TY - JOUR
T1 - Standardized treatment protocols for hypertension
T2 - global availability, characteristics, and alignment with the hypertension guideline recommendations
AU - Satheesh, Gautam
AU - Dhurjati, Rupasvi
AU - Huffman, Mark D.
AU - Rosende, Andres
AU - Rodgers, Anthony
AU - Prabhakaran, Dorairaj
AU - Ordunez, Pedro
AU - Jha, Vivekanand
AU - Salam, Abdul
N1 - Publisher Copyright:
© 2023 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Background: Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. Methods: We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. Results: Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. Conclusion: Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.
AB - Background: Hypertension control is suboptimal globally. Implementing evidence-based, simple, standardized treatment protocols (STPs) has been instrumental in effectively and efficiently improving treatment and control of hypertension. We aimed to identify, characterize, and critically appraise hypertension STPs. Methods: We defined STP as a series of steps for the pharmacological treatment of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency. STPs for adult patients were identified from the websites of relevant health organizations, Google search, and through expert consultations (until July 2023). STPs for secondary, gestational, or malignant hypertension or those that were templates/samples were excluded. Included STPs were critically appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 WHO hypertension management guideline recommendations. Results: Fifty STPs were identified. All STPs had a stepwise treatment approach, involved guideline-recommended first-line drugs, and 98% consisted of at least four steps. Majority (54%) recommended monotherapy with calcium channel blockers as first-line treatment. Only 44% STPs recommended treatment initiation with combination therapy, and 16% recommended single-pill combinations. Most (62%) had dose-intensification as the second step. Most (74%) STPs did not provide complete dosing information. Only one STP mentioned a target time for achieving BP control. On average, STPs scored a performance of 68% on the HEARTS Checklist. Conclusion: Several STPs are available globally; however, most of them have enormous scope for improvement through interventions aimed at alignment with the latest evidence-based guidelines and multistakeholder engagement.
KW - antihypertensive drugs
KW - blood pressure
KW - cardiovascular risk
KW - primary care
KW - standard treatment protocols
UR - http://www.scopus.com/inward/record.url?scp=85190176770&partnerID=8YFLogxK
U2 - 10.1097/HJH.0000000000003636
DO - 10.1097/HJH.0000000000003636
M3 - Article
C2 - 38108382
AN - SCOPUS:85190176770
SN - 0263-6352
VL - 42
SP - 902
EP - 908
JO - Journal of Hypertension
JF - Journal of Hypertension
IS - 5
ER -