Hypertension control. Report of a WHO Expert Committee.

Hypertension is the commonest cardiovascular disorder, affecting about 20% of the adult population in many countries. It is linked with coronary heart disease, stroke, congestive heart failure and renal dysfunction and is one of the major risk factors for cardiovascular mortality, which accounts for 20-50% of all deaths. Raised awareness of the public health and economic implications of hypertension is now directing attention to the need for long-term control programmes that focus on primary prevention, early detection and adequate treatment. This report of a WHO Expert Committee reviews the epidemiology and pathophysiology of hypertension, enumerates its risk factors and predictors, and makes specific proposals for its prevention and control in populations. Current approaches to the assessment and management of patients with hypertension are discussed, with emphasis on the general usefulness of systolic blood pressure measurements and on the special features of hypertension in children and adolescents, women, elderly people and those with diabetes. The potential impact of lifestyle changes is evaluated, together with the various pharmacological treatment options. While recognizing the need to take account of resource constraints and diversity in health care systems, the Committee recommends that hypertension control programmes are set up worldwide as part of a comprehensive strategy to reduce total cardiovascular risk. Its practical recommendations for policy, hypertension management and research are intended to guide decision-makers in public health, managers of control programmes and physicians and to facilitate the selection of cost-effective means of controlling hypertension in different socioeconomic settings.