nine high-income, 17 upper-middle-income, five lower-middle/low-income countries). Twenty-one reported use of national guidelines, three used regional and 17 used 'international guidelines', two-thirds used mercury, aneroid and semi-automatic sphygmomanometers and half used ambulatory blood pressure monitoring. Exercise, salt restriction and weight reduction were recommended by 31, 27 and 26 nations, respectively, but less for other diets, smoking cessation and alcohol restriction. Almost all nations used angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), calcium channel blockers and diuretics. β Blockers were only recommended for patients with coronary disease. ACEI and ARB were preferred for patients with diabetes, renal disease and metabolic syndrome. Combination treatment was recommended by all, for initiation of treatment by most, and in fixed-dose formulation by half. Most used a threshold of 140/90  mmHg to initiate drug treatment in uncomplicated patients but only half retained the threshold of 130/80  mmHg for high-risk patients. Differences in treatment patterns across regions or across high, middle and low-income countries were minimal.
  
  
  CONCLUSIONS
  There was surprising consistency across countries from different regions and with varying degrees of affluence. There was a trend towards more conservative thresholds and targets than those recommended by JNC7 or ESH/ESC 2007. Combination therapy was favoured by all, but β blockers were restricted to patients with coronary heart disease.
authors: The George Institute for Global Health, University of Sydney and the Royal Prince Alfred Hospital, Sydney, Australia. chalmers@georgeinstitute.org.au
authors: John
authors: J
authors: Chalmers
authors: Hisatomi
authors: H
authors: Arima
authors: Stephen
authors: S
authors: Harrap
authors: Rhian M
authors: RM
authors: Touyz
authors: Jeong Bae
authors: JB
authors: Park
mesh_terms: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003625:Data Collection; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers