Recommended treatment protocols to improve management of hypertension globally: A statement by Resolve to Save Lives and the World Hypertension League (WHL)

Abstract

| INTRODUC TI ONCardiovascular disease (CVD) is the world's leading cause of death, killing 18 million people per year-about one-third of all deaths. 1 Hypertension is the leading cause of CVD and contributes to 10 million deaths per year-the same number of people killed by all infectious diseases combined. 2 Whereas the burden of hypertension and CVD afflict predominantly older aged persons in high-income countries, younger populations are disproportionately affected in lowand middle-income countries. 1 It is estimated that CVD costs 2%-4% of gross national income in these countries. 3 Hypertension is amenable to treatment with generic, oncedaily, low-cost medications that are safe and effective, yet currently, fewer than 15% of adults with hypertension worldwide have their blood pressure controlled to 140/90 or lower. 4 Some countries and health systems have achieved control rates approaching 70%; 5,6 accomplishing this on a global basis could save millions of lives. The Resolve to Save Lives Cardiovascular Health Initiative has been established to help improve hypertension management. Resolve to Save Lives -a 5-year, $225 million initiative based at Vital Strategies, a global health nonprofit organization, is supporting key organizations and engaging new partners to help low-and middle-income countries accelerate and scale-up implementation of proven tools and strategies to prevent CVD. 7 These tools, together with the elimination of artificial trans-fats and a reduction of sodium consumption, could improve hypertension management and save 100 million lives over the next 30 years.

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

“…However, this has not been verified in SSA participants. Our finding of CCBs' superiority is thus important in supporting consensus from both Pan-African guidance [11] and global public health initiatives [60].…”

Scaling up effective treatment of hypertension—A pathfinder for universal health coverage

“…Based on published clinical trials, evidence‐based treatment guidelines, implementation experience in large populations, and experiences with in‐country authorities and hypertension experts, consensus conferences often preferred three core drugs for hypertension treatment protocols. These are the calcium channel blocker (CCB) amlodipine, the angiotensin receptor blocker (ARB) telmisartan (although losartan and other ARBs may be substituted), and the diuretic chlorthalidone (although hydrochlorothiazide and indapamide are more widely available) . These drugs work synergistically, allowing for improved blood pressure control at lower dosages …”

“…These are the calcium channel blocker (CCB) amlodipine, the angiotensin receptor blocker (ARB) telmisartan (although losartan and other ARBs may be substituted), and the diuretic chlorthalidone (although hydrochlorothiazide and indapamide are more widely available). 6 These drugs work synergistically, allowing for improved blood pressure control at lower dosages. 7 Amlodipine is widely available in a low-cost generic form and can be taken once daily, and laboratory testing is not required (eg, to measure potassium levels).…”

A step in the global effort to control hypertension: Fixed dose combination antihypertensive drugs

“…One of the interventions which has been advocated has been to use FDC antihypertensive drugs in simple directive protocols . Initial opposition from some specialists to simple directive protocols has been and continues to be almost universal and is an obstacle to population hypertension control.…”

“…Briefly, there are several advantages of FDC antihypertensive drugs. Approximately, 70% of people with hypertension require two or more antihypertensive medications for hypertension control . In clinical trials, use of FDC therapy resulted in improved patient adherence and had more rapid and greater blood pressure lowering compared to use of single drug medications .…”