Standardized protocols for hypertension management need alignment

There is no short supply of standardized treatment protocols (STPs) for hypertension across the globe, but many of these can be further improved through interventions targeting alignment with the latest evidence-based guidelines and engagement with multiple stakeholders, suggests a study.

Fifty STPs had been identified in this study, all of which applied a stepwise treatment approach and involved guideline-recommended first-line therapies, while 98 percent included at least four steps. More than half (54 percent) of the STPs recommended monotherapy with calcium channel blockers as first-line treatment, 44 percent endorsed combination therapy, and 16 percent single-pill combinations.

Most of these STPs (62 percent) also had dose-intensification as the second step, whereas 74 percent did not provide complete dosing information. Notably, only one STP stated a target time for achieving blood pressure (BP) control. Furthermore, the average performance score of these STPs on the HEARTS Checklist was 68 percent.

In this study, STP was defined as a series of steps for the pharmacological management of primary hypertension, with information on target population, BP threshold for treatment initiation, target BP, specific drugs/classes/doses, and follow-up frequency.

The researchers identified STPs for adult patients 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 not included in the analysis.

Eligible STPs were appraised using HEARTS in the Americas Checklist for hypertension management in primary care and compared with the 2021 guidelines set by the World Health Organization.

“Hypertension control is suboptimal globally,” the researchers said. “Implementing evidence-based, simple STPs has been instrumental in effectively and efficiently improving treatment and control of hypertension.”